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A BILL 1
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26-463 3
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 6
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To amend the District of Columbia Public Assistance Act of 1982 to establish the District 11
Workers with Disabilities program to allow employed individuals with disabilities who 12
meet eligibility requirements to enroll in Medicaid. 13
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BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this 15
act may be cited as the “Judith Heumann Memorial Workers with Disabilities Amendment Act 16
of 2026”. 17
Sec 2. The District of Columbia Public Assistance Act of 1982, effective April 6, 1982 18
(D.C. Law 4-101; D.C. Official Code § 4-201.01 passim), is amended by adding a new Title IV-19
A to read as follows: 20
“TITLE IV-A – DISTRICT WORKERS WITH DISABILITIES PROGRAM 21
“Sec. 411. Definitions. 22
“For the purposes of this title, the term: 23
“(1) “Certification period” means the period of enrollment for the program, which 24
shall begin on the date of approval and end on the date by which eligibility must be 25
redetermined. 26
“(2) “DHCF” means the Department of Health Care Finance. 27
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“(3) “Disability” shall have the same meaning as in section 1614(a)(3) of 48 the 28
Social Security Act, approved October 30, 1972 (86 Stat. 1471; 42 U.S.C. § 1382c(a)(3)(A)), 29
except for the provision of substantial gainful activity. 30
“(4) “Employed”: 31
“(A) Shall have the same meaning as provided in section 1905(v)(2) of the 32
Social Security Act, approved July 30, 1965 (79 Stat. 351; 42 U.S.C. § 1396d(v)(2)); or 33
“(B) If self-employed, means the individual has engaged in paid work, 34
subject to verification with applicable District and federal employment and tax requirements.” 35
“(5) “Enrollee” means an individual who is enrolled in the program and provided 36
coverage under Medicaid. 37
“(6) “Program” means the District Workers with Disabilities Program established 38
by this title. 39
“Sec. 412. Establishment of the District Workers with Disabilities Program. 40
“(a)(1) There is established the District Workers with Disabilities Program, to be 41
administered by the Department of Health Care Finance, to provide eligible individuals with 42
disabilities with Medicaid coverage, as authorized by section 1902 of the Social Security Act, 43
approved July 30, 1965 (79 Stat. 344; 42 U.S.C. § 1396a). 44
“(2) Within 6 months of the applicable date of this title, DHCF shall submit for 45
approval from the Centers for Medicare and Medicaid Services an amendment to the Medicaid 46
state plan to authorize the Medicaid payments described in this title. 47
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“(b) An individual shall be eligible for the program if they: 48
“(1) Are 16 years old or older; 49
“(2) Are a resident of the District of Columbia; 50
“(3) Are employed, which may be verified by providing evidence of one or more 51
of the following: 52
“(A) Recent pay stub; 53
“(B) A letter from their employer verifying employment; 54
“(C) Bank statement showing deposit of earnings; 55
“(D) Federal and District income tax returns from the most recent year for 56
which returns are available; 57
“(E) Evidence of payment of estimated taxes, if self-employed; or 58
“(F) Business ledgers, if self-employed; 59
“(4) Have a disability; and 60
“(5) Are not: 61
“(A) Residing in a medical institution or long-term care facility, such as a 62
nursing facility or intermediate care facility for individuals with intellectual disabilities; 63
“(B) An inmate of a public institution; 64
“(C) An inpatient in an institution for mental illness; provided, that an 65
individual shall be deemed ineligible solely because of a temporary inpatient admission for 66
behavioral health treatment; or 67
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“(D) Enrolled in: 68
“(i) Medicaid; 69
“(ii) The DC Healthcare Alliance; 70
“(iii) The DC Healthy Families program; or 71
“(iv) The Child and Adolescent Supplemental Security Income 72
Program. 73
“(c) An applicant shall be deemed disabled for purposes of subsection (b)(4) of this 74
section if they: 75
“(1) Receive Social Security Disability Insurance (“SSDI”) benefits; 76
“(2) Previously received SSDI or Supplemental Security Income, but lost 77
eligibility for a reason other than medical improvement; or 78
“(3) Are determined to be disabled by DHCF in accordance with this title and 79
implementing regulations. 80
“(d) DHCF may conduct periodically reviews of an enrollee’s disability status and 81
establish intervals for such reviews by rulemaking; provided, that the intervals are reasonable 82
and consistent with federal law. 83
“Sec. 413. Application process. 84
“(a) DHCF shall post on its website and provide, upon request, written information about 85
the program, including: 86
“(1) Eligibility requirements; 87
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“(2) The coverage, scope, and related services under the program; 88
