3300

GENERAL PROVISIONS

3300.1 This chapter shall govern eligibility determinations for the District of Columbia (District) Health Care Alliance program (Alliance program) authorized under D.C. Official Code § 7-1401.

3300.2 Pursuant to D.C. Official Code § 7-1401, the Department of Health Care Finance (DHCF or Department) shall be responsible for supervising and administering the Alliance program.

3300.3 The Department may provide, by contract or by other means, comprehensive community-centered health care and medical services for beneficiaries enrolled in the Alliance program pursuant to D.C. Official Code § 7-1405.

3300.4 Applicants and beneficiaries of the Alliance Program who were unjustly convicted and imprisoned in accordance with D.C. Official Code §§ 2-421 – 2-425 shall not be subject to the requirements set forth under §§ 3300.5 – 3300.6, 3300.7(c), §§ 3301.1 – 3301.19, 3302, 3303, 3304, and 3305 of this Chapter.

3300.5(a) All individuals applying for or enrolled in the Alliance program, with the exception of individuals described in § 3300.4, shall meet the following financial and non-financial eligibility factors:

(1) Be a District resident pursuant to § 3302 of this Chapter;

(2) Provide a Social Security Number (SSN), if assigned and available;

(3) If aged twenty-one (21) or over:

(A) Have a household income at or below:

(i) Two hundred and ten percent (210%) of the Federal Poverty Level (FPL), if the individual is enrolled on or before September 30, 2025;

(ii) One hundred and thirty-three percent (133%) of the FPL, if the individual is enrolled between October 1,

2025, and September 30, 2026; or

(iii) Nineteen percent (19%) of the FPL, if the individual is enrolled between October 1, 2026, and September 30, 2027; and

(B) Not be eligible for, or enrolled in, Medicare, the Children's Health Insurance Program (CHIP), Medicaid, excluding eligibility for Medicaid payment for the treatment of an emergency medical condition pursuant to 42 C.F.R. § 440.255, or enrolled in other third party medical or health coverage that meets the requirements of minimum essential coverage, as defined under 45 C.F.R. § 156.600;

(4) If aged nineteen (19) or twenty (20):

(A) Have a household income at or below two hundred and sixteen percent (216%) of the FPL; and

(B) Not be eligible for or enrolled in CHIP or Medicaid, excluding eligibility for Medicaid payment for the treatment of an emergency medical condition pursuant to 42 C.F.R. § 440.255; and

(5) If aged eighteen (18) or below:

(A) Have a household income at or below three hundred and nineteen percent (319%) of the FPL; and

(B) Not be eligible for or enrolled in CHIP or Medicaid, excluding eligibility for Medicaid payment for the treatment of an emergency medical condition pursuant to 42 C.F.R. § 440.255.

(b) Effective October 1, 2027, residents aged twenty-one (21) or over will no longer be eligible for application for or enrollment in the Alliance program; except as otherwise provided in § 3309.

(c) Income determinations under this section shall be subject to the income determination requirements set forth under § 3304.

3300.6 The Department shall use methodologies in accordance with §§ 3303 and 3304 (as applicable) of this Chapter when determining the following:

a. Income;

b. Household composition; and

c. Household size.

3300.7 The Department shall apply the following general standards in the administration of the Alliance program:

(a) Information explaining the policies governing eligibility determinations and appeals shall be provided in writing on the DHCF and Department of Human Services (DHS) websites, upon request, and at application and renewal, in plain language and in a manner that is accessible and timely to all applicants and beneficiaries, including those with limited or no English proficiency and those living with disabilities;

(b) The Alliance program information shall be provided to applicants and beneficiaries who have limited or no English proficiency through the provision of language services at no cost to them pursuant to Title VI of the Civil Rights Act of 1964, effective July 2, 1964 (42 U.S.C. §§ 2000d, et seq.), the Language Access Act of 2004, effective June 19, 2004 (D.C. Law 15-167; D.C. Official Code §§ 2-1931 et seq.); and

(c) Applicants and beneficiaries shall be informed at the time of application, renewal, or redetermination that the Department shall obtain and use available information to verify income, eligibility, and residency.

3300.8 The Department shall establish and maintain policies that govern the types of information about applicants and beneficiaries that are protected under federal and District law against unauthorized disclosure for purposes unrelated to the determination of eligibility. Protected information shall include, but is not limited to, the following:

(a) Name and address;

(b) Phone number;

(c) Social security number;

(d) Medical services provided;

(e) Social and economic conditions or circumstances;

(f) Department evaluation of personal information;

(g) Medical data, including diagnosis and past history of disease or disability;

(h) Any information received for verifying income eligibility and the amount of medical payments; and

(i) Any information received in connection with the identification of legally liable third-party resources pursuant to applicable federal regulations.

3300.9 Protected information, in accordance with § 3300.8, shall not include beneficiary identification numbers.

3300.10 The Department shall provide notice, consistent with the requirements set forth under § 3308, or other communications to the applicant or beneficiary concerning the applicant's or beneficiary's eligibility for the Alliance program.

3300.11 The Department shall provide the following information in person, by mail, by telephone, or through other commonly available electronic means (including fax or online via a web-based portal), as appropriate, to all applicants and other individuals upon request:

(a) Eligibility requirements;

(b) Covered services;

(c) The rights and responsibilities of applicants and beneficiaries; and

(d) Appeals.

SOURCE: Final Rulemaking published at 69 DCR 004550 (May 6, 2022); as amended by the Fiscal Year 2026 Budget Support Act of 2025, effective December 6, 2025 (D.C. Law 26-55; 72 DCR 009825 (September 12, 2025).