District Of Columbia 2023-2024 Regular Session

District Of Columbia Council Bill PR25-0607 Compare Versions

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

Old	New	Differences
1	1	January 10
2	2	, 2024
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 Approval Emergency Act of 2024”, 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 Chief of Staff,
22	22	DHCF, Melanie Williamson, at (202) 478-5809.
23	23	I urge the Council to take prompt and favorable action on the legislation.
24	24	Sincerely,
25	25	Muriel Bowser 1
26	26	2
27	27	3
28	28	4
29	29	5
30	30	6
31	31	7
32	32	8
33	33	9
34	34	10
35	35	11
36	36	12
37	37	13
38	38	14
39	39	15
40	40	~~
41	41	at the request of the Mayor
42	42	A PROPOSED RESOLUTION
43	43	IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
44	44	16 To declare the existence of an emergency with respect to the need to approve proposed
45	45	17 final rules submitted to the Council pursuant to section 7a of the Health Care
46	46	18 Privatization Amendment Act of 2001 to provide for implementation of updated
47	47	19 financial eligibility requirements and standards on eligibility determinations for
48	48	20 the DC Healthcare Alliance program.
49	49	21
50	50	22 RESOLVED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That
51	51	23 this resolution may be cited as the "DC Health Care Alliance Financial Eligibility
52	52	24 Rulemaking Approval Emergency Declaration Resolution
53	53	of 2024".
54	54	25 Sec. 2. (a) There is an immediate need to approve proposed final rules of the
55	55	26 Department
56	56	of Health Care Finance regarding the DC Health Care Alliance ("Alliance")
57	57	27 program.
58	58	28 (b) Pursuant to section 7a of the Health Care Privatization Amendment Act of
59	59	29 2001 ("Act" ), effective March 30, 2004 (D.C. Law 15-109; D.C. Official Code§ 7-1406),
60	60	30 the Council must approve, by act, proposed final rules that implement the Act, which
61	61	31 established the Health Care Safety Net Administration, which administers the Alliance
62	62	32 program.
63	63	33 (c) The Department of Health Care Finance in March 2023 issued a notice of
64	64	34 proposed rulemaking to update its rules governing Alliance program eligibility to create
65	65	1 2
66	66	parity with certain Medicaid eligibility requirements and processes, including most of the 35
67	67	Medicaid modified adjusted gross income (“MAGI”) financial methodology. 36
68	68	(d) The rule changes the financial eligibility methodology to further align with37
69	69	policy changes to the MAGI financial methodology by incorporating federal legislative 38
70	70	changes, which will further streamline eligibility processes. 39
71	71	(e) In response to the restart of Alliance program renewals on July 1, 2022, the40
72	72	rules also adopt upcoming Medicaid policy changes to increase the reasonable 41
73	73	compatibility standard for verifying electronic data sources when an individual attests to 42
74	74	their financial information, which will provide more room for errors that may be no fault 43
75	75	of the applicants or beneficiaries, and create a more streamlined and efficient automation 44
76	76	of application and renewal processing that reduces the risk of eligible Alliance 45
77	77	beneficiaries from losing health coverage. 46
78	78	(e) Approval on an emergency basis is necessary to reduce barriers to District47
79	79	residents establishing and continuing Alliance program eligibility. 48
80	80	Sec. 3. The Council of the District of Columbia determines that the 49
81	81	circumstances enumerated in section 2 constitute emergency circumstances making it 50
82	82	necessary that the DC Health Care Alliance Financial Eligibility Rulemaking Approval 51
83	83	Emergency Act of 2024 be adopted after a single reading. 52
84	84	Sec. 4. This resolution shall take effect immediately. 53
85	85	1
86	86
87	87	DEPARTMENT OF HEALTH CARE FINANCE
88	88
89	89	NOTICE OF FINAL RULEMAKING
90	90	[as submitted to the Council of the District of Columbia for its approval pursuant to section 7a
91	91	of the Health Care Privatization Amendment Act of 2001 (D.C. Official Code § 7-1406)]
92	92
93	93	The Director of the Department of Health Care Finance (“DHCF”), pursuant to the authority set
94	94	forth in section 7a of the Health Care Privatization Amendment Act of 2001 (“Health Care
95	95	Privatization Amendment Act”), effective July 12, 2001 (D.C. Law 14-18; D.C. Official Code §
96	96	7-1406), and section 6(6) of the Department of Health Care Finance Establishment Act of 2007,
97	97	effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6)), hereby gives
98	98	notice of the adoption of amendments to Chapter 33 (Health Care Safety Net Administration) of
99	99	Subtitle B (Public Health and Medicine) of Title 22 (Health) of the District of Columbia Municipal
100	100	Regulations (DCMR).
