D.C. Mun. Regs. tit. 29, r. 29-5599
Applicant - the same meaning as is set forth under Chapter 95 of Title 29 DCMR.
Beneficiary - An individual who has been determined eligible for Medicaid.
DC Healthy Families MCO - a managed care health plan contracted with DHCF to provide health insurance to individuals enrolled in mandatory managed care and certain individuals enrolled in voluntary managed care that choose to receive services from a managed care health plan.
Department - The Department of Health Care Finance or its designee or agent.
Dependent Child - A natural or biological, adopted or step-child who is under the age of eighteen (18), or is age eighteen (18) and a full-time student in secondary school (or equivalent vocational or technical training).
Disenrollment - Discontinuation of a Medicaid beneficiary's enrollment with a specific DC Healthy Families MCO that provides Medicaid services to District Medicaid beneficiaries in accordance with the terms of a contract with the Department.
Enrollment period - A timeframe in which a beneficiary may choose a DC Healthy Families MCO to enroll (in the case of mandatorily and voluntarily enrolled beneficiaries), or to choose to receive services through an alternative delivery system (in the case of voluntarily enrolled beneficiaries, and which would include but not be limited to an FFS delivery system or PACE.
Household -The same meaning as set forth at 42 CFR § 435.603(f).
Intermediate sanction - Suspension of all new enrollment, including default enrollment, after the date the Secretary of the U.S. Department of Health and Human Services or the Department notifies the DC Healthy Families MCO of a determination of a violation of any requirement under sections 1903(m) or 1932 of the Social Security Act.
Managed Care Organization - An entity that has a contract with DHCF to provide or make services accessible to Medicaid beneficiaries in accordance with the terms of the contract with DHCF.
Medicaid - The program established under Title XIX and Title XXI of the Act, and authorized in the District of Columbia pursuant to the Act, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2016 Repl. & 2019 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2019 Repl.)).
Recertification- The process by which the Department re-evaluates a beneficiary's eligibility for Medicaid, which usually occurs every twelve (12) months following the beneficiary's initial eligibility determination for Medicaid in accordance with the requirements of Chapter 95 of Title 29 DCMR.
D.C. Mun. Regs. tit. 29, r. 29-5599