District Of Columbia 2023-2024 Regular Session

District Of Columbia Council Bill B25-0489 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	September 21
2	2	, 2023
3	3	The Honorable Phil Mendelson
4	4	Chairman
5	5	Council of the District of Columbia
6	6	John A. Wilson Building
7	7	1350 Pennsylvania Avenue, N.W., Suite 504
8	8	Washington, D.C. 20004
9	9	Dear Chairman Mendelson:
10	10	Enclosed for consideration and enactment by the Council of the District of Columbia is the “DC
11	11	Healthcare Alliance Financial Eligibility Rulemaking Emergency Approval Act of 2023”, along
12	12	with an accompanying emergency declaration resolution.
13	13	The legislation will approve proposed final rules of the Department of Health Care Finance
14	14	(“DHCF”) regarding the operation of the DC Healthcare Alliance program that will update the
15	15	modified adjusted gross income financial methodology and increase the reasonable compatibility
16	16	standard for verifying electronic data sources when an individual attests to their financial
17	17	information. These changes will provide more room for errors that may be no fault of applicants
18	18	or beneficiaries, and create a more streamlined and efficient automation of application and
19	19	renewal processing that will reduce the risk of eligible Alliance beneficiaries losing health
20	20	coverage.
21	21	If you have any questions regarding the proposed legislation, please contact Acting Chief of
22	22	Staff and Director of the Health Care Policy and Research Administration, DHCF, Eugene
23	23	Simms, at (202) 427-1509.
24	24	I urge the Council to take prompt and favorable action on the legislation.
25	25	Sincerely,
26	26	Muriel Bowser 1
27	27	2
28	28	3
29	29	4
30	30	5
31	31	6
32	32	7
33	33	8
34	34	9
35	35	10
36	36	11
37	37	12
38	38	13
39	39	14
40	40	15
41	41	A BILL
42	42	·"
43	43	~'7P~
44	44	4hairman Phil Mendelson
45	45	at the request
46	46	of the Mayor
47	47	IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
48	48	16 To approve, on an emergency basis, rules governing the Health Care Safety Net
49	49	17 Administration to provide for implementation of updated financial eligibility
50	50	18 requirements and standards on eligibility determinations.
51	51	19
52	52	20 BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA,
53	53	21 That this act may be cited as the "DC Health Care Alliance Financial Eligibility
54	54	22 Rulemaking Emergency Approval Act
55	55	of 2023".
56	56	23 Sec. 2. Pursuant to section 7a of the Health Care Privatization Amendment Act of
57	57	24 2001, effective March 30, 2004 (D.C. Law 15-109; D.C. Official Code§ 7-1406), the
58	58	25 Council approves the proposed final rules of the Department of Health Care Finance that
59	59	26 were transmitted
60	60	to the Council by the Mayor on [INSERT DATE] to amend Chapter 33
61	61	27 (Health Care Safety Net Administration) of Subtitle B (Public Health and Medicine) of
62	62	28 Title 22 (Health) of the District of Columbia Municipal Regulations, regarding the Health
63	63	29 Care Safety Net Administration. A notice
64	64	of proposed rulemaking was published in the
65	65	30 District
66	66	of Columbia Register on March 24, 2023, at 70 DCR 003582.
67	67	31 Sec. 3. Fiscal impact statement.
