Effective July 1990, Social Security rules allow certain disabled individuals who become employed to continue receiving Medicare Part A by paying a premium. A provision of the Omnibus Budget Reconciliation Act (OBRA) of 1989 requires States to pay that Part A premium for certain eligible individuals.
The Qualified Working Disabled Individuals (QDWI) program became effective in Missouri on July 1, 1990.
The only benefit for QDWI eligibles is the payment of the Medicare Part A (Hospital Insurance) premium. QDWI eligibles do NOT receive a Medicaid card and are NOT eligible for Medicaid services or for payment of the Medicare Part B (SMI) premium, coinsurance and deductibles.
QDWI benefits can begin no earlier than July 1, 1990. If the claimant is eligible on all factors, benefits begin on the first day of the month of application.
The Buy-In Unit of the Division of Medical Services will process the payment of the Medicare Part A premium for QDWI eligibles.
There are three general eligibility requirements for the QMB program. To be eligible for the program, an individual must:
SSA determines who meets QDWI status. Basically, the individual must be under age 65, have the same disabling condition that qualified them for Medicare and lost (or is losing) premium free Medicare only because they become employed.
Do NOT send medical information to MRT on QDWI cases. SSA determines disability for QDWI cases.
If an applicant claims QDWI status, send an IOC to the IM Program and Policy Unit in State Office requesting verification of that status. Include the claimant's name, DCN, social security number, social security claim number and date of application in the IOC. We will obtain verification from SSA and notify county offices of SSA's decision. The verification of SSA QDWI status will be done manually by SSA in Baltimore; local SSA offices do not have this information. We expect it will take 6 to 8 weeks for SSA to respond to our inquiries.
“Part A” is the term given the Hospital Insurance coverage under the Medicare program. Claimants for QDWI must be enrolled in Medicare Part A. These claimants are charged a premium by Medicare for Part A coverage.
QDWI eligibility cannot begin prior to the date the claimant is charged a premium for Part A.
State Office will obtain verification of enrollment in Medicare Part A and the date of the change to premium Part A at the same time SSA QDWI status is verified.
Medical Assistance budgeting methodologies apply to QDWI except where noted.
The QDWI income standard is 200% of the Federal Poverty level for the size of the assistance group involved. QDWI income standards effective April 2018 are as follows:
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The QDWI income standard is absolute. An individual cannot spenddown to become eligible.
Include in the assistance group the participant and the participant's spouse (if living together). Dependent children are not considered in the assistance group.
NOTE: For married couples living together, include both in the assistance group even if the spouse is receiving another type of assistance. Exclude all income of the spouse from Temporary Assistance, SP, SAB and SNC grants. Include the spouse's BP grant in determining QDWI eligibility. If the participant is receiving another type of assistance, s/he is NOT QDWI eligible.
Budgeting for QDWI eligibility follows budgeting guidelines for QMB on the IM-30A. Use Lines 1 through 11 on the IM-30A. Use the income standards as noted above on Line 10 rather than QMB income standards. Do not use Lines 12 through 18 on the IM-30A for QDWI as the claimant cannot receive MA and QDWI.
EXAMPLE:
Mr. Lawrence is a 56 year old single person who has been receiving Social Security Disability for 6 years. He began employment on April 4, 2018. Social Security has determined Mr. Lawrence remains disabled and continues to be eligible for Medicare Part A with a premium. Mr. Lawrence earns $250.00 per week and is paid weekly. Mr. Lawrence is not MA eligible due to excessive resources.
| Gross Income (Line 1) ($250 x 4.333) |
$1,083.25 |
| Earned Income Exemption (Line 2) | 65.00 |
| Total (Line 2a) | 1,148.25 |
| Divide by 2 (Line 2b) | 574.13 |
| Total Exemptions (Line 2d) | 574.13 |
| Adjusted Earned Income (Line 3) | 509.12 |
| Non-earned Income (Line 4) | 00.00 |
| Total Adjusted Income (Line 5) | 509.12 |
| Personal Deduction (Line 6) | 20.00 |
| Total Exemptions (Line 8) | 20.00 |
| Adjusted Gross Income (Line 9) | 489.12 |
| QDWI Standard (Line 10) | 2,024.00 |
Mr. Lawrence is income eligible for the QDWI program.