“(3) Rights and obligations of applicants and enrollees under the program; and 89
“(4) The application form and instructions. 90
“(b)(1) An applicant shall apply for the program by submitting the following documents 91
and information to DHCF: 92
“(A) The application form and documentation; 93
“(B) The Social Security number of the applicant; and 94
“(C) A signed consent form by the applicant or their legally authorized 95
representative authorizing DHCF to verify the applicant’s information with employers, banks, 96
and public or private agencies. 97
“(2) Upon request, an applicant shall: 98
“(A) Participate in interviews to verify their eligibility; and 99
“(B) Provide additional documentation necessary to process their 100
application. 101
“(3) For an applicant whose disability has been determined by the Social Security 102
Administration, DHCF shall, no later than 30 days from the application date: 103
“(A) Determine the applicant’s eligibility, including their required 104
premium, if any; or 105
“(B) Determine that additional information or verification is required and 106
provide notice to the applicant of the information needed and deadlines for submission. 107
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“(c)(1) An individual temporarily residing outside of the District but who intends to 108
return to the District may apply by mail; provided, that they can demonstrate long-term residency 109
in the District. 110
“(2) An applicant may voluntarily withdraw an application at any time. An 111
application that has been withdrawn may not be revived unless permitted by DHCF through 112
procedures established by rulemaking. 113
“(d) If DHCF determines that an applicant is: 114
“(1) Eligible for enrollment in the program, DHCF shall issue written notice to the 115
applicant and identify the beginning and ending dates of coverage; or 116
“(2) Not eligible for enrollment in the program, DHCF shall issue a written notice 117
of its denial and include its findings and reason for denial, the applicable statutory or regulatory 118
basis for the denial, and the applicant’s right to appeal. 119
“(e) An applicant shall be denied enrollment in the program if they: 120
“(1) Do not meet the eligibility criteria; 121
“(2) Fail to submit a complete application or provide requested documentation 122
within the required timeframes; 123
“(3) Fail to cooperate with DHCF’s eligibility determination process; 124
“(4) Fail to comply with program participating requirements set by DHCF 125
through rulemaking; or 126
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“(5) Fail to comply with any deadline established by DHCF; provided, that DHCF 127
shall extend any deadline to provide additional documentation if the applicant is prevented from 128
providing the documentation due to circumstances beyond their control or if there is an 129
administrative delay or emergency beyond DHCF’s control. The extension shall remain in effect 130
for as long as the emergency circumstances persist. 131
“(f)(1) Except as otherwise provided in paragraph (2) of this subsection, an applicant’s 132
certification period shall be 12 months. 133
“(2) An enrollee may be terminated from the program during the certification 134
period if they: 135
“(A) No longer meet the eligibility criteria; 136
“(B) Fail to cooperate with DHCF’s requests for information or 137
documentation; 138
“(C) Fail to comply with program participation requirements set by DHCF 139
through rulemaking; or 140
“(D) Fail to pay their required premiums after receiving 30 days of notice 141
of late payment. 142
“(3) If DHCF terminates an enrollee from the program, it shall: 143
“(A) Inform the enrollee of their rights and obligations under the program; 144
and 145
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“(B) Provide written notice of termination and include its findings and 146
reasons for denials, the applicable statutory or regulatory basis for the denial, and the enrollee’s 147
right to appeal. 148
“(g) DHCF shall: 149
“(1) Maintain a case record for each applicant with documentation of eligibility; 150
and 151
“(2) Limit disclosures of information to purposes directly connected with 152
verifying program eligibility and administration. 153
“Sec. 414. Premiums. 154
“(a) To determine countable net income, DHCF shall subtract from the enrollee’s total 155
gross income: 156
“(1) The general income exclusions and disregards and the specific income 157
exclusions and disregards for aged, blind, or disabled coverage groups as specified under section 158
405; and 159
“(2) Any documented cost-sharing for current employer-sponsored insurance 160
coverage for the applicant. 161
“(3) DHCF shall include in the enrollee’s total gross income any annuity, pension, 162
retirement, or disability benefits to which the enrollee is entitled, including: 163
“(A) Veterans’ compensation and pensions; 164
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“(B) Social Security Disability Insurance and other Social Security 165
benefits; 166
“(C) Railroad retirement benefits; and 167
“(D) Unemployment compensation. 168
“(b) An enrollee’s assets or income may not be considered in determining an enrollee’s 169
