Code of the District of Columbia

Chapter 51. Individual Taxpayer Health Insurance Responsibility Requirement.


§ 47–5101. Definitions.

For the purposes of this chapter, the term:

(1) "Applicable entity" means:

(A) An employer or other sponsor of an employment-based health plan;

(B) The Department of Health Care Finance; or

(C) An insurance carrier licensed or otherwise authorized to offer minimum essential coverage.

(2) "Applicable individual" shall have the same meaning as provided in section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A), as the section and its implementing regulations were in effect on December 15, 2017; provided, that:

(A) An individual enrolled in the D.C. HealthCare Alliance program shall not be considered an applicable individual with respect to any month during which the individual was enrolled in the D.C. HealthCare Alliance program;

(B) An individual shall not be considered an applicable individual with respect to any month during which the individual was a resident of a jurisdiction other than the District;

(C) An individual shall not be considered an applicable individual if the individual is a member of a religious sect or division that is recognized by the United States Social Security Administration as conscientiously opposed to accepting any insurance benefits, including Social Security and Medicare; and

(D) An individual shall not be considered an applicable individual if the individual files a sworn affidavit with his or her District tax return attesting to a lack of minimum essential coverage on the basis of sincerely held religious beliefs during the entire taxable year for which the return was filed.

(3) "Authority" means the District of Columbia Health Benefit Exchange Authority, established by [§ 31-3171.04].

(4) "Chief Financial Officer" means the Chief Financial Officer of the District of Columbia, established by [§ 1-204.24a].

(5) "D.C. HealthCare Alliance" means the program established pursuant to [§ 7-1405].

(6) "Dependent" shall have the same meaning as provided in section 152 of the Internal Revenue Code of 1986 (26 U.S.C. § 152).

(7) "District shared responsibility payment" means the tax penalty incurred by a taxpayer for the failure to have the required minimum essential coverage required by this chapter.

(8) "Federal shared responsibility payment" means the tax penalty incurred by a taxpayer for the failure to have the required minimum essential coverage pursuant to the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 119; 42 U.S.C. § 18001, note) and section 5000(A) of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A).

(9) "Immigrant Children's Program" means the program established pursuant to [§ 1-307.03(b)].

(10) "Internal Revenue Code of 1986" means the Internal Revenue Code of 1986, approved October 22, 1986 (100 Stat. 2085; 26 U.S.C. § 1 et seq.).

(11) "Minimum essential coverage" means:

(A) Except as provided in subparagraph (C) of this paragraph, minimum essential coverage as defined by section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A) and its implementing regulations, as that section and its implementing regulations were in effect on December 15, 2017;

(B) The Immigrant Children's Program; and

(C) Health coverage provided under a multiple employer welfare arrangement; provided, that the multiple employer welfare arrangement provided coverage in the District on December 15, 2017, or complies with federal law and regulations applicable to multiple employer welfare arrangements that were in place as of December 15, 2017.

(12) "Multiple employer welfare arrangement" shall have the same meaning as provided in section 3(40) of the Employee Retirement Income Security Act of 1974, approved September 2, 1974 (88 Stat. 833; 29 U.S.C. § 1002(40)).


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5102. Requirement to maintain minimum essential coverage; exemptions.

(a) Beginning for tax years after December 31, 2018, and except as provided in subsection (b) of this section, an applicable individual shall, for each month, ensure that the applicable individual, and any dependent of the applicable individual who is also an applicable individual, maintains minimum essential coverage.

(b) Except as provided in paragraphs (1) and (2) of this subsection, the exemptions available from the federal requirement to maintain minimum essential coverage under section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A) and its implementing regulations, as such section and its implementing regulations were in effect on December 15, 2017, shall also be available as exemptions from the requirement to maintain minimum essential coverage contained in subsection (a) of this section, with the following modifications:

(1) Determinations as to hardship exemptions shall be made by the Authority under § 47-5104(b) rather than by the Secretary of the U.S. Department of Health and Human Services pursuant to section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act of 2010, approved March 23, 2010 (124 Stat. 177; 42 U.S.C. § 18031(d)(4)(H)).

