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PROPOSED EXTENSION OF EXISTING LOSS OF MEDICAID SEP November 24, 2025

DESCRIPTION OF PROPOSAL: Extend the existing Loss of Medicaid special enrollment period (SEP) in the DC individual market through December 31, 2026. IVL SEPs also apply in Healthy DC Plan.

BACKGROUND: The current loss of Medicaid SEP was initially established as part of Medicaid unwinding, when the Medicaid continuous coverage requirement from COVID came to an end in 2023. This SEP is set to expire December 31, 2025. Due to Medicaid eligibility changes, we propose extending the SEP to December 31, 2026. Effective January 1, 2026, the District is reducing Medicaid eligibility for Childless Adults and Parent/Caretakers to only those at or below 138% FPL. DHCF estimates this could affect 20,000 to 25,000 people. • Those up to 200% FPL meeting other eligibility requirements will be eligible for the Healthy DC Plan, the District’s newly established health coverage program, also known as Basic Health Plan under federal law. Those losing Medicaid coverage December 31, 2025 as a result of the Medicaid eligibility changes will be auto- enrolled into Healthy DC Plan for January 1, 2026 coverage. Healthy DC Plan will be in open enrollment for the first year, 2026 for those eligible. Effective dates for coverage will follow 15th of the month rule. o The Loss of Medicaid SEP would allow enrollees to receive a coverage start date of the first of the current month or first of the next month.

• Those above 200% FPL would be eligible for individual market enrollment and may qualify for lower premiums and cost-sharing reductions. Without an extension of the SEP, people losing Medicaid would have until 90 days after losing Medicaid to select a plan with an effective date of the first of the next month. o Extending the Loss of Medicaid SEP to 12/31/2026 would allow plan selection all year with a coverage start date of the first of the current month or first of the next month.