3001.1 Consumers eligible for Medicaid-funded FSMHC services must meet the following requirements:

1. (a) Are enrolled in Medicaid, or be eligible for enrollment and have an application pending; and
2. (b) Are children, youth, or adults with a mental health condition or diagnosis, or at risk of developing a diagnosable mental health condition.

3001.2 Consumers eligible for locally-funded FSMHC services are those individuals who are not eligible for Medicaid or are not enrolled in any other third-party insurance program, except the D.C. Healthcare Alliance or Immigrant Children's Program, and who meet the following requirements:

1. (a) Are bona fide residents of the District pursuant to D.C. Official Code § 7-1131.02(29);
2. (b) Are children, youth, or adults with a mental health condition or diagnosis, or at risk of developing a diagnosable mental health condition; and
3. (c) For individuals eighteen (18) years of age and older, live in households with a countable income of less than two hundred percent (200%) of the federal poverty level, and for individuals under eighteen (18) years of age, live in households with a countable income of less than three hundred percent (300%) of the federal poverty level.

3001.3 Neither Medicaid nor the Department shall reimburse providers for FSMHC services provided to any consumer that does not meet the eligibility requirements set forth above.

SOURCE: Final Rulemaking published at 67 DCR 11929 (October 16, 2020).