(2)(A) The requirement imposed by subsection (a) of this section shall not apply to:

(i) Taxpayers who are 21 years of age or older as of the last day of the tax year and whose federal adjusted gross income for the taxable year is equal to or less than an amount equal to 222% of the federal poverty level as published by the Authority in accordance with subparagraph (B) of this paragraph;

(ii) Taxpayers who are 20 years of age or younger as of the last day of the tax year and not claimed as dependents on another individual's tax form, and whose federal adjusted gross income for the taxable year is equal to or less than an amount equal to 324% of the federal poverty level, as published by the Authority in accordance with subparagraph (B) of this paragraph;

(iii) A dependent who is 21 years of age or older as of the last day of the tax year and claimed as a dependent by a taxpayer whose federal adjusted gross income for the taxable year is equal to or less than an amount equal to 222% of the federal poverty level as published by the Authority in accordance with subparagraph (B) of this paragraph; or

(iv) A dependent who is age 20 years of age or younger as of the last day of the tax year and claimed as a dependent by a taxpayer whose federal adjusted gross income for the taxable year is equal to or less than an amount equal to 324% of the federal poverty level as published by the Authority in accordance with subparagraph (B) of this paragraph.

(B)(i) The Authority, after consultation with the Director of the Department of Health Care Finance, shall publish the qualifying income levels described in subparagraph (A) of this paragraph for each taxable year based on federal poverty levels using the poverty guidelines announced by the Secretary of the U.S. Department of Health and Human Services under the authority of section 673(2) of the Community Services Block Grant Act, approved October 27, 1998 (112 Stat. 2729; 42 U.S.C. § 9902(2)).

(ii) The qualifying income levels shall be for the number of individuals that include the taxpayer, the taxpayer's spouse, and any dependents claimed by the taxpayer on the taxpayer's income tax return for that taxable year.

(iii) The Authority shall publish the qualifying income levels for the taxable year within 60 days after the announcement of the poverty guidelines announced by the Secretary of the U.S. Department of Health and Human Services for that taxable year.

(C) The percentages identified in subparagraph (A) of this paragraph may be adjusted by the Mayor if the eligibility level changes for:

(i) Medicaid;

(ii) The Children's Health Insurance Program; or

(iii) The Immigrant Children's Program.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5103. District of Columbia shared responsibility payments.

(a) If a taxpayer who is an applicable individual, or an applicable individual for whom the taxpayer is liable under subsection (b) of this section, fails to meet the requirement of § 47-5102(a) for one or more months, the taxpayer shall pay a District shared responsibility payment for tax years beginning after December 31, 2018. Subject to subsections (b) and (c) of this section, the District shared responsibility payment shall be the same as the Federal shared responsibility payment under section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A) as in effect on December 15, 2017, and its implementing regulations as in effect on December 15, 2017.

(b)(1) If a District shared responsibility payment is imposed for any month on an individual who is a dependent of a taxpayer during the taxable year, the taxpayer shall be liable for the shared responsibility payment.

(2) If a District shared responsibility payment is imposed for any month on an individual who files a joint return for the taxable year, the individual and the spouse of the individual shall be jointly liable for the shared responsibility payment.

(c)(1) The rules for determining the District shared responsibility payment shall be determined under this chapter and rules issued or incorporated pursuant to § 47-5109.

(2) The maximum amount of the District shared responsibility payment shall be determined using the District's average premium for bronze-level plans rather than the national average premium for bronze-level plans.

(3) The Authority shall annually publish on its website the District shared responsibility maximum payment amount before September 30 of the taxable year.

(4) If a taxpayer is subject to both the District shared responsibility payment and the federal shared responsibility payment under section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A) for a taxable year, the amount of the taxpayer's District shared responsibility payment shall be reduced, but not below zero, by the amount of the taxpayer's federal shared responsibility payment.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5104. Minimum essential coverage and District of Columbia shared responsibility payment requirements.

(a) Except as provided in subsection (b) of this section, an individual may claim that the individual or a dependent of the individual is not an applicable individual with respect to the minimum essential coverage requirement under § 47-5102(a) or may claim that the individual or a dependent of the individual is eligible for an exemption under § 47-5102(b) by indicating the basis for the claim on a form, to be prescribed by the Chief Financial Officer.

(b) An individual may apply to the Authority for an eligibility determination for the following two exemptions:

(1) The affordability exemption from the District shared responsibility payment requirement as provided in § 47-5102 for individuals for whom coverage is considered unaffordable based on projected income as defined by 45 C.F.R. § 155.605(d)(2), as that regulation was in effect on December 15, 2017; or

(2) The general hardship exemption from the District shared responsibility payment requirement contained in § 47-5102 by reason of general hardship, as defined by 45 C.F.R. § 155.605(d)(1), as that regulation was in effect on December 15, 2017.

