D.C. Code § 4-633: Program eligibility.

(a)

An individual shall be eligible for the Program if the individual:

(1)

Has resided in the District for at least 6 months at the time of application to the Program;

(2)

Resides in a household having a gross household income not exceeding 400% of the federal poverty guidelines as updated periodically in the Federal Register by the United States Department of Health and Human Services under the authority of 42 U.S.C. § 9902(2); and

(3)

Does not qualify for:

(A)

The DC HealthCare Alliance;

(B)

Medicare;

(C)

Medicaid; or

(D)

Other federal health-benefits programs; and

(4)

(A)

Has not had health insurance during the 6-month period prior to application to the Program;

(B)

Has had health insurance during the 6-month period prior to application to the Program but the insurance was terminated due to:

(i)

The loss of employment;

(ii)

A death of a spouse, domestic partner, or family member who maintained the individual as a beneficiary on a health-insurance plan;

(iii)

Changes in student status, including graduation, a leave of absence, or reduction to part-time study;

(iv)

A change of employment to a new employer who does not provide group health insurance;

(v)

A legal annulment, separation, divorce, or the dissolution of a domestic partnership;

(vi)

The loss of financial eligibility under Medicaid or the DC HealthCare Alliance;

(vii)

The cancellation or discontinuation of a group health insurance contract by a health insurer; or

(viii)

Any other reason as determined by the Mayor; or

(C)

Has health insurance but the annual cost to the individual is deemed unaffordable, as determined by the Mayor.

(b)

Eligibility for the Program shall not be subject to any pre-existing condition exclusions.