Page 11

District residents are eligible for MA through the Medicaid program if they fall into one of the categories of people listed in Section 2.2.1: MA Program Types provided they also meet all financial and non- financial criteria (see Part IV: Non-Financial Eligibility and Part VI: Financial Eligibility).

The Medicaid program is authorized by Title XIX of the Social Security Act which provides for federal grants to the states and the District for the medical assistance program. Specifically, Title XIX enables the District to provide medical assistance, rehabilitation, and other health-related services to those who have insufficient incomes and resources to meet the costs of necessary medical services.

Note regarding the COBRA Coverage Program: This program is now administered by the HIV/AIDS Administration within the Department of Health. The program pays the health care premiums for low and moderate-income individuals who are Human Immunodeficiency Virus (HIV)-positive and eligible for COBRA health insurance coverage from a former employer. Persons may apply by calling the HIV/AIDS Administration on (202) 727-2500.

MA Program Eligibility Criteria 2.2.1

The following groups of people are eligible for MA through Medicaid:

 Families with Children: Children and their parents, step-parents or caretakers can be eligible for Medicaid if they meet one of the following criteria (individuals receiving TANF are categorically eligible for Medicaid; see Chapter 12: Categorical Eligibility in Part IV). o TANF Standard: Individuals receiving TANF or children under age 19, their parents, step- parents, or caretakers who meet the TANF income and asset standards but are not receiving TANF; o Foster Care/Department Ward/Adoption Assistance Recipient : Children under age 18 placed in foster care (but not in institutions) and children receiving IV-E foster care payments or IV-E adoption assistance benefits are categorically eligible for Medicaid (see Chapter 12: Categorically Eligible in Part IV); o Medically Needy Families & Children: Children under the age of 21 and parents, and/or caretaker relatives with incomes below the MNIL; o Poverty Level Children and Pregnant Women: Pregnant women and infants (children under age one) with net incomes below 185 percent of the federal poverty level (FPL), children under age six with net incomes below 133 1/3 percent of the FPL, children ages six and over provided they were born after September 30, 1983 with net incomes below 100 percent of the FPL, and children 19 and 20 with net incomes under 200% of the FPL. When determining if the pregnant woman's income is below 185 percent of the FPL, the unborn child is included as a group member (i.e., if the applicant is a pregnant woman with no other children, the poverty level for a group of two is used).

Pregnant women with net incomes below 185 percent of the FPL and a medically-verified pregnancy are eligible for prenatal care during a presumptive eligibility period while their ongoing eligibility for medical services is determined. o Children with Other Health Insurance: Pregnant women and children under 19 who have other health insurance are eligible for Medicaid if their incomes are below 300 percent of the FPL; o DC Healthy Families Expansion Group for Pregnant Women and Children : Pregnant women and children under age 19 whose gross income is below 300 percent of the FPL, have no other health insurance, and are ineligible for Medicaid under the TANF Standard, Poverty Level Families and Children, and Medically Needy Families and Children criteria described above (the federal government will pay a larger share of the cost of providing health care coverage to these children because extending Medicaid to this group was done as part of the Child Health Insurance Program (CHIP);