The Washington, D.C., individual mandate has been delivered. Here’s what it means.

Since the federal repeal of the 2014 Obamacare tax penalty, Massachusetts, New Jersey and Vermont have all passed individual mandates of their own.

Now Washington, D.C., joins that group.

For District residents, it means stay the course and that — similar to life under the federal mandate — they are required to have “minimum essential coverage” beginning in 2019. Minimum essential coverage is defined as coverage that meets the expectations of the Affordable Care Act.

How the act came to be
When the federal individual mandate penalty was reduced to zero, it forced the District into action, and the idea of creating its own individual mandate was originally recommended by the District Health Benefit Exchange Authority, the entity responsible for managing the enrollment process in Washington, D.C.

Proponents sought a solution to better control premium costs and ward against a decline in overall public health. Opponents of the legislation attempted to repeal it, and a repeal did successfully pass in the House of Representatives before being voted down (54-44) in the Senate.

A closer look at the mandate
While the individual mandate will apply to most Washington, D.C., residents, there are some groups — predominantly based on income — that will be excluded from mandate consideration. These include:

  • Those age 20 and younger whose earnings total or are less than 324 percent of the federal poverty level.
  • Those age 21 and older whose income equals or falls below 222 percent of the federal poverty level.
  • Those already covered under the Immigrant Children Program or the District’s Healthcare Alliance.
  • Members of religious groups — recognized by the federal government — who do not accept insurance support and benefits.
  • Those who work in the District but reside in neighboring states.

What does the District individual mandate mean for your business?
Just as was necessary with the federal mandate, Washington, D.C.’s mandate will also require employers with employees or COBRA participants who have resided in the District at any time over the past year to provide healthcare benefits reporting. These requirements also apply to employers outside of the District that have employees who reside within the District.

The Forms 1095 and 1094, including applicable Washington, D.C., resident information, must be submitted to the District by June 30, 2020.

Similar to the Federal reporting timeline, the District requires 1095 forms to be delivered to employees by the due date of Jan. 31, 2020.

Managing your obligations
As more states add their own individual mandates, keeping track of what is expected of employers can be difficult without the support of an experienced partner.

At Health e(fx) we offer a leading compliance, analytics and workforce solution to help you track your compliance considerations and coverage options no matter where you do business or which ways the laws change. Contact us today to learn more about how our solutions can support your company.

August 30, 2019

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