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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 29-95. MEDICAID ELIGIBILITY |
Section 29-9502. RESIDENCY
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9502.1 An individual shall be a resident of the District as a condition of Medicaid eligibility.
9502.2 An individual shall be considered incapable of stating intent to reside in the District if one of the following applies to the individual:
(a) Individual has an I.Q. of forty-nine (49) or less or a mental age of seven (7) or less, based on tests acceptable to the District Department on Disability Services;
(b) Individual is judged legally incompetent; or
(c) Individual is found incapable of indicating intent by a physician, psychologist, or other similarly individual licensed in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2012 Repl.)).
9502.3 A resident of the District shall be any individual who:
(a) Meets the conditions of Subsections 9502.4 through 9502.19; or
(b) Meets the criteria specified in an interstate agreement under Subsection 9502.24.
9502.4Subject to the exceptions identified in Subsections 9502.6, 9502.11, 9502.12, and 9502.14 below, an individual under age nineteen (19) who lives in the District shall be considered a resident of the District.
9502.5Subject to the exceptions identified in Subsections 9502.6, 9502.11, 9502.12, and 9502.14 below, the state of residence of an individual who is age nineteen (19) through twenty (20) shall be where the individual resides or the state of residency of the parent or caretaker relative with whom the individual resides.
9502.6 An individual who is under the age of twenty-one (21), who is capable of stating intent to reside; who is married or emancipated, and who does not reside in an institution, shall follow the residency rules applicable to individuals who are the age of twenty-one (21) and older.
9502.7 An individual, who is the age of twenty-one (21) or older and who does not live in an institution, shall be considered a resident of the District if the individual is living in the District voluntarily and not for a temporary purpose; that is, an individual with no intention of presently leaving including individuals without a fixed address or who have entered the District with a job commitment or seeking employment, whether or not currently employed.
9502.8 For purposes of determining eligibility for Medicaid, an individual may retain his or her status as a resident of the District of Columbia if the individual considers the District to be his or her fixed place of residence to which he or she will return with the intent to reside following a temporary absence, and:
(a)The individual is absent from the District for less than ninety (90) consecutive days; or
(b) The individual is absent from the District for more than ninety (90) consecutive days for good cause, as determined by DHCF, which may include, but not be limited to, the following:
(1)School attendance: an individual under the age of twenty-two (22) who is away from the District for the sole purpose of attending a boarding school, other educational facility, or in an educational placement as set forth in Title 5-E DCMR § 3013.6, if otherwise eligible, may retain Medicaid eligibility;
(2)Medical care: an otherwise eligible individual in need of medical care that temporarily resides outside of the District may retain Medicaid eligibility as long as the need for medical care continues; or
(3)U.S. Military service: an individual with full-time employment in the U.S. military service, if otherwise eligible, may retain Medicaid eligibility while away from the District due to a duty assignment.
9502.9 Residence as defined for eligibility purposes shall not depend upon the reason for which the individual entered the District, except insofar as it may bear on whether the individual is there for a temporary purpose.
9502.10 Unless an exception applies, the State of residence for an individual who is age twenty-one (21) and over, and who is not living in an institution, but who is incapable of stating intent to reside, shall be the State where the individual lives.
9502.11 Where a District agency or designee arranges or makes an out-of-state placement for any individual aged eighteen (18) and older receiving diagnostic, treatment, or rehabilitative services related to intellectual or developmental disabilities, the District shall be the State of residence.
9502.12 The State of residence for an individual placed by the District in an out-of-District institution shall be determined as follows:
(a) An individual who is placed in an institution in another State by a District agency or designee is a District resident;
(b) If a District agency or designee arranges or makes the placement, the District is considered as the individual's State of residence, regardless of the individual’s intent or ability to indicate intent;
(c) Where a placement is initiated by a District agency or designee because the District lacks a sufficient number of appropriate facilities to provide services to its residents, the District, as the State making the placement is the individual's State of residence.
