DC may cover working residents with disabilities after budget and federal approvals from October 2027

The Department of Health Care Finance would run a Medicaid program for eligible workers with disabilities. The program would cover eligible DC residents age 16 or older who work and have a disability. An approved DC budget must account for the program's costs, and federal officials must approve the Medicaid payments. Applicants must show that they work and have a disability. Some people in facilities or already enrolled in specified health programs would be excluded. The program cannot start before October 1, 2027; its rules apply once an approved DC budget accounts for its costs.

The department would charge monthly premiums based on income but would not use income or savings to decide eligibility. These rules would apply to people enrolled in the DC workers with disabilities program. Premiums would be $0 for income at or below 138% of the federal poverty guideline and would rise at higher incomes. The department may grant a hardship claim if paying would threaten a person's ability to afford food, shelter, or clothing. An approved DC budget must account for program costs, and federal officials must approve the Medicaid payments. The premium rules would apply once an approved DC budget accounts for program costs.

The program would pay for certain medically necessary care and exclude some services and charges. These coverage rules would apply to people enrolled in the DC workers with disabilities program. Care must come from an approved provider, be covered by DC's Medicaid plan, and not be covered by another insurer or responsible payer. The program would not pay a person's share of bills under an employer health plan or cover long-term care facility services past 30 straight days. Enrollees could not join DC's Medicaid managed care plans or its listed elder care program through this coverage. An approved DC budget must account for program costs, and federal officials must approve the Medicaid payments. The coverage rules would apply once an approved DC budget accounts for program costs.