Basic Considerations
To be eligible for QDWI coverage, an A/R must meet the following conditions:
The A/R is under the age of 65.
The A/R is entitled to but not receiving RSDI disability benefits because s/he has earnings that exceed the substantial gainful activity (SGA) limits.
The A/R is eligible for Part A Medicare coverage with a monthly premium.
The A/R meets all basic and financial eligibility criteria. Length of Stay (LOS), Level of Care (LOC) and TPR assignment are not requirements of this COA.
In-kind support and maintenance (ISM) is not considered in determining QDWI eligibility.
The only coverage this COA provides is payment of the monthly Part A Medicare premium by Medicaid. No other medical expenses incurred by the QDWI recipient are paid by Medicaid.
A Medicaid card is not issued to QDWI recipients and Form 962 is not issued to the recipient or providers.
QDWI eligibility cannot begin prior to the A/R’s eligibility for Part A Medicare.