68	68	32 The Council adopts the fiscal impact statement
69	69	of the Chief Financial Officer as
70	70	33 the fiscal impact statement required by section 4a of the General Legislative Procedures
71	71	1
72	72	2
73	73	Act of 1975, approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-34
74	74	301.47a). 35
75	75	Sec. 4. Effective date. 36
76	76	This act shall take effect following approval by the Mayor (or in the event of veto 37
77	77	by the Mayor, action by the Council to override the veto), and shall remain in effect for 38
78	78	no longer than 90 days, as provided for emergency acts of the Council of the District of 39
79	79	Columbia in section 412(a) of the District of Columbia Home Rule Act, approved 40
80	80	December 24, 1973 (87 Stat. 788; D.C. Official Code § 1-204.12(a)). 41
81	81	1
82	82
83	83	DEPARTMENT OF HEALTH CARE FINANCE
84	84
85	85	NOTICE OF FINAL RULEMAKING
86	86	[as submitted to the Council of the District of Columbia for its approval pursuant to section 7a
87	87	of the Health Care Privatization Amendment Act of 2001 (D.C. Official Code § 7-1406)]
88	88
89	89	The Director of the Department of Health Care Finance (“DHCF”), pursuant to the authority set
90	90	forth in section 7a of the Health Care Privatization Amendment Act of 2001 (“Health Care
91	91	Privatization Amendment Act”), effective July 12, 2001 (D.C. Law 14-18; D.C. Official Code §
92	92	7-1406), and section 6(6) of the Department of Health Care Finance Establishment Act of 2007,
93	93	effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6)), hereby gives
94	94	notice of the adoption of amendments to Chapter 33 (Health Care Safety Net Administration) of
95	95	Subtitle B (Public Health and Medicine) of Title 22 (Health) of the District of Columbia Municipal
96	96	Regulations (DCMR).
97	97
98	98	Pursuant to sections 3 and 7 of the Health Care Privatization Amendment Act (D.C. Official Code
99	99	§§ 7-1401 and 7-1405), DHCF finances and monitors the health care and medical services that are
100	100	provided through contract to District residents enrolled in the District of Columbia Health Care
101	101	Alliance program (“Alliance program”). The Alliance program provides comprehensive health
102	102	care and medical services to District residents ages twenty-one (21) years and over, who have
103	103	incomes at or below two hundred ten percent (210%) of the federal poverty level and are not
104	104	otherwise eligible for or enrolled in Medicare, the Children’s Health Insurance Program, or
105	105	federally-funded Medicaid benefits.
106	106
107	107	This rule further aligns with recent amendments to the Medicaid Modified Adjusted Gross Income
108	108	(MAGI) financial eligibility requirements, which adopt federal legislative changes pursuant to the
109	109	Tax Cuts and Jobs Act of 2017, approved on December 22, 2017 (Pub. L. No. 115-97, 131 Stat.
110	110	2054); the Bipartisan Budget Act of 2018, approved on February 9, 2018 (Pub. L. No. 115-123,
111	111	132 Stat. 64); the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping
112	112	Insurance Delivery Stable Act, approved on January 22, 2018 (Pub. L. No. 115-120, 132 Stat. 31);
113	113	and the Patient Protection and Affordable Care Act of 2010, approved March 23, 2010 (Pub. L.
114	114	No. 111-148, 124 Stat 119), as amended. These changes include: (1) qualified lottery winnings
115	115	and qualified lump sum income (i.e., gambling) of eighty thousand dollars ($80,000) or more,
116	116	which are received in a single payout, shall be counted in the month received and over a period
117	117	of up to one hundred twenty (120) months; (2) self-attestation will be accepted as a form of
118	118	verification of qualified lottery winnings and qualified lump sum income, subject to post-eligibility
119	119	verification using available electronic data sources; (3) an undue medical or financial hardship
120	120	exemption is established for individuals impacted by the new treatment of qualified lottery and
121	121	gambling winnings, subject to criteria as may be established by the Secretary of the U.S.
122	122	Department of Health and Human Services; (4) compensation of a parent mentor, as defined under
123	123	42 U.S.C. § 1397mm(f)(5) (part of the Social Security Act) will be excluded from countable
124	124	income; (5) the deduction for qualified moving expenses will no longer be counted as an exclusion
125	125	from countable income, except for active members of the military; (6) alimony payments under
126	126	separation or divorce agreements finalized after December 31, 2018, or pre-existing agreements
127	127	modified after December 31, 2018, are no longer deductible from income; (7) payment of tuition
128	128	and fees for qualified education expenses for postsecondary education is no longer deductible from
129	129	2
130	130
131	131	income; and (8) household composition for married individuals living separately but filing joint
132	132	tax returns includes the individual plus his or her spouse. The addition of these changes will create
133	133	more parity with Medicaid and further streamline eligibility processes and avoid a bifurcated
134	134	process when evaluating eligibility for the programs.
