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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued July 22, 2020

Page 1 of H-1200 Replacing May 22, 2020

Deleted text indicated by “**” Revised/added text indicated by underscore

H-1200 QUALIFIED DISABLED AND WORKING INDIVIDUALS (QDWI)

H-1210 GENERAL INFORMATION

The OBRA law of 1989 established the Qualified Disabled Working Individual (QDWI) program to help certain individuals who lost entitlement to Social Security disability benefits and premium-free Medicare Part A coverage because their earnings exceeded the amount allowed under Social Security regulations pertaining to Substantial Gainful Activity (SGA).

SGA describes a level of work activity and earnings. Work is substantial if it involves significant physical or mental activities or a combination of both. Work is gainful if generally performed for pay or profit, or intended for profit, whether or not a profit is realized.

The applicant/enrollee must meet all of the following requirements for the QDWI buy-in program. A QDWI must:

● Be enrolled, or conditionally enrolled, in hospital insurance benefits (Medicare Part A) and must pay a premium for part A;

● Be under age 65;

● Have monthly income less than or equal to 200 percent of the Federal Poverty Income Guidelines (FPIG).

Refer to Z-200 Federal Poverty Income Guidelines;

Note: In January of each year, disregard the Social Security Administration (SSA) cost-of-living adjustment (COLA) through the month following the release of the annual FPIG update. For example, the annual FPIG is released in January, disregard COLA through February. Thereafter, determine eligibility using all income including the COLA for that year. ● Have resources equal to or less than twice the SSI limit. Refer to Z-900 Resource Limits by Program;