9502.13 Any action by a District agency or designee beyond providing information to the individual and the individual’s family constitutes arranging, or making, an out-of-District placement in an institution.
9502.14 The State of residence for an individual of any age who receives a State supplementary payment (SSP) shall be the State paying the SSP.
9502.15 Except as provided in Subsections 9502.24 and 9502.25, the State of residence for individuals under the age of twenty-one (21) receiving adoption assistance, foster care, or guardianship care under title IV-E of the Social Security Act (the Act) shall be the State where the individual resides.
9502.16 The State of residence for an institutionalized individual under the age of twenty-one (21), who is neither married nor emancipated, shall be the following:
(a) The parent's or legal guardian's State of residence at the time of placement;
(b) The current State of residence of the parent or legal guardian who files the application if the individual is institutionalized in that same State; or
(c) If the individual has been abandoned by his or her parents and has no legal guardian, the State of residence of the individual who files an application.
9502.17 For any institutionalized individual who became incapable of indicating intent before age twenty-one (21), the State of residence shall be:
(a) That of the parent applying for Medicaid on the individual's behalf, if the parents reside in separate States (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's);
(b) The parent's or legal guardian's State of residence at the time of placement (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's);
(c) The current State of residence of the parent or legal guardian who files the application if the individual is institutionalized in that State (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's); or
(d) The State of residence of the individual or party who files an application is used if the individual has been abandoned by their parent(s), does not have a legal guardian and is institutionalized in that State.
9502.18 For any institutionalized individual (regardless of any type of guardianship) who became incapable of indicating intent at or after age twenty-one (21), the State of residence is the State in which the individual is physically present, except where another State makes a placement.
9502.19 For any other institutionalized individual, the State of residence shall be the State where the individual is living and intends to reside.
9502.20 The Department shall not deny eligibility for Medicaid because an individual has not resided in the District for a specified period.
9502.21 The Department shall not deny eligibility for Medicaid to an individual in an institution, who satisfies the residency rules set forth in this section on the grounds that the individual did not establish residence in the District before entering the institution.
9502.22 The Department shall not deny or terminate an individual’s eligibility for Medicaid because of the individual's temporary absence from the District if the individual intends to return when the purpose of the absence has been accomplished, unless another State has determined that the individual is a resident there for purposes of Medicaid.
9502.23 The District may extend eligibility for Medicaid to individuals who would traditionally be considered residents of a State other than the District under an interstate agreement.
9502.24 The Department may consider an individual under the age of twenty-one (21) who receives foster care assistance from the District under title IV-E of the Social Security Act and lives in an out-of-District foster home to be a resident of the District when:
(a) The individual receives foster care as defined at 45 CFR § 1355.20;
(b) The individual receives services from a provider screened and enrolled in the District Medicaid program pursuant to 29 DCMR §§ 9400 et seq.;
(c) The District’s Child and Family Services Agency (CFSA) places the individual in an out-of-District foster home for reasons related to the safety, permanence, and well-being of abused and neglected children and their families; and
(d) The District evaluates all factors affecting the best interests of the individual and determines that continued eligibility for and enrollment in the District Medicaid program is in the best interest of the individual.
9502.25 The District may determine that continued eligibility for and enrollment in the District Medicaid program is not in the best interest of an individual described in Subsection 9502.24 for the following reasons:
(a) The individual cannot obtain services from a provider enrolled in the District’s Medicaid program because of their geographic distance from the location where the services are provided;
(b) The individual has special health needs that cannot be addressed by an available and accessible provider enrolled in the District’s Medicaid program;
(c) The individual, or someone acting responsibly for the individual, requests that the individual be enrolled in the state’s Medicaid program where the individual is living; or
(d) The District evaluates all factors affecting the best interests of the individual and determines that continued eligibility for and enrollment in the District Medicaid program is not in the best interest of the individual.
9502.26 Where two or more States cannot resolve which State is the State of residence, and in the absence of an interstate agreement between the District and another State governing disputed residency, the State where the individual is physically located shall be the State of residence.