10905.1 Individuals enrolled in the Alliance or ICP who are determined eligible for FCEP CHIP shall be automatically enrolled into an FCEP CHIP managed care organization (MCO), in accordance with § 10905.6, and shall be considered enrolled on the first (1st) day of the month in which an application is received by the Department pursuant to § 10901.9.

10905.2 For new applicants who are not transitioning from the Alliance or ICP eligibility groups, the Department shall send a notice (in addition to the notice of the eligibility determination described in § 10901.10) to the applicant that informs the applicant of the following:

1. (a) The beneficiary's right to choose to enroll in available MCOs contracted with the Department;
2. (b) The timeframe for which the beneficiary may choose an MCO in which to enroll;
3. (c) An explanation that if the beneficiary does not choose an MCO within the timeframe given under subparagraph (b), an MCO shall be auto-assigned to the beneficiary in accordance with the process described under §§ 10905.4(a)–(b); and
4. (d) A list of available MCOs that are contracted with the Department.

10905.3 The beneficiary described under § 10905.2 shall have thirty (30) calendar days from the date of the notice, described under § 10905.2, to select an MCO and to submit his or her selection to the Department through the following means of communication:

1. (a) Over the internet at https://www.dchealthyfamilies.com/;
2. (b) By telephone;
3. (c) By mail; or
4. (d) Through other commonly available electronic means.

10905.4 If a beneficiary described under § 10905.2 does not choose an MCO within the

timeframe specified in § 10905.2, the beneficiary shall be automatically assigned to an MCO. Auto-assignment shall occur in accordance with the following requirements:

(a) The Department shall use a process where each MCO's position in the assignment order is stored in an electronic system that remembers the next MCO in order for the purpose of automated, sequential beneficiary assignment;

(b) The Department shall enroll all members of the same household into the same MCO as other members of the same household unless a family member has requested another MCO; and

(c) Auto-assignment and enrollment into an MCO shall be completed within sixty (60) calendar days of the end of the initial thirty (30) calendar day MCO enrollment selection period identified in § 10905.3.

10905.5 On the date of the beneficiary's auto-assignment to an MCO in accordance with § 10905.4 the Department shall send an additional notice to the beneficiary that contains the following information:

(a) An explanation that the beneficiary has been automatically enrolled into an MCO, including the name and contact information for the selected MCO; and

(b) A description of the beneficiary's rights under auto-assignment, including the beneficiary's right to disenrollment.

10905.6 For beneficiaries that are transitioning from the Alliance or ICP eligibility groups, beneficiaries shall remain enrolled in the MCO in which they are currently enrolled, but shall have the option to choose a different MCO in accordance with §§ 10905.3, 10905.9, and 10906.4.–

10905.7 If the Department approves a beneficiary's enrollment into an MCO by the fifteenth (15th) day of the month, the beneficiary's enrollment in an MCO shall be effective on the first (1st) day of the following month.

10905.8 If the Department approves a beneficiary's enrollment into an MCO after the fifteenth (15th) day of the month, the beneficiary's enrollment in the MCO shall be effective on the first (1st) day of the second (2nd) month after the month in which the Department approves the enrollment.

10905.9 Beneficiaries enrolled in an MCO may opt to enroll in a different MCO for any reason:

(a) Within ninety (90) calendar days of enrollment;

(b) During an annual open enrollment period, which shall be from November 1 through January 31 each year.

(c) During special open enrollment periods (applicable to eligible individuals who experience certain life events, including loss of coverage) identified by DHCF and specified in guidance published on the DHCF website.

10905.10 Thirty (30) calendar days in advance of the open enrollment period, the Department shall send a notice to all currently enrolled MCO beneficiaries to inform the beneficiary of the open enrollment period and the process and required timeframes for selection of an MCO for the upcoming plan year.

10905.11 If the beneficiary chooses to change the MCO in which the beneficiary is currently enrolled, in accordance with § 10905.5, the beneficiary may submit his or her new election to the Department through the following means:

(a) Over the internet at https://www.dchealthyfamilies.com/ ;

(b) By telephone;

(c) By mail; or

(d) Through other commonly available electronic means.

10905.12 A beneficiary in FCEP CHIP that was not formerly enrolled in the Alliance or ICP eligibility group shall be eligible for retroactive medical coverage prior to the date that the beneficiary is considered enrolled under § 10905.1 up to ninety (90) calendar days prior to the date of application, as long as all other eligibility factors are met, including pregnancy.

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