135	135
136	136	DHCF is also raising the reasonable compatibility standard to match financial information
137	137	obtained from federal and state electronic data sources with self-attested application information
138	138	to align with upcoming Medicaid policy changes. Consistent with the requirements set forth under
139	139	42 U.S.C. 1320b-7 (part of the Social Security Act) and 42 C.F.R. § 435.952, the District uses
140	140	electronic data sources to verify Medicaid financial eligibility, and a reasonable compatibility
141	141	standard to match financial information obtained from federal and state electronic data sources
142	142	with attested application information. Under the District’s reasonable compatibility standard, an
143	143	applicant or beneficiary would not be required to provide additional documentation when self-
144	144	attested income is below the applicable income threshold, the data source reports an income above
145	145	the applicable income threshold, and the difference between them is less than ten percent (10%)
146	146	of the amount given by the data sources. The District adopted the same reasonable compatibility
147	147	standard for the Alliance program. However, ten percent (10%) is a low range for error, and
148	148	electronic income data may not always be completely accurate or up to date with an applicant’s or
149	149	beneficiary’s recent income changes. As part of the District’s plan to unwind continuous Medicaid
150	150	enrollment when the federal public health emergency ends, the District is raising the reasonable
151	151	compatibility standard from ten percent (10%) to twenty percent (20%). This rulemaking aligns
152	152	with this upcoming Medicaid policy change, which will provide more room for errors that may be
153	153	no fault of the applicants or beneficiaries, and is consistent with guidance provided by the Centers
154	154	for Medicare and Medicaid Services that states should raise their reasonable compatibility
155	155	standards. This change will also create a more streamlined and efficient automation of application
156	156	and renewal processing, minimize the need for paper-based manual work, and help reduce the risk
157	157	of eligible Alliance beneficiaries losing health coverage. DHCF estimates that proposed changes
158	158	in this rule will result in an increase of six hundred eighty thousand dollars ($680,000) in total
159	159	local expenditures in Fiscal Year 2023.
160	160
161	161	A Notice of Proposed Rulemaking was published in the District of Columbia Register on March
162	162	24, 2023, at 70 DCR 003582. No comments were received, and no changes have been made to the
163	163	text of the rules as proposed.
164	164
165	165	The proposed final rules were submitted to the Council of the District of Columbia pursuant to
166	166	section 7a of the Health Care Privatization Amendment Act of 2001, effective July 12, 2001 (D.C.
167	167	Law 14-18; D.C. Official Code § 7-1406). The Council approved the rules through Resolution No.
168	168	[INSERT NUMBER] on [INSERT DATE].
169	169
170	170	The Director of DHCF took final action to adopt this rulemaking on [INSERT DATE], and the
171	171	rules shall become effective upon publication of this notice in the District of Columbia Register.
172	172
173	173	Chapter 33, HEALTH CARE SAFETY NET ADMINISTRATION, of Subtitle B, PUBLIC
174	174	HEALTH AND MEDICINE, of Title 22, HEALTH, of the DCMR is amended as follows:
175	175
176	176	Section 3304 FINANCIAL ELIGIBILITY REQUIREMENTS, is amended as follows:
177	177	3
178	178
179	179
180	180	Subsection 3304.2 is amended to read as follows:
181	181
182	182	3304.2 For individuals who expect to file a federal income tax return or who expect to be
183	183	claimed as a tax dependent by another tax filer for the taxable year in which an
184	184	eligibility determination is made, household composition shall be determined as
185	185	follows:
186	186
187	187	(a) The household of an individual who expects to be a tax filer consists of the
188	188	tax filer and all of the tax dependents the tax filer expects to claim;
189	189
190	190	(b) The household of a tax dependent, except individuals identified at § 3304.5,
191	191	consists of the tax filer claiming the tax dependent and all other tax
192	192	dependents expected to be claimed by that tax filer;
193	193
194	194	(c) The household of a married individual who lives with their spouse consists
195	195	of both spouses regardless of whether they expect to file a joint federal tax
196	196	return or whether one (1) or both spouses expect to be claimed as a tax
197	197	dependent by another tax filer;
198	198
199	199	(d) The household of a married individual who does not live with their spouse
200	200	but who files a joint federal tax return with their spouse includes both
201	201	spouses;
202	202
203	203	(e) The household of a married individual who does not live with their spouse
204	204	and who is filing a federal tax return separately from their spouse, does not
205	205	include the spouse in the individual’s household; and
206	206
207	207	(f) The household of a pregnant woman consists of the pregnant woman plus
208	208	the number of children she is expected to deliver. In the case of determining
209	209	the family size of other individuals who have a pregnant woman in their
210	210	household, the pregnant woman is counted herself plus the number of
211	211	children she is expected to deliver.
