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Aged, Blind and Disabled Manual Policy Manual Number: 120.025 Section: Medicare Savings Programs Chapter: Qualified Disabled Working Individuals

May 1, 2025 Division of TennCare 4 Ineligible Parent’s Deemed Income + $ 0.00 General Deduction ($20) - $ 20.00 Child Support Disregard - $ 0.00 Widow/Widower Entitlement Disregard - N/A DAC Entitlement Disregard - N/A COLA Deduction - N/A Total Net Unearned Income = $ 180.00 Self-Employment Income

$ 0.00 Earned Income + $ 1,300.00 Irregular Earned Income Disregard - $ 0.00 Student Earned Income Exclusion - $ 0.00 Ineligible Spouse’s Deemed Earned Income + $ 0.00 Remaining General Deduction - $ 0.00 Earned Income Deduction - $ 65.00 Impairment Related Work Expense - $ 0.00 ½ Deduction - $ 617.50 Blind Work Expense - $ 0.00 Total Net Earned Income = $ 617.50 Total Countable Income (Total Net Unearned Income + Total Net Earned Income) = $ 797.50 Qualified Income Trust - $ 0.00 Net Countable Income

$ 797.50 Income Test Limit

$ 2,010.00 Income Test Result

PASS Patient Liability

N/A

The above budget is current as of March 2017. 8. Termination of QDWI Benefits

An individual will lose QDWI eligibility when:

a. He becomes eligible for any category of TennCare Medicaid; b. Personal resources exceed the resource limit; c. Income exceeds 200% of the current FPL; d. She becomes age 65 and is entitled to premium-free Medicare Part A; or e. SSA notifies TennCare that the individual is no longer considered disabled.