*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2011 |
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03.35.20 - Qualified Working Disabled (QWD) |
Archived: June 1, 2016 (Previous Versions) |
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 meet a blind or disabled basis and 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 and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
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 or eligibility to enroll in Medicare Part A.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
U.S. citizens who are enrolled or eligible to enroll in Medicare are not required 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.
DHS pays Medicare premiums through the buy-in for people who are enrolled in QWD.
Household Composition (standard guidelines)
Follow standard MA guidelines in Determining Household Size for MA to determine which household members to count in the household size when determining QWD eligibility for a person who is not requesting Elderly Waiver (EW), but has a spouse who is on EW. However, do not count the person’s spouse in the household size if the spouse is on EW. See Exceptions to MA Household Size.
Example:
Jack is on EW and is eligible for Medicare. He lives with his wife Wendy and their 17-year-old daughter Mary. Wendy is eligible for Medicare and is not requesting EW.
Action:
Determine Wendy’s eligibility for QWD using a household size of two (Wendy and Mary).
Use Method B for income and assets.
Asset limit is:
l $4,000 for a household of one.
l $6,000 for a household of two or more.
Income Guidelines (standard guidelines)
Income standard is 200% FPG. Income eligibility is determined on a monthly basis. QWD does not have a six-month or annual standard.
Example:
Myrtle is paid bi-weekly through her employer. In December, she will receive three paychecks and her income will be higher than the 200% FPG standard.
Action:
Myrtle’s total net income exceeds the standard in December. She is ineligible for QWD in December.
Apply the standard $20 disregard, as well as allowing any income deductions and disregards for the applicable blind or disabled status.
Disregard RSDI cost-of-living adjustments (COLA) for January through June of each year.
Exclude Aid and Attendance benefits and Allowances for Unusual Medical Expenses received from the Veteran’s Administration.
Spenddowns (standard guidelines)
There are no spenddown provisions for QWD.
Example:
Bud’s income is 210% FPG. He is ineligible for QWD even if he has covered expenses that would allow him to spend down to 200% FPG.
The only benefit provided by QWD is the payment of Medicare Part A premiums.
Service Delivery (Prepaid MHCP Manual)
People who are only receiving QWD assistance are excluded from managed care enrollment.
Not applicable.
Eligibility for QWD ends when the enrollee is no longer eligible to enroll in Medicare Part A under the QWD act, has excess income or assets, becomes otherwise eligible for MA, or fails to meet any other eligibility factor.
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.