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ENROLLED ORIGIN.
AN ACT
D.C. ACT 26-360
INTHE COUNCIL OF THE DISTRICTOF COLUMBIA
JULY 2, 2026
‘ToamendtheDistrictofColumbiaPublicAssistanceActof1982toestablishtheDistrictWorkerswithDisabilitiesprogramtoallowemployedindividualswithdisabilitieswhomeeteligibilityrequirementstoenrollinMedicaid.
BE ITENACTED BY THE COUNCIL OF THE DISTRICTOF COLUMBIA, Thatthis
actmay be citedas the“JudithHeumann Memorial Workers withDisabilitiesAmendment Act.
of2026”.
Sec 2.The Districtof Columbia PublicAssistanceAct of 1982,effectiveApril6, 1982
(D.C. Law 4-101; D.C. OfficialCode § 4-201.01passim), isamended by adding a new titleIV-A.
toreadas follows:
“TITLEIV-A~DISTRICTWORKERSWITHDISABILITIESPROGRAM“Sec. 411. Definitions.
“Forthepurposesofthistitle,theterm:“(1)“Certificationperiod”meanstheperiodofenrollmentfortheprogram,whichshallbeginonthedateofapprovalandendonthedatebywhicheligibilitymustberedetermined.
“(2)SDHCF”meanstheDepartmentofHealthCareFinance.“@)“Disability”shallhavethesamemeaningasinsection1614(a)(3)(A)oftheSocialSecurityAct,approvedOctober30,1972(86Stat.1471;42U.S.C.§1382c(a)(3)(A)).exceptfortheprovisionofsubstantialgainfulactivity.
“(4)“Employed”:“(A)Shallhavethesamemeaningasprovidedinsection1905(v)(2)ofthe
SocialSecurityAct,approvedJuly30,1965(79Stat.351;42U.S.C.§1396d(v)(2));or“(B)Ifself-employed,meanstheindividualhasengagedinpaidwork,subjecttoverificationwithapplicableDistrictandfederalemploymentandtaxrequirements.
“(6)“Enrollee”meansanindividualwhoisenrolledintheprogramandprovidedcoverageunderMedicaid.“(6)“Program” means the DistrictWorkers with DisabilitiesProgram established
bythistitle.
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ENROLLED ORIGINAL
“Sec.412.EstablishmentoftheDistrictWorkerswithDisabilitiesProgram.“(a)(1)NoearlierthanOctober1,2027,thereshallbeestablishedtheDistrictWorkerswithDisabilitiesProgram,tobeadministeredbytheDepartmentofHealthCareFinance,toprovideeligibleindividualswithdisabilitieswithMedicaidcoverage,asauthorizedbysection1902oftheSocialSecurityAct,approvedJuly30,1965(79Stat.344;42U.S.C.§1396a)“(2)Within6monthsoftheapplicabledateofthistitle,DHCFshallsubmitforapprovalfromtheCentersforMedicareandMedicaidServicesanamendmenttotheMedicaidstateplantoauthorizetheMedicaidpaymentsdescribedinthistitle.“(b)Anindividualshallbeeligiblefortheprogramifthey:
*(1)Are16yearsoldorolder;
“(2)Area residentoftheDistrict;“(3)Areemployed,whichmaybeverifiedbyprovidingoneormoreofthefollowing: “(A)Recentpaystub;“(B)A letterfromtheiremployerverifyingemployment;“(C)Bankstatementshowingdepositofearnings;
“(D)FederalandDistrictincometaxretumsfromthemostrecentyearforwhichreturnsareavailable;
“(E)Evidenceofpaymentofestimatedtaxes,ifselfemployed;or“(P)Businessledgers,ifself-employed:“(4)Haveadisability;and
(5)Arenot:(A)Residinginamedicalinstitutionorlong-termcarefacility,suchasanursingfacilityorintermediatecarefacilityforindividualswithintellectualdisabilities;
“(B)Aninmateofa publicinstitution;“(C)Aninpatientinaninstitutionformentalillness;provided,thatanindividualshallbedeemedineligiblesolelybecauseofatemporaryinpatientadmissionforbehavioralhealthtreatment;or“(D)Enrolledin:
“(@)Medicaid;“(ii)TheDC HealtheareAlliance;“Giii)TheDC HealthyFamiliesprogram;or“(iv)TheChildandAdolescentSupplementalSecurityIncome
Program.
