10900 GENERAL PROVISIONS

10900.1 The District of Columbia (District) provides medical assistance to pregnant women who meet both financial and non-financial requirements under the provisions of this Chapter through a program entitled the “From Conception to End of Pregnancy (FCEP) Children’s Health Insurance Program (CHIP).”

10900.2 All individuals applying for the FCEP CHIP eligibility group shall meet the following financial and non-financial eligibility factors:

(a) Reside in the District or meet the District’s residency requirements in accordance with 42 C.F.R. § 435.403 and 29 DCMR § 9502;

(b) Have a household income at or below three hundred nineteen percent (319%) of the federal poverty level (FPL), as determined in accordance with § 10904 (unless the applicant is an individual under the age of twenty-one (21) who is in foster care under the responsibility of the District, in which case the income limitation shall not apply, consistent with the provisions of 29 DCMR § 9500 ); and

(c) Not be eligible for or enrolled in Medicaid under any Medicaid eligibility category, the Alliance program, or the Immigrant Children’s Program. If an Alliance or Immigrant Children’s Program beneficiary is eligible for FCEP CHIP eligibility group in accordance with the requirements of this Chapter, the beneficiary shall be disenrolled from their current eligibility group and enrolled in the FCEP CHIP eligibility group.

10900.3 The Department shall use methodologies in accordance with § 10904 of this Chapter (as applicable) when determining the following:

(a) Income;

(b) Household composition; and

(c) Household size.

10900.4 The Department shall not count resources when determining income eligibility.

10900.5 The Department shall apply the following general standards in the administration of FCEP CHIP:

(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 and upon request, at the time of application and at renewal, in plain language and in a manner that is accessible and timely, to all applicants and beneficiaries, including those living with disabilities and those with limited or no-English proficiency, in accordance with Title VI of the Civil Rights Act of 1964, effective July 2, 1964 (42 U.S.C. § 2000d, et seq.), and the Language Access Act of 2004, effective June 19, 2004 (D.C. Law 15-167; D.C. Official Code § 2-1931 et seq.), as applicable; and

(b) The Department shall inform applicants and beneficiaries at the time of application, renewal, or redetermination that the Department shall obtain and use available information to the greatest extent possible to verify income, residency, and other non-financial eligibility factors.

10900.6 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 includes information in a medical record or designated record that can be used to identify an individual. Protected information includes, but is not limited to, the following:

(a) Name and address;

(b) Phone number;

(c) Social security number (SSN);

(d) Health plan number;

(e) Account number;

(f) Medical services provided;

(g) Social and economic conditions or circumstances;

(h) Department evaluation of personal information;

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

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

(k) Any information received in connection with the

identification of legally liable third-party resources pursuant to applicable federal regulations.

10900.7 The Department shall provide notice, consistent with the requirements set forth under § 10908, to the applicant or beneficiary concerning the applicant's or beneficiary's eligibility for FCEP CHIP.

10900.8 The Department shall provide the following information regarding the FCEP CHIP (including notices described in § 10900.7) by commonly available electronic means (including fax or online via web-based portal), telephone, mail, or in person, as appropriate, to all applicants and other individuals upon request:

(a) Eligibility requirements of the program;

(b) Covered services;

(c) The rights and responsibilities of applicants and beneficiaries for eligibility or coverage under the program; and

(d) The process for appealing an agency determination.

10900.9 The Department shall issue and maintain all policies and procedures (including transmittals or other sub-regulatory guidance) relevant to FCEP CHIP eligibility determinations. DHCF shall make its policies available at www.dhcf.dc.gov and shall provide updates as necessary.

SOURCE: Final Rulemaking published at 72 DCR 013183 (November 28, 2025).