5101:1-39-01.2 Medicaid: qualified working disabled individuals (QWDI).

(A) The Omnibus Budget Reconciliation Act of 1989 requires states to provide medicaid to certain qualified working disabled individuals (QWDIs) for the purpose of paying medicare cost-sharing expenses. For QWDIs, medicare cost-sharing expenses are limited to payment of medicare Part A premiums. These individuals have lost Title II disability benefits due to earnings in excess of the substantial gainful activity (SGA) level; however, they are permitted to enroll for medicare Part A.

(B) QWDIs are a categorically related covered group under the medicaid program. QWDIs are only eligible for payment of medicare Part A premiums.

(C) A QWDI is an individual:

(1) Who is entitled to enroll in hospital insurance benefits (medicare Part A) under section 1818A of the Social Security Act;

(2) Whose countable income does not exceed two hundred per cent of the federal poverty level;

(3) Whose countable resources do not exceed twice the standard under the supplemental security income (SSI) program; and

(4) Who is not otherwise eligible for medicaid.

(D) A QWDI must meet the application and verification requirements as set forth in Chapter 5101:1-38 of the Administrative Code.

(E) Unless otherwise noted in this rule, a QWDI must meet the medicaid eligibility requirements as set forth in Chapter 5101:1-39 of the Administrative Code.

(F) To determine QWDI eligibility an individual’s income must be compared to the QWDI income standard as set forth in rule 5101:1-39-21 of the Administrative Code. The CDJFS shall apply the current medicaid income methodologies (e.g., income exemptions, disregards, deeming) when determining an individual’s countable income.

(G) The effective date of benefits under this provision is based on the date of application and the date on which all eligibility criteria, including enrollment for medicare Part A, are met.

(H) Eligibility for QWDI medicaid may be extended retroactively to the third month prior to the month of application, provided the individual met all eligibility criteria including enrollment for medicare Part A during the three-month period.

(I) Since QWDI individuals must be otherwise ineligible for medicaid, there is no dual medicaid eligibility under this provision.

HISTORY: Eff 7-1-90 (Emer.); 9-8-90; 1-1-91; 10-1-02

Rule promulgated under: RC 111.15

Rule authorized by: RC 5111.01, 5111.011

Rule amplifies: RC 5111.01, 5111.011

Replaces: 5101:1-39-53.3

R.C. 119.032 review dates: 10/01/2007