2147 Qualified Disabled Working Individuals

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Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Qualified Disabled Working Individuals

Effective Date:

February 2020

Chapter:

2100

Policy Number:

2147

Previous Policy Number(s):

MT 13

Updated or Reviewed in MT:

MT-58

Requirements

Qualified Disabled Working Individuals (QDWI) is a class of assistance (COA) that provides payment of the monthly Part A Medicare premium for disabled working individuals.

Basic Considerations

To be eligible for QDWI coverage, an A/R must meet the following conditions:

  • The A/R is under the age of 65.

  • The A/R is entitled to but not receiving RSDI disability benefits because s/he has earnings that exceed the substantial gainful activity (SGA) limits.

  • The A/R is eligible for Part A Medicare coverage with a monthly premium.

  • The A/R meets all basic and financial eligibility criteria.

    Length of Stay (LOS), Level of Care (LOC) and TPR assignment are not requirements of this COA.

In-kind support and maintenance (ISM) is not considered in determining QDWI eligibility.

The only coverage this COA provides is payment of the monthly Part A Medicare premium by Medicaid. No other medical expenses incurred by the QDWI recipient are paid by Medicaid.

A Medicaid card is not issued to QDWI recipients and Form 962 is not issued to the recipient or providers.

QDWI eligibility cannot begin prior to the A/R’s eligibility for Part A Medicare.

Procedures

Follow the steps below to determine QDWI eligibility.

Step 1

Accept the A/R’s Medicaid application.
Step 2

Obtain information required to complete the eligibility determination.
Step 3

Determine that the A/R is ineligible for full Medicaid coverage under all other COAs.
Step 4

Obtain the following verification from the Social Security Administration:

  • The termination of the A/R’s RSDI disability payment due to excessive earned income.

  • The A/R’s eligibility for Part A Medicare coverage with a monthly premium.
Step 5

Determine all basic eligibility criteria except LOS, LOC and TPR. Refer to Chapter 2200, Basic Eligibility Criteria.
Step 6

Determine financial eligibility using the current QDWI income and resource limits. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting to determine the following:

  • whose income and resources to consider

  • which SSI income and resource limit (individual or couple) to use

  • which eligibility budget to complete.
Step 7

Approve under QDWI COA if the A/R meets all the above eligibility criteria, including retroactive months if needed.