PM 06-06-03: Qualified Disabled Working Individuals (QDWI)

WAG 06-06-03

DHS pays the Medicare Part A, hospitalization coverage, premium for some people who lose premium-free coverage because of employment. These people are called Qualified Disabled Working Individuals (QDWI). QDWIs are not given recipient ID numbers or MediPlan cards.

The Social Security Administration refers people who may be eligible as a QDWI. Requests for QDWI benefits are handled by the Bureau of Program and Field Management Services. The Bureau determines eligibility for QDWI coverage. If the Family Community Resource Center is contacted by a person who may be a QDWI, refer the person to the Bureau. See WAG 06-06-03 for referral procedures.

To be eligible for QDWI a person must:

  • be enrolled or entitled to enroll in Medicare Part A;
  • have an income of not more than 200% of the Federal Poverty Level;
  • have assets of not more than twice the SSI level for an individual or couple;
  • not be eligible for Medicaid except through the QDWI program;
  • have a social security number;
  • meet citizenship and residency requirements; and
  • assign rights of payment.

QDWI coverage becomes effective based on the date of application and when all the eligibility criteria, including Medicare Part A enrollment, are met.

Example: If a person who is already enrolled in Medicare Part A applies for QDWI benefits on September 1, eligibility can be:

  • September 1; or
  • up to 3 months before September 1, if all eligibility criteria were met during the 3-month period.

If the person's enrollment in Medicare Part A is not effective until October 1, eligibility cannot start until October 1.