“(¢)Anapplicantshallbedeemeddisabledforpurposesofsubsection(b)(4)ofthis
sectionifthey:“(1)ReceiveSocialSecurityDisabilityInsurance(“SSDI”)benefits;“(2)PreviouslyreceivedSSDIorSupplementalSecurityIncome,butlosteligibilityforareasonotherthanmedicalimprovement;or
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ENROLLED ORIGINAL
“(3)AredeterminedtobedisabledbyDHCFinaccordancewiththistitleandimplementingregulations.“(d)DHCFmayconductperiodicallyreviewsofan enrollee’sdisabilitystatusandestablishintervalsforsuchreviewsbyrulemaking;provided,thattheintervalsarereasonableandconsistentwithfederallaw.
“Sec,413.Applicationprocess.
“(a)DHCEshallpostonitswebsiteandprovide,uponrequest,writteninformationabouttheprogram,includin;“(1)Eligibilityrequirements;“(2)Thecoverage,scope,andrelatedservicesundertheprogram;“(3)Rightsandobligationsofapplicantsandenrolleesundertheprogram;and“(4)Theapplicationformandinstructions.“(b)(1)AnapplicantshallapplyfortheprogrambysubmittingthefollowingdocumentsandinformationtoDHCF:
“(A)Theapplicationformanddocumentation;“(B)TheSocialSecuritynumberoftheapplicant;and“(©)AsignedconsentformbytheapplicantortheirlegallyauthorizedrepresentativeauthorizingDHCFtoverifytheapplicant’sinformationwithemployers,banks,andpublicorprivateagencies.“(2)Uponrequest,anapplicantshall:“(A)Participateininterviewstoverifytheireligibility:and“(B)Provideadditionaldocumentationnecessarytoprocesstheir
application.
“(3)ForanapplicantwhosedisabilityhasbeendeterminedbytheSocialSecurity
Administration,DHCF shall,no laterthan30 days from theapplicationdate:
(A)Determinetheapplicant’seligibility,includingtheirrequired
premium,ifany;or
“(B)Determinethatadditionalinformationorverificationisrequiredand
providenoticeto theapplicantof theinformationneeded and deadlinesforsubmission.
“()(1)AnindividualtemporarilyresidingoutsideoftheDistrictbutwhointendsto
returntotheDistrictmayapplybymail;provided,thattheycandemonstratelong-termresidency
intheDistrict.
“(2)An applicantmayvoluntarilywithdrawanapplicationatanytime.An
applicationthathasbeenwithdrawnmaynotberevivedunlesspermittedbyDHCF through
proceduresestablishedbyrulemaking.
“(d)IfDHCF determinesthatan applicantis:
“(1)Eligibleforenrollmentintheprogram,DHCF shallissuewrittennoticetothe
applicantandidentifythebeginningandendingdatesofcoverage;or
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“(2)Noteligibleforenrollmentintheprogram,DHCFshallissueawrittennoticeofitsdenialandincludeitsfindingsandreasonfordenial,theapplicablestatutoryorregulatorybasisforthedenial,andtheapplicant’srighttoappeal.“(e)Anapplicantshallbedeniedenrollmentintheprogramifthey:“(1)Donotmeettheeligibilitycriteria;
“(2)Failtosubmitacompleteapplicationorproviderequesteddocumentationwithintherequiredtimeframe;““(3)FailtocooperatewithDHCF’seligibilitydeterminationprocess;“@)FailtocomplywithprogramparticipatingrequirementssetbyDHCFthroughrulemaking;or“(5)FailtocomplywithanydeadlineestablishedbyDHCF;provided,thatDHCF
shallextendanydeadlinetoprovideadditionaldocumentationiftheapplicantispreventedfromprovidingthedocumentationduetocircumstancesbeyondtheircontrolorifthereisan
administrativedelayoremergencybeyondDHCF’scontrol.Theextensionshallremainineffectforaslongastheemergencycircumstancespersist.
“()(1)Exceptasotherwiseprovidedinparagraph(2)ofthissubsection,anapplicant’scertificationperiodshallbe12months.“(2)Anentolleemaybeterminatedfromtheprogramduringthecertificationperiodifthey:
“(A)Nolongermeettheeligibilitycriteria;“(B)FailtocooperatewithDHCF’srequestsforinformationordocumentation;
“(C)FailtocomplywithprogramparticipationrequirementssetbyDHCFthroughrulemaking;or
“(D)Failtopaytherequiredpremiumsafterreceiving30daysofnoticeoflatepayment.
