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DC Health Benefit Exchange Operations

Schedule and Work Plan

HBX Advisory Work Groups

Education and Outreach to Individuals and Small Businesses

Consumer Assistance: Navigators, In-Person Assisters and Certified Counselors

Undocumented Residents

Undocumented persons are not eligible to purchase health plans through the District’s health benefit exchange. Specifically, 42 U.S. C. §18031(d)(2)(A) states that “[a]n Exchange shall make available qualified health plans to qualified individuals and qualified employers.  Section 18031(d)(2)(B)(i) states that “[a]n Exchange may not make available any health plan that is not a qualified health plan.”  In terms of who is a “qualified individual,” § 18032(f)(1)(A) defines the term, with respect to an Exchange, as “an individual who (i) is seeking to enroll in a qualified health plan in the individual market offered through the Exchange; and (ii) resides in the State that established the Exchange.”  Section § 18032(f)(3), which limits Exchange access to lawful residents, provides:

If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

As such, because the HBX is limited to offering “qualified health plans” to “qualified individuals,” and because undocumented person “shall not be treated as a qualified individual and may not be covered under a qualified health plan,” undocumented persons may not purchase health plans through the HBX.

Exchange Funding

Grant funding to build the exchange was received from The Center for Consumer Information & Insurance Oversight (CCIIO), the federal government agency responsible for helping to implement many provisions of the Affordable Care Act, the historic health reform bill that was signed into law March 23, 2010.

A total of $82,186,048 has been received from the federal government (CIIO) in Exchange establishment grant funding.  Please see summary of exchange grants and expenditures. [PDF]

Please note the tables do not reflect the Medicaid funding that will pay for approximately one third of the IT system development in Release 1.  The summary only reflects Exchange grants, not other grants/funding from federal government under the ACA.

Background Studies and Market Research