10901 APPLICATION AND REDETERMINATION

10901.1 Pregnant individuals enrolled in the Alliance program or ICP who are eligible for FCEP CHIP under this Chapter, and individuals reporting a change of circumstances based on pregnancy or otherwise notifying the Department of their desire to receive benefits under the FCEP CHIP eligibility group shall be subject to the requirements for determining eligibility described under § 10901.14. Beneficiaries currently enrolled in the Alliance program or ICP who transition to FCEP CHIP under this Chapter shall not be subject to the application requirements set forth under §§ 10901.2 – 10901.9 of this section.

10901.2 Except for applicants who are already enrolled in the Alliance program or ICP, a new applicant shall apply for FCEP CHIP by submitting to the Department an application form designated by the Department, which may be found on its website at https://dhcf.dc.gov/service/how-apply-medical-coverage. The application form may be submitted to the Department:

1. (a) In person;
2. (b) By mail;
3. (c) By phone;
4. (d) By fax; or
5. (e) Through other commonly available electronic means, including online via a web-based portal.

10901.3 The application and any required verification may be submitted by:

1. (a) The applicant;
2. (b) An adult who is in the applicant’s household or family;
3. (c) An authorized representative of the applicant, pursuant to § 10901.20; or
4. (d) An individual acting responsibly on behalf of the applicant, if the applicant is a minor or incapacitated.

10901.4 When determining eligibility, the Department shall, where possible, determine eligibility using available electronic information .

10901.5 Where the Department requires additional information to determine eligibility, the Department shall provide written notice that includes a statement of the specific information needed to determine eligibility and the date by which an applicant or beneficiary shall provide the required information.

10901.6 The Department shall issue an eligibility determination, consistent with the timeframe described under § 10901.10, based on the receipt of an application that includes, at a minimum:

1. (a) The applicant's name;
2. (b) The applicant's District address. If the applicant is homeless, attests to their homelessness (consistent with § 10902.4), and cannot provide contact information, the applicant may select a mailing address provided from a list maintained by DHS, or provide an email address or a phone number for the Department to contact the applicant; and
3. (c) A signature (wet, digital, or electronic, as appropriate) under penalty of perjury.

10901.7 The applicant shall complete the following application process in order for the Department to determine whether an applicant meets the eligibility factors for FCEP CHIP:

1. (a) Provide a complete, signed, and dated application for FCEP CHIP in accordance with § 10901.8; and
2. (b) Submit required verifications for financial and non-financial eligibility factors.

10901.8 An application shall be considered complete if the following requirements are met:

1. (a) All information requested in the application, including household composition, residency, income, and other demographic information needed to determine eligibility is provided;
2. (b) The application is signed and dated, under penalty of perjury.

10901.9 The Department shall use the date the application is received by the Department, or for current ICP or Alliance beneficiaries, the date the pregnancy is reported to

the Department, to determine the earliest date for which medical assistance under FCEP CHIP can be effective, consistent with the enrollment requirements described under § 10905.1.

10901.10 The Department shall issue written notice of its eligibility determination within forty-five (45) calendar days of the date an application is received by the Department. The Department may extend the forty-five (45) day period pursuant to D.C. Official Code § 4-205.26 when a delay is caused by unusual circumstances beyond the Department's control, such as:- (a) Circumstances wholly within the applicant's control;

- (b) Circumstances beyond the applicant's control, such as hospitalization or imprisonment; or

- (c) An administrative or other emergency that could not be reasonably controlled by the Department.10901.11 An applicant or the applicant's authorized representative pursuant to § 10901.20 may withdraw an application upon request and prior to an eligibility determination through the following means:- (a) In person;

- (b) By mail;

- (c) By telephone, if a signed statement is additionally submitted; or

- (d) Through other commonly available electronic means, including fax or online via a web-based portal.10901.12 A beneficiary shall notify the Department within ten (10) calendar days of any change in circumstance that directly affects the beneficiary's eligibility to receive medical assistance in the FCEP CHIP eligibility group, including a conclusion of the pregnancy such as miscarriage, abortion, or stillbirth.10901.13 The Department shall re-determine the eligibility span for a beneficiary if the Department obtains information from other sources (including birth records or self-attestation) that the beneficiary's pregnancy has concluded.10901.14 The Department shall re-determine eligibility for beneficiaries identified at § 10901.12 and 10901.13 at the time the change is reported and after the sixty (60) day postpartum period ends.