“(3)IfDHCFterminatesanenrolleeftomtheprogram,itshall:“(A)Informtheenrolleeoftheirrightsandobligationsundertheprogram;and
“(B)Providewrittennoticeofterminationandincludeitsfindingsandreasonsfordenials,theapplicablestatutoryorregulatorybasisforthedenial,andtheenrollee’srighttoappeal.“(g)DHCFshall:“(1)Maintainacaserecordforeachapplicantwithdocumentationofeligibility:and
(2)Limitdisclosuresofinformationtopurposesdirectlyconnectedwithverifyingprogrameligibilityandadministration.
“Sec.414. Premiums.
ENROLLED ORIGINAL
“(a)(1)Todeterminecountablenetincome,DHCFshallsubtractfromtheenrolleestotalgrossincome: “(A)Thegeneralincomeexclusionsanddisregardsandthespecificincomeexclusionsanddisregardsforaged,blind,ordisabledcoveragegroupsasspecifiedundersection405;and
“(B)Anydocumentedcost-sharingforcurrentemployer-sponsoredinsurancecoveragefortheapplicant.
“(2)DHCFshallincludeintheenrollee’stotalgrossincomeanyannuity,pension,retirement,ordisabilitybenefitstowhichtheenrolleeisentitled,including:“(A)Veterans’compensationandpensions;
“(B)SocialSecurityDisabilityInsuranceandotherSocialSecuritybenefits;
“(C)Railroadretirementbenefits;and“(D)Unemploymentcompensation.*(b)Anenrollee’sassetsorincomemaynotbeconsideredindetermininganenrollee’seligibilityforcoverageundertheprogram.“(©)Anenrolleeshallpayamonthlypremiumof:
“(1)Forincomesatorbelow138%ofthefederalpovertylevel,$0permonth;“(2)Forincomesabove138%to200%ofthefederalpovertylevel,$25permonth;
“(3)Forincomesabove200%to250%ofthefederalpovertylevel,$40permonth;
“(4)Forincomesabove250%to300%ofthefederalpovertylevel,$55per
month; “(5)Forincomesabove300%to450%ofthefederalpovertylevel,4%ofnetcountablemonthlyincome;
(6)Forincomesabove450%to600%ofthefederalpovertylevel,5%ofnetcountablemonthlyincome;and
“(7)Forincomesabove600%ofthefederalpovertylevel,7.5%ofnetcountablemonthlyincome.
“(d)DHCFmay,throughrulemaking,adjustannuallythemonthlypremiumamountstoaccountforchangestotheConsumerPriceIndex.
“(e)(1)(A)Anenrolleeshalltimelysubmittheapplicablemonthlypremiumunlesstheysubmitaclaimofhardship.
“(B)(i)DHCFmaygrantaclaimofhardshipifpaymentofthemonthlypremiumwouldcompromisetheenrollee’sabilitytoobtainbasicfood,shelter,orclothing.“Gi)DHCFshallissueawrittendecisiononanenrollee’shardshipclaimwithin30daysofreceipt.
“iiIfDHCFdeniesthehardshipclaim,theenrolleeshallpaytheoutstandingpremiumwithin10daysofreceivingnotice.
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ENROLLED ORIGINAL.
(2)DHCEshallallowagraceperiodofupto6monthswithina12-monthperiodforenrolleeswholoseemploymentinvoluntarilyorformedicalreasonstoremainintheprogram;provided,thattheenrolleecontinuestopaytheapplicablepremium.“@3)Anenrolleewhofailstopaytherequiredpremiumwithin30daysofnoticeshallbeterminatedfromtheprogramandmaynotre-enrolluntilalloutstandingpremiumshavebeenpaid.
“Sec.415.Recertification“(a)(1)AnenrolleeshallsubmitarecertificationapplicationtoDHCFannuallytocontinuetoreceivecoverageundertheprogram,
“(2)DHCFshallissuearecertificationformtoeachenrolieeatleast60dayspriortotheendofthecurrentcertificationperiod.
“(3)Anenrolleeshallsubmittherecertificationapplicationandalldocumentationbythelastdayofthecertificationperiod;provided,thatanenrolleehasupto90daysafterthecertificationperiodtosubmitadditionalmaterialsrequestedbyDHCF.Iftheenrolleeisdeemedcligibleduringthe90-dayperiod,theenrollee’scoverageshallberetroactivetothefirstdayofthenewcertificationperiod.
“(b)(1)DHCFmayrejectanapplicant’srecertificationapplicationforanyreasonoutlinedinsection413(e)or(1).
