§ 4-633 — Program eligibility.

(a) An individual shall be eligible for the Program if the individual:

(1) Has resided in the District for at least 6 months at the time of application to the Program;

(2) Resides in a household having a gross household income not exceeding 400% of the federal poverty guidelines as updated periodically in the Federal Register by the United States Department of Health and Human Services under the authority of 42 U.S.C. § 9902(2); and

(3) Does not qualify for:

(A) The DC HealthCare Alliance;

(B) Medicare;

(C) Medicaid; or

(D) Other federal health-benefits programs; and

(A) Has not had health insurance during the 6-month period prior to application to the Program;

(B) Has had health insurance during the 6-month period prior to application to the Program but the insurance was terminated due to:

(i) The loss of employment;

(ii) A death of a spouse, domestic partner, or family member who maintained the individual as a beneficiary on a health-insurance plan;

(iii) Changes in student status, including graduation, a leave of absence, or reduction to part-time study;

(iv) A change of employment to a new employer who does not provide group health insurance;

(v) A legal annulment, separation, divorce, or the dissolution of a domestic partnership;

(vi) The loss of financial eligibility under Medicaid or the DC HealthCare Alliance;

(vii) The cancellation or discontinuation of a group health insurance contract by a health insurer; or

(viii) Any other reason as determined by the Mayor; or

(C) Has health insurance but the annual cost to the individual is deemed unaffordable, as determined by the Mayor.

(b) Eligibility for the Program shall not be subject to any pre-existing condition exclusions.

Legislative History

Aug. 16, 2008, D.C. Law 17-219, § 5043, 55 DCR 7598; Feb. 4, 2010, D.C. Law 18-104, § 3(a), 56 DCR 9182