10901.15 For Alliance and ICP beneficiaries that report a change in circumstance due to pregnancy, the effective date of eligibility for FCEP CHIP shall be the first day of the month in which the reported change of circumstance due to pregnancy is reported.10901.16 The Department shall begin the termination process for FCEP CHIP eligibility in accordance with the requirements described in § 10908 when:- (a) The beneficiary's certification period expires, which shall be the last day of the month of the sixtieth (60^th) day following the date of delivery (i.e., childbirth);

- (b) A beneficiary's pregnancy ends due to miscarriage, abortion, or stillbirth;

- (c) The beneficiary no longer meets all eligibility factors;

- (d) The beneficiary requests termination; or

- (e) The beneficiary fails to respond to a request for verification of information, as described under § 10901.5, by the date provided in that request.10901.17 Upon receipt of a request for termination of eligibility by the beneficiary or the beneficiary's authorized representative in writing (including a written request submitted through mail, or other commonly available electronic means including by fax or online via a web-based portal) or telephonically, the Department shall terminate the beneficiary's eligibility on:- (a) The last day of the month in which the Department receives the request, if there are fifteen (15) or more calendar days remaining in the month;

- (b) The last day of the month following the month in which the Department receives the request, if there are fewer than fifteen (15) calendar days remaining in the month; or

- (c) A date earlier than those referenced in subparagraphs (a) and (b), upon request by the beneficiary.10901.18 A request to terminate FCEP CHIP eligibility shall be complete if all the following requirements are met:- (a) The request is in writing and submitted in-person, by mail, by phone (if a signed statement is additionally submitted in accordance with paragraph

(b) of this subsection), or through other commonly available electronic means (including fax);

(b) The request is signed and dated by the beneficiary or the beneficiary's authorized representative, under penalty of perjury; and

(c) The request includes all information necessary to determine the identity of the beneficiary seeking termination, including the individual's name, date of birth, address, phone number, and beneficiary identification number (if one was assigned or is available).

10901.19 The Department shall provide written notice of termination no later than fifteen (15) calendar days prior to termination, but may waive the requirement that the notice be provided no later than fifteen (15) calendar days before the action pursuant to § 10908.5 through § 10908.7.

10901.20 An applicant or beneficiary may designate someone to be an authorized representative to act on the individual's behalf and assist with an application, a redetermination of eligibility, and other ongoing communications with the Department. The Department shall require the following:

(a) The designation of an authorized representative shall be in writing and signed by the individual seeking representation, except where there is legal documentation of authority (including a court order establishing legal guardianship or power of attorney) to act on behalf of an individual under District law, which may serve in the place of a signed written authorization;

(b) The authority of an authorized representative shall be valid until the represented applicant or beneficiary, or authorized representative, notifies the Department that the representative is no longer authorized to act on the applicant's or beneficiary's behalf; or there is a change in the legal authority upon which the representative's authority was based.;

(c) An authorized representative, to the extent provided in the signed designation or legal document described in paragraph (a) of this subsection, may be authorized to:

(1) Sign an application on behalf of an applicant;

(2) Receive copies of notices and other communications from the Department;

(3) Act on behalf of an applicant or beneficiary in all other

matters with the Department; and

(4) Complete and submit redetermination forms; and

(d) An authorized representative shall agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the represented applicant or beneficiary provided by the Department.

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