(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.
