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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 9

Social Security COLA increases will be excluded in determining eligibility during the first three months of a calendar year.

17540 Retroactive Coverage

Retroactive eligibility does apply to this group unlike the QMB program. Benefits may begin with the month of application. Retroactive coverage is available for the three months prior to the month of application. Coverage cannot be effective prior to January 1 of the calendar year in which the application is filed.

17550 Capped Allocation

This provision is effective for premiums payable beginning with January 1998 and ending with December 2002. Each state will receive a specific capped allocation for QIs.

Because of the capped allocation, we must limit the number of QIs selected in a calendar year so that the amount of benefits provided to these individuals does not exceed our state allocation. QIs will be selected on a first-come, first- served basis. This means the QIs are selected in the order in which they apply for benefits.

Once a QI is approved, the QI is entitled to receive assistance for the remainder of the calendar year, provided the individual meets the eligibility requirements. However, the fact that an individual receives assistance at any time during the year does not necessarily entitle the individual to continued assistance for any succeeding year. We will give preference to individuals who were QIs, in the last month of the previous year.

17560 Redetermination of Eligibility

A redetermination of eligibility must be completed at least every 12 months. We will promptly redetermine eligibility when information is received about changes in circumstances that may affect eligibility.

17700 Qualified and Disabled Working Individuals

Effective July 1, 1990, Section 6408 of the Omnibus Budget Reconciliation Act (OBRA) of 1989 mandates coverage of certain Medicare beneficiaries who are still disabled but lost premium-free Part A Medicare coverage because they returned to work. Medicaid will pay the Part A premium for Qualified Disabled and Working Individuals (QDWIs) who meet the income requirements.

A QDWI is an individual: ·who is entitled to enroll in Medicare Part A under §1818A of the Social Security Act; ·whose income does not exceed 200% of the Federal Poverty Level; and ·who is not otherwise eligible for Medicaid.

17700.1 Application Process

Social Security Administration will notify these individuals that they may be eligible to purchase Part A. If the individual is eligible for premium Part A, the SSA representative will determine potential QDWI status and refer the individual to the Medicaid office.

The individual and his spouse, if married, must complete a Medicaid application and provide the necessary verifications.

17700.2 Medicare Beneficiary

Applicants MUST apply for Medicare Part A. The individual must apply for Medicare Part A during their initial enrollment period which is identified in the notice they receive from SSA. If they do not apply during the specified time frame, they must wait until the general enrollment period - January, February and March.

17700.3 Financial Eligibility

The income methodologies of the SSI program will be used to determine eligibility for this program. See the QMB section for definitions of income. (DSSM 17300)

17700.3.1 Income

In order to be eligible, a QDWI's income cannot exceed 200% of the Federal Poverty Level. Follow the income deductions described in the QMB section.

17700.4 Effective Date of Coverage

Eligibility as a QDWI cannot be effective prior to July 1, 1990. The effective date of benefits is based on the date of application and the date on which all eligibility criteria are met, including enrollment in Part A.

17700.4.1 Retroactive Coverage

Retroactive coverage is available under this program.

For example, an individual applies for benefits on October 1 and is already enrolled in Part A. Eligibility could be effective back to July 1. If this individual's Part A enrollment was not effective until November 1, then eligibility as a QDWI cannot be effective until November 1.

17700.5 Redetermination of Eligibility

A redetermination of eligibility must be completed at least every 12 months. We will promptly redetermine eligibility when information is received about changes in circumstances that may affect eligibility.