EXAMPLE:
Mrs. Jones is 47 year old and lives with her spouse. She has been receiving Social Security Disability for 4 years. Mr. Jones earns $1500.00 per month. Mrs. Jones became employed on April 19, 2018 earning $6.00 per hour, 40 hours per week and she is paid every 2 weeks. Social Security has determined that Mrs. Jones remains disabled and continues to be eligible for Medicare Part A with a premium. The Jones' have available resources totaling $2950.00.
| Gross Earned Income (Line 1) ($6x40x2.166=519.84+1500) |
$2,019.84 |
| Earned Income Exemption (Line 2) | 65.00 |
| Total (Line 2a) | 2,084.84 |
| Divide by 2 (Line 2b) | 1,042.42 |
| Total Exemptions (Line 2d) | 1,042.42 |
| Adjusted Earned Income (Line 3) | 977.42 |
| Non-Earned Income (Line 4) | 00.00 |
| Total Adjusted Income (Line 5) | 977.42 |
| Personal Exemption (Line 6) | 20.00 |
| Total Exemptions (Line 8) | 20.00 |
| Adjusted Gross Income (Line 9) | 957.42 |
| QDWI Standard (Line 10) | 2,744.00 |
Mrs. Jones is income eligible for the QDWI program.
EXAMPLE:
Mrs. Cree is 55 years old and lives with her 67 year old spouse. Mr. Cree receives Social Security retirement of $777.00 per month. Mrs. Cree has been receiving Social Security Disability for 5 years. Mrs. Cree became employed on April 2, 2018. She earns $1600 per month. Social Security has determined that Mrs. Cree remains disabled and is eligible for Medicare Part A with a premium.
| Gross Earned Income (Line 1) | $1,600.00 |
| Earned Income Exemption (Line 2) | 65.00 |
| Total (Line 2a) | 1,665.00 |
| Divide by 2 (Line 2b) | 832.50 |
| Total Exemptions (Line 2d) | 832.50 |
| Adjusted Earned Income (Line 3) | 767.50 |
| Non-Earned Income (Line 4) | 777.00 |
| Total Adjusted Income (Line 5) | 1,544.50 |
| Personal Exemption (Line 6) | 20.00 |
| Total Exemptions (Line 8) | 20.00 |
| Adjusted Gross Income (Line 9) | 1,524.50 |
| QDWI Standard (Line 10) | 2,744.00 |
Mrs. Cree is QDWI eligible.
The QDWI resource maximums are twice the SSI maximums. Currently, the QDWI maximums are:
| Single | $4,000 |
| Married | $6,000 |
Resources for the QDWI program include anything considered as available under the December 1973 eligibility guidelines for aged and disabled persons (Refer to Section 1030.000.00 ). Consider the resources of all members of the assistance group.
Transfer of property is not an eligibility factor for the QDWI program.
QDWI eligibles must not be otherwise eligible for Medicaid. When an individual applies for QDWI, explore eligibility for other types of assistance. Record the determination of ineligibility for other assistance on the IM-2. If the claimant is eligible for any other type of assistance, s/he is not eligible for QDWI. NOTE: If it appears the claimant is MA eligible, a disability determination by MRT is required.
The citizenship/alien status requirement is the same as for MHF. Refer to Section 0905.010.30.
The residency requirement is the same as for MA. Refer to Section 1015.000.00.
The social security number requirement is the same as for MA. Refer to Section 1005.010.00.
Enter the application in the name of the applicant for “W” type of assistance. Only one individual may be registered on a “W” type of assistance. Register a separate application for each spouse if both apply for QDWI benefits.
All regular IM application procedures apply. The use of the IM-1 and IM-2 or IM-1MA, and availability of fair hearings is the same as for any other adult Medicaid program. Instruct the client to complete pages 1-7 of the IM-2.
Take the following steps to approve a case for QDWI:
If ineligible, reject the application using the appropriate rejection code.