(c) On or before January 31, 2020 and each January 31 each year thereafter, the Authority shall notify the individual and the Chief Financial Officer of any exemption determination made pursuant to subsection (b) of this section for the previous taxable year.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5105. Reporting of health insurance coverage.

(a) An applicable entity that provides minimum essential coverage to an individual during a calendar year shall submit a return at a time determined by the Chief Financial Officer, which shall include the information contained in a return described in section 6055 of the Internal Revenue Code of 1986 (26 U.S.C. § 6055) and its implementing regulations, as that section and implementing regulations were in effect on December 15, 2017, and any such information required by the Chief Financial Officer.

(b)(1) Except as provided in paragraph (2) of this subsection, an applicable entity required to submit a return pursuant to subsection (a) of this section shall furnish to each individual whose name is required to be on the return a written statement showing the:

(A) Name and address of the entity required to make the return;

(B) The phone number of the information contact for such applicable entity or their delegee; and

(C) Information required regarding the individual.

(2) The requirements of this subsection may be satisfied by a written statement provided to an individual that is consistent with the requirements of section 6055 of the Internal Revenue Code of 1986 (26 U.S.C. § 6055) and its implementing regulations, as that section and implementing regulations were in effect on December 15, 2017.

(c)(1) In the case of coverage provided by an entity that is a governmental unit or an agency or instrumentality of a governmental unit, the officer or employee who enters into the agreement to provide such coverage shall be responsible for the returns required by this section.

(2) An entity may contract with a third-party service provider, including an insurance carrier, to provide the returns required by this section.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5106. Annual notification.

The Chief Financial Officer, in consultation with the Authority and the Director of the Department of Health Care Finance, shall develop a program to provide reasonable notice to taxpayers who paid a District shared responsibility payment during the previous taxable year. The notification shall include information on how to apply for:

(1) Individual health insurance;

(2) Medicaid; and

(3) The Children's Health Insurance Program.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5107. Individual Insurance Market Affordability and Stability Fund.

(a) There is established as a special fund the Individual Insurance Market Affordability and Stability Fund ("Fund"), which shall be administered by the Mayor in accordance with subsection (c) of this section.

(b) Revenue from the District shared responsibility payments collected pursuant to § 47-5103 shall be deposited into the Fund.

(c) Money in the Fund shall be used to:

(1) Engage in outreach to uninsured District residents to increase health insurance coverage;

(2) Provide information to District residents on options for health insurance coverage; and

(3) Engage in activities that increase the availability of health insurance options or increase the affordability of insurance premiums in the individual health insurance market, for District residents.

(d)(1) The money deposited into the Fund shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time.

(2) Subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5108. Liability.

A taxpayer who fails to pay the District of Columbia shared responsibility payment imposed by § 47-5103 shall be subject to all collection, enforcement, and administrative provisions applicable to unpaid taxes or fees, as provided in Chapter 18, Chapter 41, Chapter 42, Chapter 43, and Chapter 44 of this title.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).


§ 47–5109. Rules.

(a)(1) All federal regulations implementing section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A), as such regulations were in effect on December 15, 2017, are incorporated by reference into the District of Columbia Municipal Regulations and, unless modified or superseded by regulations issued pursuant to paragraph (2) of this subsection, shall be used to implement the provisions of this chapter. Federal guidance interpreting the federal regulations implementing section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A), as such guidance was in effect on December 15, 2017, shall also apply.

(2) The Chief Financial Officer may amend the incorporated regulations and guidance and issue rules to implement the provisions of this chapter; except, that:

(A) The Mayor, and not the Chief Financial Officer, may amend the incorporated regulations and guidance and issue rules related to the definitions of applicable individual and minimum essential coverage and the exemptions under § 47-5102(b); and

(B) The Authority, and not the Chief Financial Officer, may amend the incorporated regulations and guidance and issue rules related to the authority specifically provided to the Authority under this chapter.

(b) By November 1, 2018, the Chief Financial Officer, in consultation with the Authority, shall provide to the Mayor for publication in the District of Columbia Register the complete text of the incorporated regulations and guidance referred to in subsection (a)(1) of this section.


(Oct. 30, 2018, D.C. Law 22-168, § 5002(b), 65 DCR 9388.)

Emergency Legislation

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) creation of this section, see § 5002 of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).