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Effective: May 1, 2007 |
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03.35.20ar2 - Qualified Working Disabled (QWD) (Archive) |
Archived: June 1, 2008 |
Some employed people under age 65 with disabilities may lose their Retirement, Survivors, and Disability Insurance (RSDI) and premium-free Medicare benefits because their income exceeds Substantial Gainful Activity (SGA) limits. These people may receive help with Medicare costs through the Qualified Working Disabled (QWD) program if they are eligible to enroll in Medicare Part A with a premium under the Qualified Working Disabled Adult provisions of the Social Security Act .
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
Follow standard MA guidelines.
Eligibility may begin up to three months before the date of application assuming all other factors are met.
Renewals (standard guidelines)
Do not require six-month renewals for QWD enrollees who meet any of the exceptions noted in six-month renewals.
Verify enrollment in Medicare Part A when required for QWD eligibility.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
U.S. citizens who are enrolled or eligible to enroll in Medicare are exempt from the requirement to provide citizenship or identity documentation.
For noncitizens, follow standard guidelines for federally funded MA.
Residency (standard guidelines)
Follow standard MA guidelines.
Medicare Part A premiums for QWD-eligible clients are considered cost-effective by BRS and do not require further review.
Household Composition (standard guidelines)
Follow standard MA guidelines.
Use Method B for income and assets.
Asset limit is:
l $4000 for a household of one.
l $6000 for a household of two or more.
Income Guidelines (standard guidelines)
Income standard is 200% FPG.
In addition to allowing the income deductions and disregards for the applicable blind or disabled status, apply the standard $20 disregard when determining QWD eligibility.
Disregard RSDI cost-of-living adjustments (COLA) for January through June of each year.
Spenddowns (standard guidelines)
There are no spenddown provisions for QWD.
The only benefit provided by QWD is the payment of Medicare Part A premiums.
Service Delivery (standard guidelines)
People who are eligible for only QWD are excluded from managed care enrollment.
Not applicable.
Eligibility for QWD ends when the enrollee is no longer eligible to enroll in Medicare under the QWD act, or has excess income or assets.
People who qualify for MA, including MA-EPD, are not eligible for QWD. People who are eligible for MA may be eligible for payment of Medicare Part A premiums through the buy-in.
People who are eligible for QWD may be eligible for and choose MA for Employed Persons with Disabilities (MA-EPD) instead. MA-EPD charges premiums but provides more benefits than QWD.