Code of the District of Columbia

Chapter 6A. Healthy DC Program.


§ 4–631. Definitions.

For the purposes of this chapter, the term “health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, including an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, a multiple employer welfare arrangement, or any other person providing a plan of health insurance subject to the authority of the Commissioner of the Department of Insurance, Securities, and Banking.


(Aug. 16, 2008, D.C. Law 17-219, § 5041, 55 DCR 7598.)

Short Title

Short title: Section 5040 of D.C. Law 17-219 provided that subtitle R of title V of the act may be cited as the “Healthy DC Act of 2008”.


§ 4–632. Establishment of Healthy DC Program; administration.

(a) There is established the Healthy DC Program (“Program”), which shall provide affordable health benefits to eligible individuals.

(b) The Program shall be administered by the Department of Health Care Finance, established by Chapter 7D of Title 7.

(c) The Program shall be funded through the Healthy DC and Health Care Expansion Fund, established by § 31-3514.02.

(d)(1) The Program shall be subject to the availability of funding.

(2) Nothing in this chapter shall be construed to create or constitute an entitlement to health insurance or health or medical benefits.


(Aug. 16, 2008, D.C. Law 17-219, § 5042, 55 DCR 7598; Sept. 24, 2010, D.C. Law 18-223, § 5025(a), 57 DCR 6242.)

Effect of Amendments

D.C. Law 18-223, in subsec. (c), substituted “Healthy DC and Health Care Expansion Fund” for “Healthy DC Fund”.

Emergency Legislation

For temporary (90 day) amendment of section, see § 5(a) of Medicaid Resource Maximization Emergency Amendment Act of 2010 (D.C. Act 18-390, May 7, 2010, 57 DCR 4339).

For temporary (90 day) amendment of section, see § 2(a) of Healthy DC Emergency Amendment Act of 2010 (D.C. Act 18-528, August 3, 2010, 57 DCR 8095).

For temporary (90 day) amendment of section, see § 5025(a) of Fiscal Year 2011 Budget Support Emergency Act of 2010 (D.C. Act 18-463, July 2, 2010, 57 DCR 6542).

For temporary (90 day) amendment of section, see § 2(a) of Healthy DC Congressional Review Emergency Amendment Act of 2010 (D.C. Act 18-569, October 19, 2010, 57 DCR 10082).

Temporary Legislation

Section 5(a) of D.C. Law 18-205, in subsec. (c), substituted “Healthy DC and Health Care Expansion Fund” for “Healthy DC Fund”.

Section 7(b) of D.C. Law 18-205 provided that the act shall expire after 225 days of its having taken effect.

Section 2(a) of D.C. Law 18-270, in subsec. (a), substituted “health benefits or premium subsidies for employer-sponsored coverage” for “health benefits”.

Section 4(b) of D.C. Law 18-270 provided that the act shall expire after 225 days of its having taken effect.

Editor's Notes

For requirement that by October 1, 2021, health insurance coverage through the DC HealthCare Alliance include transportation costs for travel to and from non-emergency prenatal and postpartum health care appointments, § 5043 of D.C. Act 24-159.


§ 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.


(Aug. 16, 2008, D.C. Law 17-219, § 5043, 55 DCR 7598; Feb. 4, 2010, D.C. Law 18-104, § 3(a), 56 DCR 9182.)

Effect of Amendments

D.C. Law 18-104, in subsec. (a)(2), substituted “not exceeding” for “between 200% and”; and, in subsec. (a)(4)(C), deleted “employer-based” following “Has” and deleted “premium” following “annual”.

Emergency Legislation

For temporary (90 day) amendment of section, see § 3(a) of Hospital and Medical Services Corporation Regulatory Emergency Amendment Act of 2009 (D.C. Act 18-277, January 11, 2010, 57 DCR 935).

For temporary (90 day) amendment of section, see § 2(b) of Healthy DC Emergency Amendment Act of 2010 (D.C. Act 18-528, August 3, 2010, 57 DCR 8095).