“(2)IfDHCFfindsthatanapplicantisnolongereligible,itshallissueawrittennoticeofterminationandprovideitsfindingsandreasonfortermination,theapplicablestatutoryorregulatorybasisforthetermination,anyrefundofenrollmentfees,andtherighttoappeal.
“Sec.416. Responsibilitiesof theenrolleeand liability.
“(a)An enrolleeor theenrollee’sauthorizedlegalrepresentativeshall:
“(1)NotifyDHCF within30 daysof any change thatmay affecttheenrollee’s
eligibilityintheprogram;
“(2)Limituseoftheprogrambenefitstotheindividualwhosenameappearson
thehealthinsurancecard;
“(3)Cooperatewith DHCF inprovidingforms and informationnecessaryfor
eligibility,programintegrity,andthird-partyreimbursement;
“(4)ProvidetimelynoticetoDHCF of any accidentor incidentgivingriseto
potentialthird-partyliability,includingtheidentitiesof partiesinvolved,attorneys,and insurers;
“(5)Reportanyknownthird-partyhealthinsurancecoverageorotherpartythat
may be liableforthecostof care,and shallcooperateinDHCF’s effortsto recoversuch costs;
and
“(6)Discontinueuseofprogrambenefitsuponreceiptofwrittennoticeoftyortermination.
ENROLLED ORIGINAL
“(b)Anenrollee’sfailuretocomplywithsubsection(a)ofthissectionmayresultinterminationofbenefitsunderthistitle,therecoveryofimproperlypaidbenefits,andanyotherremediesavailableunderDistrictorfederallaw.
“(c)Anenrolleeshall:“(1)BedeemedtohaveauthorizedDHCFtoaccessrecordsandinformation,
necessarytopursuethird-partyreimbursement;“(2)AssigntoDHCFtherighttocollectavailablebenefitsfromanyliablethirdparty;and
(3)AssistandcooperatewithDHCFinrecoveringavailablethird-partybenefitsandpayments.
“(@)DCF mayrecoverthecostofmedicalassistanceimproperlypaidonbehalfofanenrolleeunderthisprogram,including:“(1)Benefitspaidforanyperiodduringwhichtheenrolleewasnoteligibleforcoverage;
“(2)Benefitspaidasaresultofmistepresentation,failuretoreport,orfailuretocooperatewithprogramrequirements;and“@)BenefitspaidpendingtheoutcomeofahearingwhereDHCF’sadverseactionisupheld.“(@)DHCFmayimposealienandseekreimbursementagainstpropertyorassetsofacurrentorformerenrolleetotheextentpermittedbyfederalandDistrictlaw.“()DHCFmayacceptvoluntaryrepaymentfromacurrentorformerenrollee,orfromapersonactingonbehalfoftheenrollee,forthecostofbenefitsimproperlypaid.
“(g)AnapplicantorenrolleeoftheprogrammaycontestadeterminationmadebyDHCFbyrequestingafairhearingundertheproceduressetforthinsection109oftheDistrictofColumbiaAdministrativeProcedureAct,effectiveOctober21,1968(82Stat.1208;D.C.OfficialCode§2-509).
“Sec.417.Scopeofcoverage.
“(a)An enrolleeshallbeeligibleformedicallynecessaryservicesiftheservicesare:
“(1)FurnishedbyaproviderwhoisapprovedbyDHCFtoparticipateinthe
District’sMedicaidprogram;
*(2)CoveredundertheDistrict’sMedicaidstateplan;
“(3)Nototherwisecoveredunderemployer-sponsoredinsuranceoranyother
healthinsuranceavailabletotheenrollee;and
“(4)Notsubjecttothirdpartyliability.
“(b)The Districtshallnotcovercopayments,deductibles,or coinsuranceapplicableto
‘employeesponsoredinsurancecoverageheldbyanenrollee.
“(c)An enrolleeshallnotbeentitledto:
“(1)EnrollinMedicaid managed careprograms administeredby theDistrict;
“(2)EnrollintheProgram of All-InclusiveCare fortheElderly;or
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“(3)Coverageoflong-termcarefacil tyservicesexceeding30consecutivedays.