101	101
102	102	Pursuant to sections 3 and 7 of the Health Care Privatization Amendment Act (D.C. Official Code
103	103	§§ 7-1401 and 7-1405), DHCF finances and monitors the health care and medical services that are
104	104	provided through contract to District residents enrolled in the District of Columbia Health Care
105	105	Alliance program (“Alliance program”). The Alliance program provides comprehensive health
106	106	care and medical services to District residents ages twenty-one (21) years and over, who have
107	107	incomes at or below two hundred ten percent (210%) of the federal poverty level and are not
108	108	otherwise eligible for or enrolled in Medicare, the Children’s Health Insurance Program, or
109	109	federally-funded Medicaid benefits.
110	110
111	111	This rule further aligns with recent amendments to the Medicaid Modified Adjusted Gross Income
112	112	(MAGI) financial eligibility requirements, which adopt federal legislative changes pursuant to the
113	113	Tax Cuts and Jobs Act of 2017, approved on December 22, 2017 (Pub. L. No. 115-97, 131 Stat.
114	114	2054); the Bipartisan Budget Act of 2018, approved on February 9, 2018 (Pub. L. No. 115-123,
115	115	132 Stat. 64); the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping
116	116	Insurance Delivery Stable Act, approved on January 22, 2018 (Pub. L. No. 115-120, 132 Stat. 31);
117	117	and the Patient Protection and Affordable Care Act of 2010, approved March 23, 2010 (Pub. L.
118	118	No. 111-148, 124 Stat 119), as amended. These changes include: (1) qualified lottery winnings
119	119	and qualified lump sum income (i.e., gambling) of eighty thousand dollars ($80,000) or more,
120	120	which are received in a single payout, shall be counted in the month received and over a period
121	121	of up to one hundred twenty (120) months; (2) self-attestation will be accepted as a form of
122	122	verification of qualified lottery winnings and qualified lump sum income, subject to post-eligibility
123	123	verification using available electronic data sources; (3) an undue medical or financial hardship
124	124	exemption is established for individuals impacted by the new treatment of qualified lottery and
125	125	gambling winnings, subject to criteria as may be established by the Secretary of the U.S.
126	126	Department of Health and Human Services; (4) compensation of a parent mentor, as defined under
127	127	42 U.S.C. § 1397mm(f)(5) (part of the Social Security Act) will be excluded from countable
128	128	income; (5) the deduction for qualified moving expenses will no longer be counted as an exclusion
129	129	from countable income, except for active members of the military; (6) alimony payments under
130	130	separation or divorce agreements finalized after December 31, 2018, or pre-existing agreements
131	131	modified after December 31, 2018, are no longer deductible from income; (7) payment of tuition
132	132	and fees for qualified education expenses for postsecondary education is no longer deductible from
133	133	2
134	134
135	135	income; and (8) household composition for married individuals living separately but filing joint
136	136	tax returns includes the individual plus his or her spouse. The addition of these changes will create
137	137	more parity with Medicaid and further streamline eligibility processes and avoid a bifurcated
138	138	process when evaluating eligibility for the programs.
