§ 1–307.03. Medical assistance expansion program establishment.

(a) The Mayor shall establish a program to expand medical assistance to adult District residents with an annual household income up to 200% of the federal poverty level.

(1) The Mayor may provide medical assistance to eligible residents by making arrangements with managed care providers either on a fee-for-service or capitated basis.

(2) Enrollees of the program shall select a health maintenance organization with a current contract with the District to provide managed care services.

(3) The Mayor shall assign any enrollee who does not choose a provider within a reasonable period of time to the District of Columbia Health and Hospitals Public Benefit Corporation.

(4)(A) In fiscal year 2000, the Mayor may establish a pilot project to expand Medicaid coverage to not more than 2,400 adult District residents.

(B) The funding for the pilot shall be derived by amending the Disproportionate Share adjustment paid to hospitals.

(5) To implement any expansion for adult District residents with an annual household income up to 200% of the federal poverty level the Mayor shall:

(A) Seek and obtain all necessary waivers of federal Medicaid statutes, rules, and regulations; and

(B) Amend the District State Medicaid plan.

(b) The Mayor shall establish a program to provide medical assistance to undocumented children not eligible for coverage under Medicaid who reside in the District and have an annual household income up to 319% of the federal poverty level for children age 18 or younger, and up to 216% of the federal poverty level for children ages 19 and 20. In determining a household income under this subsection, the Mayor may implement an income disregard amount, based on family size, of up to 5% of the federal poverty level or such higher percentage as may be authorized by the federal government as an income disregard for the determination of eligibility for Medicaid.

(1) The Mayor may provide medical assistance to eligible residents by making arrangements with managed care providers either on a fee-for-service or capitated basis.

(2) Upon the Mayor's determination of a resident's eligibility for the program, the Mayor shall enroll the resident in the program and assign the enrollee to a health maintenance organization with a current contract with the District to provide health care services for program enrollees.

(3) For a period of time of at least 30 days after the Mayor's assignment of an enrollee under paragraph (2) of this subsection, the enrollee may choose to enroll in a different health maintenance organization with a current contract with the District to provide health care services for program enrollees.

(4) In fiscal year 2000, the Mayor shall establish a pilot program to provide medical assistance to not more than 500 immigrant children not eligible to be covered under Medicaid.

(c) Beginning on October 1, 2021, the Mayor may modify the standards for eligibility to enroll in a program established by subsections (a) and (b) of this section to increase the number of District residents who would be eligible to enroll in the program to the extent such expansion is consistent with the District's budget and financial plan.

(d) The Mayor may provide financial support to providers to register the uninsured in conformity with the financial plan and budget.

(e) Nothing in this section, § 1-307.05, or § 1-307.06 shall be deemed to create or constitute an entitlement or right to medical coverage.

(Oct. 20, 1999, D.C. Law 13-38, § 2202, 46 DCR 6373; Oct. 19, 2000, D.C. Law 13-172, § 4802(a), 47 DCR 6308; Mar. 3, 2010, D.C. Law 18-111, § 7009, 57 DCR 181; Nov. 13, 2021, D.C. Law 24-45, § 5012, 68 DCR 010163.)

Prior Codifications

1981 Ed., § 1-360.1.

Section References

This section is referenced in § 1-307.06.

Effect of Amendments

D.C. Law 13-172, in subsec. (b)(4), substituted “immigrant” for “undocumented”.

Sections 3902 and 3903 of D.C. Law 13-172 provided:

“Sec. 3902. The Medical Assistance Administration (‘MAA’) shall work closely with all District agencies and the Budget Director of the Council of the District of Columbia, in establishing Medicaid rates and Medicaid waiver programs to maximize Federal dollars as a means of reimbursement for services provided by District of Columbia agencies.

“Sec. 3903. MAA shall submit to the Council no later than 15 days after the end of each quarter a report that identifies new District agency programs that are participating in the Medicaid program and the potential savings in local funds associated with their participation.”

D.C. Law 18-111, in subsec. (e), deleted the first sentence which read: “This section, § 1-307.05, and § 1-307.06 are subject to the availability of appropriations.”

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5012 of Fiscal Year 2022 Budget Support Emergency Act of 2021 (D.C. Act 24-159, Aug. 23, 2021, 68 DCR 008602).

For temporary (90-day) addition of section, see § 902 of the Fiscal Year 1999 Budget Support Congressional Review Emergency Act of 1999 (D.C. Act 13-41, March 31, 1999, 46 DCR 3446).

For temporary (90-day) directive to Medical Assistance Administration to work with District agencies and the Council Budget Director to establish rates and programs to maximize Federal reimbursement dollars and to report to the Council on new agency programs participating in Medicaid, see §§ 3902 and 3903 of the Fiscal Year 2001 Budget Support Emergency Act of 2000 (D.C. Act 13-376, July 24, 2000, 47 DCR 6574).

For temporary (90 day) amendment of section, see §§ 3902, 3903, and 4802 of the Fiscal Year 2001 Budget Support Congressional Review Emergency Act of 2000 (D.C. Act 13-438, October 20, 2000, 47 DCR 8740).

For temporary (90 day) amendment of section, see § 7009 of Fiscal Year 2010 Budget Support Second Emergency Act of 2009 (D.C. Act 18-207, October 15, 2009, 56 DCR 8234).

For temporary (90 day) amendment of section, see § 7009 of Fiscal Year Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-260, January 4, 2010, 57 DCR 345).

Short Title

Section 2201 of D.C. Law 13-38 provided: “This title may be cited as the ‘Medical Assistance Expansion Program Act of 1999’.”

Editor's Notes

Short title: Section 5051 of D.C. Law 17-219 provided that subtitle T of title V of the act may be cited as the “Medicaid Fee-For-Service State Plan Amendment Act of 2008”.

Section 5052 of D.C. Law 17-219 provided: “By October 1, 2008, the Mayor shall submit to the Council a Medicaid state plan amendment that will increase the specialty physician and primary care physician reimbursement rates under the District Medicaid fee-for-service program to match the specialty physician and primary care physician reimbursement rates under the federal Medicare program.”