10999

When used in this chapter, the following terms and phrases shall have the following meanings:

Applicant - an individual who is seeking an eligibility determination for medical assistance in the FCEP CHIP through an application submission.

Authorized representative – a legally authorized individual or entity able to act responsibly on an individual’s behalf in assisting with the individual’s application and renewal of eligibility and other ongoing communications with the agency.

Beneficiary - an individual who has been determined eligible and is currently receiving medical assistance in FCEP CHIP.

Certification Period – the timeframe used to determine eligibility under FCEP CHIP, which is the duration of the beneficiary’s pregnancy and until the last day of the month which the sixty (60) day postpartum period ends.

Department - the Department of Health Care Finance (DHCF) or its designee.

Disenrollment – discontinuation of a beneficiary’s enrollment in the beneficiary’s current MCO.

Eligibility determination – an approval, denial, renewal, or termination of eligibility.

Fair Hearings - an administrative procedure that gives applicants and beneficiaries the opportunity to contest adverse decisions regarding eligibility and benefit determinations.

Federal Poverty Level - a measure of income level issued annually by the U.S. Department of Health and Human Services that is used to determine eligibility for medical assistance programs, including FCEP CHIP, in the District.

Household Composition – a determination that is made to establish family size for the purpose of determining income eligibility, in accordance with 29 DCMR § 9506, using MAGI methodology.

Household Income – the countable income of every individual included in an applicant or beneficiary’s household.

Inmate - an individual in custody and held involuntarily through operation of law enforcement authorities in a public institution, which includes facilities operated by, or under contract with, the United States, a state, a territory, a political subdivision of a state or territory, or an American Indian/Alaska Native tribe for the confinement or rehabilitation of persons charged with or convicted of a criminal offense or other persons held involuntarily in lawful custody through operation of law enforcement authorities (e.g., state or federal prisons, local jails, detention facilities (including juvenile detention facilities), or other penal settings such as boot camps and wilderness camps). An individual is not considered an inmate if the individual resides in a child care institution, publicly operated community residence that serves no more than sixteen (16) residents, a public educational or vocational training institution, or a halfway house.

Limited or no-English proficiency – as defined in D.C. Official Code § 2-1931, the inability to adequately understand or to express oneself in the spoken or written English language.

Medical assistance - health care services provided by a managed care organization (MCO) in accordance with the terms of a contract between the District government and the MCO to provide managed care health services on a capitated basis.

Modified adjusted gross income – income calculated using the financial methodologies used to determine modified adjusted gross income as defined in 26 U.S.C. § 36B(d)(2)(B) and 42 C.F.R. § 435.603.

Noncustodial Parent - a parent who does not have a court order or binding separation, divorce, or custody agreement establishing primary physical custody controls; or if there is no such order or agreement or in the event of a shared custody agreement, the noncustodial parent is the parent with whom the child does not spend most nights, pursuant to 42 C.F.R. §435.603 (f)(2)(iii)(A)-(B).

Postpartum Period – the time frame that begins on the day of delivery or other conclusion of the pregnancy, and ends on the sixtieth (60th) day after the delivery or other conclusion of the pregnancy occurs.

Parent - a person who has a natural or biological child, an adopted child, or a step-child.

Renewal - annual review to evaluate continued eligibility for medical assistance in FCEP CHIP.

Resident – a person who is presently and voluntarily living in the District of Columbia, with the intention to continue living in the District of Columbia.

State – includes any of the fifty (50) constituent political entities of the United States and the District of Columbia.

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