139	139
140	140	DHCF is also raising the reasonable compatibility standard to match financial information
141	141	obtained from federal and state electronic data sources with self-attested application information
142	142	to align with upcoming Medicaid policy changes. Consistent with the requirements set forth under
143	143	42 U.S.C. 1320b-7 (part of the Social Security Act) and 42 C.F.R. § 435.952, the District uses
144	144	electronic data sources to verify Medicaid financial eligibility, and a reasonable compatibility
145	145	standard to match financial information obtained from federal and state electronic data sources
146	146	with attested application information. Under the District’s reasonable compatibility standard, an
147	147	applicant or beneficiary would not be required to provide additional documentation when self-
148	148	attested income is below the applicable income threshold, the data source reports an income above
149	149	the applicable income threshold, and the difference between them is less than ten percent (10%)
150	150	of the amount given by the data sources. The District adopted the same reasonable compatibility
151	151	standard for the Alliance program. However, ten percent (10%) is a low range for error, and
152	152	electronic income data may not always be completely accurate or up to date with an applicant’s or
153	153	beneficiary’s recent income changes. As part of the District’s plan to unwind continuous Medicaid
154	154	enrollment when the federal public health emergency ends, the District is raising the reasonable
155	155	compatibility standard from ten percent (10%) to twenty percent (20%). This rulemaking aligns
156	156	with this upcoming Medicaid policy change, which will provide more room for errors that may be
157	157	no fault of the applicants or beneficiaries, and is consistent with guidance provided by the Centers
158	158	for Medicare and Medicaid Services that states should raise their reasonable compatibility
159	159	standards. This change will also create a more streamlined and efficient automation of application
160	160	and renewal processing, minimize the need for paper-based manual work, and help reduce the risk
161	161	of eligible Alliance beneficiaries losing health coverage. DHCF estimates that proposed changes
162	162	in this rule will result in an increase of six hundred eighty thousand dollars ($680,000) in total
163	163	local expenditures in Fiscal Year 2023.
164	164
165	165	A Notice of Proposed Rulemaking was published in the District of Columbia Register on March
166	166	24, 2023, at 70 DCR 003582. No comments were received, and no changes have been made to the
167	167	text of the rules as proposed.
168	168
169	169	The proposed final rules were submitted to the Council of the District of Columbia pursuant to
170	170	section 7a of the Health Care Privatization Amendment Act of 2001, effective July 12, 2001 (D.C.
171	171	Law 14-18; D.C. Official Code § 7-1406). The Council approved the rules through Resolution No.
172	172	[INSERT NUMBER] on [INSERT DATE].
173	173
174	174	The Director of DHCF took final action to adopt this rulemaking on [INSERT DATE], and the
175	175	rules shall become effective upon publication of this notice in the District of Columbia Register.
176	176
177	177	Chapter 33, HEALTH CARE SAFETY NET ADMINISTRATION, of Subtitle B, PUBLIC
178	178	HEALTH AND MEDICINE, of Title 22, HEALTH, of the DCMR is amended as follows:
179	179
180	180	Section 3304 FINANCIAL ELIGIBILITY REQUIREMENTS, is amended as follows:
181	181	3
182	182
183	183
184	184	Subsection 3304.2 is amended to read as follows:
185	185
186	186	3304.2 For individuals who expect to file a federal income tax return or who expect to be
187	187	claimed as a tax dependent by another tax filer for the taxable year in which an
188	188	eligibility determination is made, household composition shall be determined as
189	189	follows:
190	190
191	191	(a) The household of an individual who expects to be a tax filer consists of the
192	192	tax filer and all of the tax dependents the tax filer expects to claim;
193	193
194	194	(b) The household of a tax dependent, except individuals identified at § 3304.5,
195	195	consists of the tax filer claiming the tax dependent and all other tax
196	196	dependents expected to be claimed by that tax filer;
197	197
198	198	(c) The household of a married individual who lives with their spouse consists
199	199	of both spouses regardless of whether they expect to file a joint federal tax
200	200	return or whether one (1) or both spouses expect to be claimed as a tax
201	201	dependent by another tax filer;
202	202
203	203	(d) The household of a married individual who does not live with their spouse
204	204	but who files a joint federal tax return with their spouse includes both
205	205	spouses;
206	206
207	207	(e) The household of a married individual who does not live with their spouse
208	208	and who is filing a federal tax return separately from their spouse, does not
209	209	include the spouse in the individual’s household; and
210	210
211	211	(f) The household of a pregnant woman consists of the pregnant woman plus
212	212	the number of children she is expected to deliver. In the case of determining
213	213	the family size of other individuals who have a pregnant woman in their
214	214	household, the pregnant woman is counted herself plus the number of
215	215	children she is expected to deliver.
216	216	Subsection 3304.6 is amended to read as follows:
217	217
218	218	3304.6 MAGI-based income shall be determined using federal income tax rules for
219	219	determining adjusted gross income except as otherwise provided in this Section.