eligibility for coverage under the program. 170
“(c) An enrollee shall pay a monthly premium of: 171
“(1) For incomes at or below 138% of the federal poverty level, $0 per month; 172
“(2) For incomes above 139% to 200% of the federal poverty level, $25 per 173
month; 174
“(3) For incomes above 200% to 250% of the federal poverty level, $40 per 175
month; 176
“(4) For incomes above 250% to 300% of the federal poverty level, $55 per 177
month; 178
“(5) For incomes above 300% to 450% of the federal poverty level, 4% of net 179
countable monthly income; 180
“(6) For incomes above 450% to 600% of the federal poverty level, 5% of net 181
countable monthly income; and 182
“(7) For incomes above 600% of the federal poverty level, 7.5% of net countable 183
monthly income. 184
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“(d) DHCF may, through rulemaking, adjust annually the monthly premium amounts to 185
account for changes to the Consumer Price Index. 186
“(e)(1)(A) An enrollee shall timely submit the applicable monthly premium unless they 187
submit a claim of hardship. 188
“(B)(i) DHCF may grant a claim of hardship if payment of the monthly 189
premium would compromise the enrollee’s ability to obtain basic food, shelter, or clothing. 190
“(ii) DHCF shall issue a written decision on an enrollee’s hardship 191
claim within 30 days of receipt. 192
“(iii) If DHCF denies the hardship claim, the enrollee shall pay the 193
outstanding premium within 10 days of receiving notice. 194
“(2) DHCF shall allow a grace period of up to 6 months within a 12-month period 195
for enrollees who lose employment involuntarily or for medical reasons to remain in the 196
program; provided, that the enrollee continues to pay the applicable premium. 197
“(3) An enrollee who fails to pay the required premium within 30 days of notice 198
shall be terminated from the program and may not re-enroll until all outstanding premiums have 199
been paid. 200
“Sec. 415. Recertification. 201
“(a)(1) An enrollee shall submit a recertification application to DHCF annually to 202
continue to receive coverage under the program. 203
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“(2) DHCF shall issue a recertification form to each enrollee at least 60 days prior 204
to the end of the current certification period. 205
“(3) An enrollee shall submit the recertification application and all documentation 206
by the last day of the certification period; provided, that an enrollee has up to 90 days after the 207
certification period to submit additional materials requested by DHCF. If the enrollee is deemed 208
eligible during the 90-day period, the enrollee’s coverage shall be retroactive to the first day of 209
the new certification period. 210
“(b)(1) DHCF may reject an applicant’s recertification application for any reason outlined 211
in section 413(e) or (f). 212
“(2) If DHCF finds that an applicant is no longer eligible, it shall issue a written 213
notice of termination and provide its findings and reason for termination, the applicable statutory 214
or regulatory basis for the termination, any refund of enrollment fees, and the right to appeal. 215
“Sec. 416. Responsibilities of the enrollee and liability. 216
“(a) An enrollee or the enrollee’s authorized legal representative shall: 217
“(1) Notify DHCF within 30 days of any change that may affect the enrollee’s 218
eligibility in the program; 219
“(2) Limit use of the program benefits to the individual whose name appears on 220
the health insurance card; 221
“(3) Cooperate with DHCF in providing forms and information necessary for 222
eligibility, program integrity, and third-party reimbursement; 223
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“(4) Provide timely notice to DHCF of any accident or incident giving rise to 224
potential third-party liability, including the identities of parties involved, attorneys, and insurers; 225
“(5) Report any known third-party health insurance coverage or other party that 226
may be liable for the cost of care, and shall cooperate in DHCF’s efforts to recover such costs; 227
and 228
“(6) Discontinue use of program benefits upon receipt of written notice of 229
ineligibility or termination. 230
“(b) An enrollee’s failure to comply with subsection (a) of this section may result in 231
termination of benefits under this title, the recovery of improperly paid benefits, and any other 232
remedies available under District or federal law. 233
“(c) An enrollee shall: 234
“(1) Be deemed to have authorized DHCF to access records and information 235
necessary to pursue third-party reimbursement; 236
“(2) Assign to DHCF the right to collect available benefits from any liable third 237
party; and 238
“(3) Assist and cooperate with DHCF in recovering available third-party benefits 239
and payments. 240
“(d) DHCF may recover the cost of medical assistance improperly paid on behalf of an 241
enrollee under this program, including: 242
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“(1) Benefits paid for any period during which the enrollee was not eligible for 243
coverage; 244
