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COMAR 10.09.24.03

356 State of Maryland Medical Assistance Manual Revised July 2012 QDWI Eligibility Criteria The A/R must have been entitled to Medicare Part A while eligible for Social Security disability benefits and have lost eligibility because he/she is working. The individual must continue to be considered disabled by the SSA. The age range for QDWI eligibility is 21-64 years old. The applicant should be tested under ABD regulations. Eligibility as a QDWI is based on the disabled individual losing Social Security benefits due to employment. If the person is married, the income and resources of the spouse are considered, even though the AU only includes the QDWI eligible person. The income considered available to the A/R may not exceed 200% of the FPL for the household size (one or two persons if there is a spouse). The resources considered available to the A/R may not exceed twice the maximum standard for Supplemental Security Income (SSI). Since the current SSI resource standard is $2,000.00, the maximum allowable resources for QDWI eligibility are $4,000.00 for one person and $6,000.00 for a couple. This is the same resource standard used for QMB/SLMB; however, the income limit is different. To be eligible for QDWI, the applicant/recipient may not be active in any other Medicaid coverage group When a person active as a QDWI (S06) applies for more comprehensive Medicaid benefits during the certification period and is determined eligible in another coverage group, the S06 case must be closed in conjunction with opening the new case to avoid dual participation in CARES. The Case Manager must establish a 745 Alert for the end of the new MA certification period, as reminder to review for the S06 eligibility. If the individual loses eligibility for the higher Medicaid coverage group, the Case Manager should follow current redetermination procedures in the MA Manual, Chapter 12, including consideration as a QDWI. Verify that the QDWI status still applies, using SOLQ/SVES) The A/R must meet the technical Medicaid requirements in COMAR 10.09.24.04 and .05. Since these individuals must still be considered disabled by SSA, they will not receive a disability determination by the State Review Team (SRT). Disability status must be verified on SOLQ/SVES. Use this information to complete the CARES DEM2 screen Disability Fields Income and resources are considered according to the requirements in COMAR 10.09.24 for a non-institutionalized aged, blind or disabled person. (NOTE: A person becomes entitled free Medicare Part A when he or she attains age 65 and is considered aged.) The QDWI coverage group does NOT provide for any retroactive coverage prior to the month of application

Application

Individuals must apply for this Medicaid benefit at the LDSS. Eligibility for this program is not granted automatically. It is based on a letter from SSA to the person indicating potential eligibility. The CM must still use SOLQ/SVES to verify the eligibility status. Once the