“Sec.418.Providerparticipationandreimbursement.“(a)TherequirementsforproviderparticipationandreimbursementforservicesfurnishedtoenrolleesoftheprogramshallbegovernedbyDHCFthroughrulemaking,including:
“(1)ThegeneralMedicaidproviderparticipationcriteria;and“(2)Theservice-specificparticipationandreimbursementrequirements,includingprovisionsapplicabletophysicianservices,hospitalservices,homehealthcare,personalcare,andothercoveredbenefits,asdeterminedbyDHCF.“(b)A providerfurnishingservicestoarecipientunderthisprogramshallseekpaymentfromanyliablethirdparty,includinganinsurer,beforebillingDHCF.
“Sec.419.Rulemaking,“TheMayor,pursuanttoTitleIoftheDistrictofColumbiaAdministrativeProcedure
Act,approvedOctober21,1968(82Stat.1204;D.C.OfficialCode§2-501etseg.),shallissuerulestoimplementtheprovisionsofthistitle.”.
“Sec.420.DistrictWorkerswithDisabilitiesPremiumFund.“(a)ThereisestablishedasaspecialfundtheDistrictWorkerswithDisabilitiesPremiumFund(“Fund”),whichshallbeadministeredbyDHCFinaccordancewithsubsections(c)and(d)ofthissection.“(b)Allpremiumrevenuefundscollectedpursuanttosection414shallbedepositedinthe
Fund.“(c)MoneyintheFundshallbeusedforthefollowingpurposes:“(1)TooffsettheDistrict’sshareofMedicaidexpendituresincurredfortheprogram;and
“(2)Tosupportadministrativecostsdirectlyattributabletotheprogram.“(@)(1)ThemoneydepositedintotheFundbutnotexpendedinafiscalyearshallnotreverttotheunassignedfundbalanceoftheGeneralFundoftheDistrictofColumbiaattheendofafiscalyear,oratanyothertime.
“(2)Subjecttoauthorizationinanapprovedbudgetandfinancialplan,anyfundsappropriatedintheFundshallbecontinuallyavailablewithoutregardtofiscalyearlimitation.
“Sec.421.InvestmentsinMedicaid-buyinsoftwaredevelopment.“DHCEshallupdatetheDistrictofColumbiaAccessSystem(“DCAS”),includingbuildingaplatformtocollectpaymentforpremiums,forthepurposeofimplementingtheprogramestablishedbythistitle.”.
Sec.3.Applicability
ENROLLED ORIGINAL
(a)Section2shallapplyuponthedateofinclusionofitsfiscaleffectinanapprovedbudgetandfinancialplan.
(b)TheChiefFinancialOfficershallcertifythedateoftheinclusionofthefiscaleffectinanapprovedbudgetandfinancialplan,andprovidenoticetotheBudgetDirectoroftheCouncilofthecertification.(c)(1)TheBudgetDirectorshallcausethenoticeofthecertificationtobepublishedinthe
DistrictofColumbiaRegister.(2)Thedateofpublicationofthenoticeofthecertificationshallnotaffecttheapplicabilityoftheprovisionidentifiedinsubsection(a)ofthissection.
Sec.4.Fiscalimpactstatement.TheCounciladoptsthefiscalimpactstatementinthecommitteereportasthefiscalimpactstatementrequiredbysection4aoftheGeneralLegislativeProceduresActof1975,approvedOctober16,2006(120Stat.2038;D.C.OfficialCode§1-301.47a).
Sec.5.Effectivedate.ThisactshalltakeeffectfollowingapprovalbytheMayor(orintheeventofvetobytheMayor,actionbytheCounciltooverridetheveto)anda30-dayperiodofcongressionalreviewasprovidedinsection602(c)(1)oftheDistrictofColumbiaHomeRuleAct,approvedDecember24,1973(87Stat.813;D.C.OfficialCode§ 1-206.02(c)(1)).
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‘hairman
Councilofthe DistrictofColumbia
UNSIGNED
Mayor
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[X]ITEMONCONSENTCALENDAR
COUNCILOF THEDISTRICTOF COLUMBIA.
WASHINGTON,DC,20004
(xacrion FirstReading,CC
DaVOTEpate tay5,2026
[x1voicevoTe Approved
RECORDEDVOTEONREQUEST
ABSENT
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= Be ¢ CERTIFICATIONRECORD Ve
6ASSecretarytoTheCoun Dale
DocketNo.B26-0463
[ ]TEM ON CONSENT CALENDAR:
UXTACTION FinalReading
[X]VOTEDATE June2, 2026
[xavoicevore ‘Approved
RECORDEDVOTEONREQUEST
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CERTIFICATIONRECORD /Pose Q Gs.16‘Secretary1theCounei Date