“(2) Benefits paid as a result of misrepresentation, failure to report, or failure to 245
cooperate with program requirements; and 246
“(3) Benefits paid pending the outcome of a hearing where DHCF’s adverse 247
action is upheld. 248
“(e) DHCF may impose liens and seek reimbursement against property or assets of a 249
current or former enrollee to the extent permitted by federal and District law. 250
“(f ) DHCF may accept voluntary repayment from a current or former enrollee, or from a 251
person acting on behalf of the enrollee, for the cost of benefits improperly paid. 252
“(g) An applicant or enrollee of the program may contest a determination made by 253
DHCF by requesting a fair hearing under the procedures set forth in section 109 of the District of 254
Columbia Administrative Procedure Act, effective October 21, 1968 (82 Stat. 1208; D.C. Official 255
Code § 2-509). 256
“Sec. 417. Scope of coverage. 257
“(a) An enrollee shall be eligible for medically necessary services if the services are: 258
“(1) Furnished by a provider who is approved by DHCF to participate in the 259
District’s Medicaid program; 260
“(2) Covered under the District’s Medicaid state plan; 261
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“(3) Not otherwise covered under employer-sponsored insurance or any other 262
health insurance available to the enrollee; and 263
“(4) Not subject to third party liability. 264
“(b) The District shall not cover copayments, deductibles, or coinsurance applicable to 265
employee sponsored insurance coverage held by an enrollee. 266
“(c) An enrollee shall not be entitled to: 267
“(1) Enrollment in Medicaid managed care programs administered by the District; 268
“(2) Enrollment in the Program of All-Inclusive Care for the Elderly; or 269
“(3) Coverage of long-term care facility services exceeding 30 consecutive days. 270
“Sec. 418. Provider participation and reimbursement. 271
“(a) The requirements for provider participation and reimbursement for services 272
furnished to enrollees of the program shall be governed by DHCF through rulemaking, 273
including: 274
“(1) The general Medicaid provider participation criteria; and 275
“(2) The service-specific participation and reimbursement requirements, including 276
provisions applicable to physician services, hospital services, home health care, personal care, 277
and other covered benefits, as determined by DHCF. 278
“(b) A provider furnishing services to a recipient under this program shall seek payment 279
from any liable third party, including an insurer, before billing DHCF. 280
“Sec. 419. Rulemaking. 281
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“The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure 282
Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), shall issue 283
rules to implement the provisions of this title.”. 284
“Sec. 420. District Workers with Disabilities Premium Fund. 285
“(a) There is established as a special fund the District Workers with Disabilities Premium 286
Fund (“Fund”), which shall be administered by DHCF in accordance with subsections (c) and (d) 287
of this section. 288
“(b) All premium revenue funds collected pursuant to section 414 shall be deposited in the 289
Fund. 290
“(c) Money in the Fund shall be used for the following purposes: 291
“(1) To offset the District’s share of Medicaid expenditures incurred for the 292
program; and 293
“(2) To support administrative costs directly attributable to the program. 294
“(d)(1) The money deposited into the Fund but not expended in a fiscal year shall not 295
revert to the unassigned fund balance of the General Fund of the District of Columbia at the end 296
of a fiscal year, or at any other time. 297
“(2) Subject to authorization in an approved budget and financial plan, any funds 298
appropriated in the Fund shall be continually available without regard to fiscal year limitation.”. 299
Sec. 3. Applicability. 300
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(a) Section 2 shall apply upon the date of inclusion of its fiscal effect in an approved 301
budget and financial plan. 302
(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect in 303
an approved budget and financial plan, and provide notice to the Budget Director of the Council 304
of the certification. 305
(c)(1) The Budget Director shall cause the notice of the certification to be published in the 306
District of Columbia Register. 307
(2) The date of publication of the notice of the certification shall not affect the 308
applicability of the provision identified in subsection (a) of this section. 309
Sec. 4. Fiscal impact statement. 310
The Council adopts the fiscal impact statement in the committee report as the fiscal 311
impact statement required by section 4a of the General Legislative Procedures Act of 1975, 312
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 313
Sec. 5. Effective date. 314
This act shall take effect following approval by the Mayor (or in the event of veto by the 315
Mayor, action by the Council to override the veto) and a 30-day period of congressional review 316
as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 317
24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)). 318