For temporary (90 day) amendment of section, see § 2(c) of Healthy DC Congressional Review Emergency Amendment Act of 2010 (D.C. Act 18-569, October 19, 2010, 57 DCR 10082).

Temporary Legislation

Section 3(a) of D.C. Law 18-134, in subsec. (a)(2), substituted “not exceeding” for “between 200% and”; and, in subsec. (a)(4)(C), deleted “employer based” and “premium”.

Section 6(b) of D.C. Law 18-134 provided that the act shall expire after 225 days of its having taken effect.

Section 2(b) of D.C. Law 18-270 added subsec. (c) to read as follows:

“(c) Regarding premium subsidies for employer-sponsored coverage:

“(1) To be eligible for premium subsidies for employer-sponsored coverage, an individual shall meet the criteria set forth in subsection (a) of this section and be offered qualified employer-sponsored coverage as defined by the Department of Health Care Finance.

“(2) Subsection (a)(4) of this section shall not apply to family members of an eligible individual for the purpose of receiving premium subsidies for family coverage.”.

Section 4(b) of D.C. Law 18-270 provided that the act shall expire after 225 days of its having taken effect.


§ 4–634. Program benefits; affordability.

(a) The Program shall provide, at a minimum, health and medical benefits that are equal to those provided to individuals enrolled in the DC HealthCare Alliance.

(b) The Program shall limit annual premium costs for program participants as follows:

(1) For a program participant with a gross household income of 300% of the federal poverty guidelines or less, the annual premium shall not exceed 3% of the participant’s gross household income; and

(2) For a program participant with a gross household income that exceeds 300% of the federal poverty guidelines, the annual premium shall not exceed 5% of the participant’s gross household income.


(Aug. 16, 2008, D.C. Law 17-219, § 5044, 55 DCR 7598; Feb. 4, 2010, D.C. Law 18-104, § 3(b), 56 DCR 9182.)

Effect of Amendments

D.C. Law 18-104 rewrote subsec. (b), which had read as follows: “(b) The Program shall limit annual premium costs to 3% or less of a Program participant’s gross income.”

Emergency Legislation

For temporary (90 day) amendment of section, see § 3(b) of Hospital and Medical Services Corporation Regulatory Emergency Amendment Act of 2009 (D.C. Act 18-277, January 11, 2010, 57 DCR 935).

For temporary (90 day) amendment of section, see § 2(c) of Healthy DC Emergency Amendment Act of 2010 (D.C. Act 18-528, August 3,

Temporary Legislation

Section 201(a) of D.C. Law 17-326, in subsec. (a), substituted “October 1, 2009” for “July 1, 2009”.

Section 402(b) of D.C. Law 17-326 provided that the act shall expire after 225 days of its having taken effect.

Section 3(b) of D.C. Law 18-134 amended subsec. (b) to read as follows:

“(b) The Program shall limit annual premium costs for program participants as follows:

“(1) For a program participant with a gross household income of 300% of the federal poverty guidelines or less, the annual premium shall not exceed 3% of the participant’s gross household income; and

“(2) For a program participant with a gross household income that exceeds 300% of the federal poverty guidelines, the annual premium shall not exceed 5% of the participant’s gross household income.”.

Section 6(b) of D.C. Law 18-134 provided that the act shall expire after 225 days of its having taken effect.

Section 2(c) of D.C. Law 18-270 rewrote subsec. (a) and added subsec. (c) to read as follows:

“(a) The Program shall provide health and medical benefits comparable to the DC Employee Health Benefits Program.”

“(c) Subsection (b) shall not apply to program participants receiving premium subsidies.”.

Section 4(b) of D.C. Law 18-270 provided that the act shall expire after 225 days of its having taken effect.


§ 4–635. Program implementation.

(a) The Mayor shall make the Program available to eligible individuals by January 1, 2010.

