Section 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.Amended by D.C. Law 24-45,§ V-B-5012, 68 DCR 010163, eff. 11/13/2021.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.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."