212	212	Subsection 3304.6 is amended to read as follows:
213	213
214	214	3304.6 MAGI-based income shall be determined using federal income tax rules for
215	215	determining adjusted gross income except as otherwise provided in this Section.
216	216	Countable income shall include the following:
217	217
218	218	(a) Wages, salaries, tips, and other forms of earned income;
219	219
220	220	(b) Taxable and tax-exempt interest;
221	221
222	222	(c) Ordinary dividends;
223	223
224	224	(d) Qualified dividends;
225	225	4
226	226
227	227
228	228	(e) Taxable refunds, credits, or offsets of state and local income taxes;
229	229
230	230	(f) Alimony received;
231	231
232	232	(g) Business income or losses;
233	233
234	234	(h) Capital gains or losses;
235	235
236	236	(i) Other taxable gains or losses;
237	237
238	238	(j) Taxable Individual Retirement Account (IRA) distributions;
239	239
240	240	(k) Taxable amounts of pensions and annuities;
241	241
242	242	(l) Income from certain investments such as rental real estate, royalties,
243	243	partnerships, S corporations, trusts;
244	244
245	245	(m) Farm income or losses;
246	246
247	247	(n) Unemployment compensation;
248	248
249	249	(o) Taxable and tax-exempt Social Security benefits except as provided in
250	250	Subsection 3304.6(q) below;
251	251
252	252	(p) Lump sum payments, which shall be counted as follows:
253	253
254	254	(1) Qualified lottery winnings and qualified lump sum income shall be
255	255	counted using the following formula (lottery winnings paid out in
256	256	installments shall not be considered “qualified lottery winnings” and
257	257	shall be considered unearned, recurring income that is counted in the
258	258	month they are received):
259	259
260	260	(A) Single payment winnings less than eighty thousand dollars
261	261	($80,000.00) shall be counted in the month received in their
262	262	entirety, only for the individual who received the winnings;
263	263
264	264	(B) Single payment winnings of at least eighty thousand dollars
265	265	($80,000.00) but less than ninety thousand dollars
266	266	($90,000.00) shall be counted as income over two (2)
267	267	months, with an equal amount counted in each month, only
268	268	for the individual who received the winnings. For other
269	269	household members, the winnings should be counted under
270	270	§ 3304.6(p)(2); and
271	271
272	272	5
273	273
274	274	(C) For every additional ten thousand dollars ($10,000.00) of
275	275	single payment winnings, one (1) month is added to the
276	276	period over which total winnings are divided, in equal
277	277	installments, and counted as income up to a maximum of
278	278	one hundred twenty (120) months only for the individual
279	279	who received the winnings. This calculation shall be
280	280	consistent with the table showing the amount of monthly
281	281	income attributed to increasing amounts of winnings and the
282	282	number of months over which the winnings are counted
283	283	found in the Centers for Medicare and Medicaid Services
284	284	(CMS) State Health Official Letter # 19-003, Attachment B,
285	285	pages 12 – 13, at https://www.medicaid.gov/federal-policy-
286	286	guidance/downloads/sho19003.pdf (last visited on June 28,
287	287	2022). For other household members, the winnings shall be
288	288	counted under § 3304.6(p)(2); and
289	289
290	290	(2) Other lump sum payments that are not qualified lottery winnings or
291	291	qualified lump sum income are counted in the month received; and
292	292
293	293	(q) Any other income reported on the Internal Revenue Service Form 1040.