(b) To meet the deadline set forth in subsection (a) of this section, the Mayor is authorized to enter into a contract with one or more health insurers to administer the Program.

(c) Any contract entered into pursuant to this section shall require annual reporting of clinical-quality measurements and utilization data to the Mayor.


(Aug. 16, 2008, D.C. Law 17-219, § 5045, 55 DCR 7598; Feb. 4, 2010, D.C. Law 18-104, § 3(c), 56 DCR 9182.)

Effect of Amendments

D.C. Law 18-104, in subsec. (a), substituted “January 1, 2010” for “July 1, 2009”.

Emergency Legislation

For temporary (90 day) amendment of section, see § 201(b) of Fiscal Year 2009 Balanced Budget Support Emergency Amendment Act of 2008 (D.C. Act 17-572, December 2, 2008, 55 DCR 12452).

For temporary (90 day) addition, see § 201(b) of Fiscal Year 2009 Balanced Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-13, February 23, 2009, 56 DCR 1920).

For temporary (90 day) amendment of section, see § 3(c) of Hospital and Medical Services Corporation Regulatory Emergency Amendment Act of 2009 (D.C. Act 18-277, January 11, 2010, 57 DCR 935).

For temporary (90 day) amendment of section, see § 2(d) of Healthy DC Emergency Amendment Act of 2010 (D.C. Act 18-528, August 3, 2010, 57 DCR 8095).

For temporary (90 day) amendment of section, see § 2(d) of Healthy DC Congressional Review Emergency Amendment Act of 2010 (D.C. Act 18-569, October 19, 2010, 57 DCR 10082).

Temporary Legislation

Section 3(c) of D.C. Law 18-134, in subsec. (a), substituted “January 1,2010” for “July 1, 2009”.

Section 6(b) of D.C. Law 18-134 provided that the act shall expire after 225 days of its having taken effect.

Section 2(d) of D.C. Law 18-270 added subsec. (d) to read as follows: “(d) The Mayor is authorized to provide premium subsidies to qualified eligible individuals.”.

Section 4(b) of D.C. Law 18-270 provided that the act shall expire after 225 days of its having taken effect.


§ 4–636. Prohibitions.

It shall be unlawful for a health insurer to eliminate or restrict the availability of a health insurance plan offered in the District with the intent of shifting beneficiaries to the Program. An entity found to be in violation of this section shall be subject to a fine of not less than $10,000.


(Aug. 16, 2008, D.C. Law 17-219, § 5046, 55 DCR 7598.)


§ 4–637. Disposition of fines and penalties.

Fines and penalties collected pursuant to this chapter shall be deposited in the Healthy DC and Health Care Expansion Fund, established by § 31-3514.02.


(Aug. 16, 2008, D.C. Law 17-219, § 5047, 55 DCR 7598; Sept. 24, 2010, D.C. Law 18-223, § 5025(b), 57 DCR 6242.)

Effect of Amendments

D.C. Law 18-223 substituted “Healthy DC and Health Care Expansion Fund” for “Healthy DC Fund”.

Emergency Legislation

For temporary (90 day) amendment of section, see § 5(b) of Medicaid Resource Maximization Emergency Amendment Act of 2010 (D.C. Act 18-390, May 7, 2010, 57 DCR 4339).

For temporary (90 day) amendment of section, see § 5025(b) of Fiscal Year 2011 Budget Support Emergency Act of 2010 (D.C. Act 18-463, July 2, 2010, 57 DCR 6542).

Temporary Legislation

Section 5(b) of D.C. Law 18-205 substituted “Healthy DC and Health Care Expansion Fund” for “Healthy DC Fund”.

Section 7(b) of D.C. Law 18-205 provided that the act shall expire after 225 days of its having taken effect.


§ 4–638. Rules.

The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, shall issue rules to implement the provisions of this chapter.


(Aug. 16, 2008, D.C. Law 17-219, § 5048, 55 DCR 7598.)