220	220	Countable income shall include the following:
221	221
222	222	(a) Wages, salaries, tips, and other forms of earned income;
223	223
224	224	(b) Taxable and tax-exempt interest;
225	225
226	226	(c) Ordinary dividends;
227	227
228	228	(d) Qualified dividends;
229	229	4
230	230
231	231
232	232	(e) Taxable refunds, credits, or offsets of state and local income taxes;
233	233
234	234	(f) Alimony received;
235	235
236	236	(g) Business income or losses;
237	237
238	238	(h) Capital gains or losses;
239	239
240	240	(i) Other taxable gains or losses;
241	241
242	242	(j) Taxable Individual Retirement Account (IRA) distributions;
243	243
244	244	(k) Taxable amounts of pensions and annuities;
245	245
246	246	(l) Income from certain investments such as rental real estate, royalties,
247	247	partnerships, S corporations, trusts;
248	248
249	249	(m) Farm income or losses;
250	250
251	251	(n) Unemployment compensation;
252	252
253	253	(o) Taxable and tax-exempt Social Security benefits except as provided in
254	254	Subsection 3304.6(q) below;
255	255
256	256	(p) Lump sum payments, which shall be counted as follows:
257	257
258	258	(1) Qualified lottery winnings and qualified lump sum income shall be
259	259	counted using the following formula (lottery winnings paid out in
260	260	installments shall not be considered “qualified lottery winnings” and
261	261	shall be considered unearned, recurring income that is counted in the
262	262	month they are received):
263	263
264	264	(A) Single payment winnings less than eighty thousand dollars
265	265	($80,000.00) shall be counted in the month received in their
266	266	entirety, only for the individual who received the winnings;
267	267
268	268	(B) Single payment winnings of at least eighty thousand dollars
269	269	($80,000.00) but less than ninety thousand dollars
270	270	($90,000.00) shall be counted as income over two (2)
271	271	months, with an equal amount counted in each month, only
272	272	for the individual who received the winnings. For other
273	273	household members, the winnings should be counted under
274	274	§ 3304.6(p)(2); and
275	275
276	276	5
277	277
278	278	(C) For every additional ten thousand dollars ($10,000.00) of
279	279	single payment winnings, one (1) month is added to the
280	280	period over which total winnings are divided, in equal
281	281	installments, and counted as income up to a maximum of
282	282	one hundred twenty (120) months only for the individual
283	283	who received the winnings. This calculation shall be
284	284	consistent with the table showing the amount of monthly
285	285	income attributed to increasing amounts of winnings and the
286	286	number of months over which the winnings are counted
287	287	found in the Centers for Medicare and Medicaid Services
288	288	(CMS) State Health Official Letter # 19-003, Attachment B,
289	289	pages 12 – 13, at https://www.medicaid.gov/federal-policy-
290	290	guidance/downloads/sho19003.pdf (last visited on June 28,
291	291	2022). For other household members, the winnings shall be
292	292	counted under § 3304.6(p)(2); and
293	293
294	294	(2) Other lump sum payments that are not qualified lottery winnings or
295	295	qualified lump sum income are counted in the month received; and
296	296
297	297	(q) Any other income reported on the Internal Revenue Service Form 1040.
298	298
299	299	Subsection 3304.7 is amended to read as follows:
300	300
301	301	3304.7 Countable income shall exclude the following:
302	302
303	303	(a) Income scholarships, awards, or fellowship grants used for education
304	304	purposes and not for living expenses;
305	305
306	306	(b) American Indian/Alaska Native income as defined in 42 C.F.R. §
307	307	435.603(e);
308	308
309	309	(c) Educator expenses;
310	310
311	311	(d) Certain business expenses of reservists, performing artists, and fee-based
312	312	government officials;
313	313
314	314	(e) Health savings account deductions;
315	315
316	316	(f) Moving expenses for active duty members of the military who are ordered
317	317	to move or change duty stations. For individuals that are not active duty
318	318	members of the military, moving expenses shall not be excluded from
319	319	income through tax year 2025;
320	320
321	321	(g) Deductible parts of self-employment taxes;
322	322
323	323	(h) Self-employed Simplified Employee Pension (SEP), Savings Incentive
324	324	Match Plan for Employees (SIMPLE), and qualified plans;
325	325	6
326	326
327	327
328	328	(i) Self-employed health insurance deductions;
329	329
330	330	(j) Penalties on early withdrawal of savings;
331	331
332	332	(k) Alimony paid pursuant to a separation or divorce agreement finalized on or
333	333	before December 31, 2018 that has not been modified after December 31,