294	294
295	295	Subsection 3304.7 is amended to read as follows:
296	296
297	297	3304.7 Countable income shall exclude the following:
298	298
299	299	(a) Income scholarships, awards, or fellowship grants used for education
300	300	purposes and not for living expenses;
301	301
302	302	(b) American Indian/Alaska Native income as defined in 42 C.F.R. §
303	303	435.603(e);
304	304
305	305	(c) Educator expenses;
306	306
307	307	(d) Certain business expenses of reservists, performing artists, and fee-based
308	308	government officials;
309	309
310	310	(e) Health savings account deductions;
311	311
312	312	(f) Moving expenses for active duty members of the military who are ordered
313	313	to move or change duty stations. For individuals that are not active duty
314	314	members of the military, moving expenses shall not be excluded from
315	315	income through tax year 2025;
316	316
317	317	(g) Deductible parts of self-employment taxes;
318	318
319	319	(h) Self-employed Simplified Employee Pension (SEP), Savings Incentive
320	320	Match Plan for Employees (SIMPLE), and qualified plans;
321	321	6
322	322
323	323
324	324	(i) Self-employed health insurance deductions;
325	325
326	326	(j) Penalties on early withdrawal of savings;
327	327
328	328	(k) Alimony paid pursuant to a separation or divorce agreement finalized on or
329	329	before December 31, 2018 that has not been modified after December 31,
330	330	2018;
331	331
332	332	(l) Alimony received pursuant to a separation or divorce agreement finalized
333	333	on or after January 1, 2019, or pursuant to a pre-existing agreement
334	334	modified on or after January 1, 2019;
335	335
336	336	(m) Individual Retirement Arrangements (IRA) deductions;
337	337
338	338	(n) Student loan interest deductions;
339	339
340	340	(o) Discharged student loan debt of a borrower if the debt is discharged due to
341	341	the death or permanent and total disability of the student, as described under
342	342	Section 11031 of the Tax Cuts and Jobs Act of 2017, approved on December
343	343	22, 2017 (Pub. L. No. 115-97, 131 Stat. 2054);
344	344
345	345	(p) Public assistance benefits;
346	346
347	347	(q) Domestic production activities deductions;
348	348
349	349	(r) Supplemental Security Income (SSI) benefits under Title XVI of the Social
350	350	Security Act; and
351	351
352	352	(s) Compensation of a parent mentor, as defined under 42 U.S.C. § 1397mm
353	353	(f)(5) of the Social Security Act, that assists families with children that are
354	354	eligible, but not enrolled, in Medicaid, in accordance with Section 3004 of
355	355	the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth
356	356	by Keeping Insurance Delivery Stable Act of 2017, approved on January
357	357	22, 2018 (Pub. L. No. 115-120, 132 Stat. 28) (HEALTHY KIDS Act).
358	358
359	359	Subsection 3304.13 is amended to read as follows:
360	360
361	361	3304.13 The Department shall verify financial eligibility through one (1) or more federal
362	362	and state electronic data sources, except for qualified lottery winnings and qualified
363	363	lump sum payments, for which the Department shall accept self-attestation, subject
364	364	to post-eligibility verification using available electronic data sources.
365	365
366	366	Subsection 3304.15 is amended to read as follows:
367	367
368	368	3304.15 The reasonable compatibility standard for financial information shall be met when:
369	369
370	370	7
371	371
372	372	(a) The attestation and data sources are both above the District Alliance
373	373	program’s applicable income standard;
374	374
375	375	(b) The attestation and data sources are both below the District Alliance
376	376	program’s applicable income standard;
377	377
378	378	(c) The attestation is below the District Alliance program’s applicable income
379	379	standard and the data sources are above the applicable income standard,
380	380	when the difference between them is less than twenty percent (20%) of the
381	381	amount given by data sources; or
382	382
383	383	(d) The attestation is zero (0) income and no income data is available from
384	384	electronic data sources.
