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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-64. MEDICAID SECTION 1115 HEALTH CARE REFORM DEMONSTRATION PROJECT |
Section 29-6406. ENROLLMENT CEILING AND WAITING LIST
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6406.1The District's Medical Assistance Administration shall establish a ceiling on the number of participants for each year of the project. If the number of applications exceeds the annual enrollment ceiling prior to the Demonstration Project implementation, then participants in the Demonstration Project shall be selected by the District's HIV/AIDS Administration on a first come, first served basis, in the order in which their applications were received.
6406.2After the initial selection of participants in the Demonstration Project is made and the annual enrollment ceiling is established, all other applicants shall be placed on a waiting list.
6406.3After the initial enrollment ceiling and initial waiting list are established, each subsequent applicant shall be placed on the waiting list in the order in which the application is received by the HIV/AIDS Administration.
6406.4An applicant on a waiting list shall receive quarterly statements from the HIV/AIDS Administration with the following information:
(a)The applicant's position on the waiting list; and
(b)The projected length of time the applicant shall have to wait prior to enrollment into the HIV/AIDS Demonstration Project.
6406.5The applicant shall be eligible to enroll in the Demonstration Project when a Notice of Action (NOA) is received from the HIV/AIDS Administration. The NOA shall be mailed both to the initially chosen applicant and to the case manager (unless the applicant expressly prohibits such communication with the case manager to the HIV/AIDS Administration).
6406.6A selected applicant shall have thirty (30) days from the date of the NOA in which to confirm enrollment in the Demonstration Project to the HIV/AIDS Administration.
6406.7If the confirmation for enrollment is not received by the HIV/AIDS Administration within thirty (30) days from the date of the NOA, another applicant shall be invited to enroll in the Demonstration Project.
6406.8If the HIV/AIDS Administration receives the selected applicant's confirmation after thirty (30) days but before ninety (90) days from the date of the NOA, the applicant shall be moved to the top of the waiting list.
6406.9A selected applicant who has not confirmed enrollment within ninety (90) days from the date of the NOA shall be required to reapply to participate in the Demonstration Project.
6406.10The District of Columbia may extend the NOA time lines for confirmation for applicants in extraordinary circumstances.
6406.11An applicant who has reapplied to participate in the Demonstration Project pursuant to 6406.9 may be allowed to fill a vacancy which becomes available for the following reasons:
(a)An initial Demonstration Project recipient has disenrolled for reasons such as, relocation, death, or failure to meet program eligibility requirements at re-determination; or
(b)An initial Demonstration Project recipient has become eligible, due to re-determinations, for other existing Medicaid coverage through Titles XIX or XXI of the Social Security Act.