Bill > B26-0463

This bill establishes the District Workers with Disabilities Program, which will provide Medicaid coverage for employed individuals with disabilities in Washington, D.C. The program is designed for residents aged 16-64 who are employed and have a disability, but are not currently enrolled in other healthcare programs. Eligibility requires documentation of employment, disability status (verified by the Department or Social Security Administration), and meeting specific residency and non-institutional living requirements. The program will have a sliding scale premium based on the participant's income, ranging from no premium for those at or below 138% of the federal poverty level to up to 7.5% of income for those above 600%. Participants must meet ongoing responsibilities such as reporting changes in income or eligibility, limiting benefit use to themselves, and cooperating with program requirements. The Department of Health Care Finance will administer the program, determining eligibility, setting certification periods, and establishing rules for coverage. The program will provide medically necessary services not covered by other insurance, with providers following existing Medicaid participation criteria. Participants have the right to appeal eligibility decisions, and the program includes provisions for fraud prevention, third-party liability recovery, and potential liens against recipients' assets.

Health and Social Services

https://lims.dccouncil.gov/Legislation/B26-0463