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MRG UPDATED: JUNE 2011 74 CATEGORICAL FACTORS MEDICARE SAVINGS PROGRAM If the A/R meets the above criteria s/he is eligible for Medicaid payment of the Medicare Part B premiums. Qualified Disabled and Working Individuals (QDWIs) The A/R must: 1. have lost Part A benefits because of return to work; 2. be a disabled worker less than 65 years of age; 3. have income equal to or less than 200% of the federal poverty level; 4. have resources not in excess of twice the SSI limit; therefore, resources cannot exceed $4,000 for a household of one or $6,000 for a household of two; and 5. not be otherwise eligible for Medicaid. If the A/R meets the above five criteria s/he is eligible for Medicaid payment of the Medicare Part A premium, not the Medicare Part B premium. Qualifying Individuals – (QI) The A/R must: 1. have Part A of Medicare; 2. have income equal to or greater than 120% and less than 135% of the federal poverty level. NOTE: There is no resource test for QI. Additionally, individuals cannot be eligible for Medicaid and QI status at the same time. If the A/R meets the above criteria s/he is eligible for Medicaid payment of the Medicare Part B premiums, each month. Applicants should use the DOH-4328 when applying for this benefit. The DOH-4220 or the LDSS-2921 may not be required for persons applying for MSP benefits only. Each state has been given a capped allocation to fund these premium payments.