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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

F-192 Medicare Entitlement Requirements for Qualified Disabled and Working Individuals (QDWI) MS Manual 07/01/20 The following requirements must be met by an individual to qualify for benefits as a QDWI: 1. Lost Medicare Part A and SSA-Disability Insurance Benefits (SSA-DIB) due to Substantial Gainful Activity (SGA) – The individual must have previously received and lost entitlement to SSA-DIB and Medicare Part A solely due to earnings that exceed the SGA amount, as determined by the Social Security Administration. If the individual’s loss of SSA-DIB and Medicare Part A was for another reason (e.g., no longer has a disability), the individual will not qualify as a QDWI. 2. Entitled to Reenroll in Medicare Part A – The individual must be entitled to reenroll for Medicare Part A and must reapply for coverage with the Social Security Administration prior to QDWI certification. The following information must be verified: a) Individual’s blindness or disability is continuing b) Individual’s entitlement to SSA-DIB and Medicare Part A was lost solely due to SGA c) Individual has reenrolled for Medicare Part A d) Effective date of Medicare Part A coverage. The individual will be asked to provide any notices received from SSA or to obtain the needed information directly from SSA.

F-193 Initial Enrollment Period and General Enrollment Period for Medicare Part A MS Manual 01/01/22 A Qualified Disabled and Working Individuals (QDWI) applicant must reenroll for Medicare Part A, if they have not previously reenrolled prior to making application. The Social Security Administration will send notices to those individuals who lost or will lose Medicare Part A solely due to Substantial Gainful Activity (SGA), advising them to contact the SSA office. Once reapplication has been made for Medicare Part A, SSA will refer potentially eligible individuals to the County Office to make a QDWI application.