334	334	2018;
335	335
336	336	(l) Alimony received pursuant to a separation or divorce agreement finalized
337	337	on or after January 1, 2019, or pursuant to a pre-existing agreement
338	338	modified on or after January 1, 2019;
339	339
340	340	(m) Individual Retirement Arrangements (IRA) deductions;
341	341
342	342	(n) Student loan interest deductions;
343	343
344	344	(o) Discharged student loan debt of a borrower if the debt is discharged due to
345	345	the death or permanent and total disability of the student, as described under
346	346	Section 11031 of the Tax Cuts and Jobs Act of 2017, approved on December
347	347	22, 2017 (Pub. L. No. 115-97, 131 Stat. 2054);
348	348
349	349	(p) Public assistance benefits;
350	350
351	351	(q) Domestic production activities deductions;
352	352
353	353	(r) Supplemental Security Income (SSI) benefits under Title XVI of the Social
354	354	Security Act; and
355	355
356	356	(s) Compensation of a parent mentor, as defined under 42 U.S.C. § 1397mm
357	357	(f)(5) of the Social Security Act, that assists families with children that are
358	358	eligible, but not enrolled, in Medicaid, in accordance with Section 3004 of
359	359	the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth
360	360	by Keeping Insurance Delivery Stable Act of 2017, approved on January
361	361	22, 2018 (Pub. L. No. 115-120, 132 Stat. 28) (HEALTHY KIDS Act).
362	362
363	363	Subsection 3304.13 is amended to read as follows:
364	364
365	365	3304.13 The Department shall verify financial eligibility through one (1) or more federal
366	366	and state electronic data sources, except for qualified lottery winnings and qualified
367	367	lump sum payments, for which the Department shall accept self-attestation, subject
368	368	to post-eligibility verification using available electronic data sources.
369	369
370	370	Subsection 3304.15 is amended to read as follows:
371	371
372	372	3304.15 The reasonable compatibility standard for financial information shall be met when:
373	373
374	374	7
375	375
376	376	(a) The attestation and data sources are both above the District Alliance
377	377	program’s applicable income standard;
378	378
379	379	(b) The attestation and data sources are both below the District Alliance
380	380	program’s applicable income standard;
381	381
382	382	(c) The attestation is below the District Alliance program’s applicable income
383	383	standard and the data sources are above the applicable income standard,
384	384	when the difference between them is less than twenty percent (20%) of the
385	385	amount given by data sources; or
386	386
387	387	(d) The attestation is zero (0) income and no income data is available from
388	388	electronic data sources.
389	389
390	390	A new subsection 3304.21 is added to read as follows:
391	391
392	392	3304.21 An individual whose income exceeds the applicable Medicaid Modified Adjusted
393	393	Gross Income (MAGI) income limit due to the application of the formula for
394	394	qualified lottery winnings and qualified lump sum income, as described in §
395	395	3304.6(p)(1), may continue to be eligible to the extent the Department determines
396	396	that the denial of eligibility of the individual would cause an undue medical or
397	397	financial hardship as determined on the basis of criteria as may be established by
398	398	the Secretary of the U.S. Department of Health and Human Services.
399	399
400	400	Section 3399, DEFINITIONS, is amended as follows:
401	401
402	402	The following new definition, of “Certification period”, is added after the existing definition
403	403	of “Bilateral contract modification”:
404	404
405	405	Certification period – Alliance program eligibility is determined for a twelve (12)
406	406	month period. This period is called a certification period.
407	407
408	408	The following new definitions, of “Other lump sum payments” and “Parent mentor”, are
409	409	added after the existing definition of “Option”, to read as follows:
410	410
411	411	Other lump sum payments – non-recurring payments that are not qualified lottery
412	412	winnings or gambling winnings, and may include but not be limited to
413	413	backpay, a retroactive benefit payment, state tax refund, or an insurance
414	414	settlement.
415	415
416	416	Parent Mentor - as defined under 42 U.S.C. § 1397mm (f)(5).
417	417
418	418	The following new definitions, of “Qualified lottery winnings” and “Qualified lump sum
419	419	income”, are added after the existing definition of “Purchase order”, to read as follows:
420	420
421	421	Qualified lottery winnings – as defined under 42 U.S.C. § 1396a(e)(14)(K)(v).
422	422	8
423	423
424	424
425	425	Qualified lump sum income – as defined under § 1396a(e)(14)(K)(vi) (i.e.,
426	426	gambling winnings).