385	385
386	386	A new subsection 3304.21 is added to read as follows:
387	387
388	388	3304.21 An individual whose income exceeds the applicable Medicaid Modified Adjusted
389	389	Gross Income (MAGI) income limit due to the application of the formula for
390	390	qualified lottery winnings and qualified lump sum income, as described in §
391	391	3304.6(p)(1), may continue to be eligible to the extent the Department determines
392	392	that the denial of eligibility of the individual would cause an undue medical or
393	393	financial hardship as determined on the basis of criteria as may be established by
394	394	the Secretary of the U.S. Department of Health and Human Services.
395	395
396	396	Section 3399, DEFINITIONS, is amended as follows:
397	397
398	398	The following new definition, of “Certification period”, is added after the existing definition
399	399	of “Bilateral contract modification”:
400	400
401	401	Certification period – Alliance program eligibility is determined for a twelve (12)
402	402	month period. This period is called a certification period.
403	403
404	404	The following new definitions, of “Other lump sum payments” and “Parent mentor”, are
405	405	added after the existing definition of “Option”, to read as follows:
406	406
407	407	Other lump sum payments – non-recurring payments that are not qualified lottery
408	408	winnings or gambling winnings, and may include but not be limited to
409	409	backpay, a retroactive benefit payment, state tax refund, or an insurance
410	410	settlement.
411	411
412	412	Parent Mentor - as defined under 42 U.S.C. § 1397mm (f)(5).
413	413
414	414	The following new definitions, of “Qualified lottery winnings” and “Qualified lump sum
415	415	income”, are added after the existing definition of “Purchase order”, to read as follows:
416	416
417	417	Qualified lottery winnings – as defined under 42 U.S.C. § 1396a(e)(14)(K)(v).
418	418	8
419	419
420	420
421	421	Qualified lump sum income – as defined under § 1396a(e)(14)(K)(vi) (i.e.,
422	422	gambling winnings).
423	423
424	424	GOVERNMENT OF THE DISTRICT OF COLUMBIA
425	425	OFFICE OF THE ATTORNEY GENERAL
426	426
427	427
428	428
429	429
430	430	ATTORNEY GENERAL
431	431	B
432	432	RIAN L. SCHWALB
433	433
434	434
435	435	Legal Counsel Division
436	436
437	437
438	438
439	439	MEMORANDUM
440	440
441	441	TO: Beverly Perry
442	442	Senior Advisor
443	443	Office of Policy and Legislative Affairs
444	444
445	445	FROM: Megan D. Browder
446	446	Deputy Attorney General
447	447	Legal Counsel Division
448	448
449	449	DATE: January 4, 2023
450	450
451	451	SUBJECT: Legal Sufficiency Review of the “Alliance Enrollment and Financial
452	452	Eligibility Amendment Rulemaking Approval Resolution of 2022”
453	453	(AD-22-744B)
454	454	________________________________________________________________________
455	455	This is to Certify that this Office has reviewed the above-
456	456	referenced resolution and that we have found it to be legally sufficient. If you have any questions in this regard, please do not hesitate to call me at 724-5524.
457	457
458	458	______________________________ Megan D. Browder
459	459
460	460
461	461	Government of the District of Columbia
462	462	Office of the Chief Financial Officer
463	463
464	464	Glen Lee
465	465	Chief Financial Officer
466	466
467	467
468	468
469	469
470	470
471	471	1350 Pennsylvania Avenue, NW, Suite 203, Washington, DC 20004 (202)727-2476
472	472	www.cfo.dc.gov
473	473	MEMORANDUM
474	474
475	475	TO: The Honorable Phil Mendelson
476	476	Chairman, Council of the District of Columbia
477	477
478	478	FROM: Glen Lee
479	479	Chief Financial Officer
480	480
481	481	DATE: January 18, 2023
482	482
483	483	SUBJECT: Fiscal Impact Statement – Alliance Enrollment and Financial Eligibility
484	484	Amendment Rulemaking Approval Resolution of 2023
485	485
486	486	REFERENCE: Draft Introduction as provided to the Office of Revenue Analysis on
487	487	January 13, 2023
488	488
489	489
490	490	Conclusion
491	491
492	492	Funds are sufficient in the fiscal year 2023 through fiscal year 2026 budget and financial plan to
493	493	implement the proposed rules.
