5101:1-39-01.2 Medicare: qualified disabled and working individuals (QDWI).

(A) This rule sets forth the eligibility requirements, coverage period, and benefits of the qualified disabled and working individuals (QDWI) program established by section 1905(s) of the Social Security Act (as in effect on January 1, 2010).

(B) Definitions.

(1) "Enrolled", for the purposes of this rule, means that an individual is in receipt of benefits under a medicare health plan.

(2) "QDWI" means the qualified disabled and working individuals program established by section 1905(s) of the Social Security Act (as in effect on January 1, 2010). This program is sometimes referred to as the qualified working disabled individuals (QWDI) program.

(C) Eligibility. To receive QDWI benefits, an individual must: (1) Be enrolled in medicare part A (part A) under section 1818A of the Social Security Act (as in effect on January 1, 2010). Coverage can be identified as being provided under section 1818A of the Social Security Act when the individual: (a) Has not reached age sixty-five; and (b) Has lost disability benefits under Title II of the Social Security Act (as in effect on January 1, 2010) solely due to earnings in excess of the substantial gainful activity (SGA) level established by the social security administration (SSA); and (c) Is paying a premium for part A coverage; and (d) Has provided no document or communication from the SSA indicating another basis for part A coverage.

(2) Have countable income, as determined under Chapter 5101:1-39 of the Administrative Code, which does not exceed two hundred per cent of the federal poverty level for the individual's family size.

(3) Have countable resources, as determined under Chapter 5101:1-39 of the Administrative Code, which do not exceed twice the standard under the supplemental security income (SSI) program.

(4) Not be otherwise eligible for medicaid.

(5) Meet the application, conditions of eligibility, and verification requirements set forth in Chapter 5101:1-38 of the Administrative Code.

(D) Coverage period.

(1) Eligibility for QDWI benefits begins no earlier than the third month prior to the month of application, provided the individual met all eligibility criteria including enrollment in part A during the three-month period.

(2) The date and effect of termination of QDWI benefits is set forth in rule 5101:1-38-03 of the Administrative Code.

(E) Administrative agency responsibilities. The administrative agency shall: (1) Deny benefits under this rule if any of the conditions for denial set forth in rules 5101:1-38-01 and 5101:1-38-01.8 of the Administrative Code are met; or (2) Terminate benefits under this rule if any of the conditions for termination set forth in rules 5101:1-38-01 and 5101:1-38-01.8 of the Administrative Code are met; or (3) Approve benefits if an individual is eligible for QDWI benefits, and pay the individual's monthly part A premium as set forth in rule 5101:1-38-03 of the Administrative Code, effective the month that QDWI coverage begins.

(F) Individual responsibilities. The individual must inform the county department of job and family services (CDJFS) of any changes in the individual's part A or part B coverage.

Replaces:

5101:1-39- 01.2

Effective: 01/01/2010
R.C. 119.032 review dates: 01/01/2015
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01 , 5111.011
Prior Effective Dates: 7/1/1990 (Emer.), 9/8/1990, 1/1/1991, 10/1/2002