494	494
495	495	Background
496	496
497	497	The bill approves two proposed rulemakings by the Department of Health Care Finance (DHCF) that
498	498	make changes to rules for the District of Columbia Healthcare Alliance (Alliance) program.
499	499
500	500	The first rulemaking increases the Alliance eligibility period from six months of eligibility to twelve
501	501	months of eligibility. This increase will align the rules with eligibility period changes that were
502	502	included in the fiscal year 2023 budget.
503	503	1
504	504
505	505	The second rulemaking updates the Modified Adjusted Gross Income (MAGI) financial eligibility
506	506	requirements calculation methodology. With this change, the Alliance MAGI methodology will align
507	507	with Medicaid MAGI methodology .
508	508
509	509	The second rulemaking also aligns the Alliance program with upcoming Medicaid policy changes to
510	510	increase the reasonable compatibility standard for verifying electronic data sources when an
511	511
512	512	1
513	513	Fiscal Year 2023 Budget Support Act of 2022 , Subtitle V(C), Alliance Enrollment Amendment Act of 2022,
514	514	effective September 21, 2022 (D.C. Law 24-167; 69 DCR 11937). The Honorable Phil Mendelson
515	515	FIS: “Alliance Enrollment and Financial Eligibility Amendment Rulemaking Approval Resolution of 2023,”
516	516	Introduction as provided to the Office of Revenue Analysis on January 13, 2023
517	517
518	518	Page 2 of 2
519	519
520	520	individual attests to their financial information. The District uses electronic data sources to verify
521	521	Medicaid and Alliance financial eligibility, and a reasonable compatibility standard to match financial
522	522	information obtained from federal and state electronic data sources with attested application
523	523	information. If an applicant’s self-attested income is within the reasonable compatibility standard,
524	524	the applicant is not required to submit more documentation to be eligible to enroll in Alliance. The
525	525	proposed rule will increase the reasonable compatibility standard from ten percent to twenty
526	526	percent to be consistent with federal guidance on Medicaid.
527	527
528	528	Financial Plan Impact
529	529
530	530	Funds are sufficient in the fiscal year 2023 through fiscal year 2026 budget and financial plan to
531	531	implement the proposed rules.
532	532
533	533	Approving rules that extend the Alliance enrollment period from six months to twelve months does
534	534	not have an additional cost. The fiscal year 2023 budget and financial plan includes funding to
535	535	implement the enrollment extension. Updating the MAGI financial eligibility requirements
536	536	calculation methodology does not have a cost to the District. Approving rules that increase the
537	537	reasonable compatibility standard from ten percent to twenty percent will slightly increase the
538	538	number of Alliance beneficiaries enrolled in the program. The estimated cost of the additional
539	539	enrollees is $680,000 in fiscal year 2023 and $2.8 million over the financial plan. DHCF can absorb
540	540	these costs using savings realized from the extension of public health emergency enhanced Federal
541	541	Medical Assistance Percentage through the end of the calendar year and through growth included in
542	542	the financial plan. The agency also anticipates efficiencies from having the same reasonable
543	543	compatibility standard in place for Medicaid and Alliance enrollment, since the application and
544	544	renewal process will be more streamlined, although efficiency savings have not been quantified.
545	545
546	546
547	547	Alliance Enrollment and Financial Eligibility Amendment Rulemaking Approval Resolution of 2023
548	548	Total Cost
549	549	FY 2023 FY 2024 FY 2025 FY 2026 Total
550	550	Reasonable
551	551	Compatibility
552	552	(a) $680,000 $691,000 $704,000 $716,000 $2,791,000
553	553	Table Notes:
554	554	(a) Assumes 1.75 percent cost growth.
555	555