16 Del. Admin. Code § 17000-17700
Effective July 1, 1990, Section 6408 of the Omnibus Budget Reconciliation Act (OBRA) of 1989 mandates coverage of certain Medicare beneficiaries who are still disabled but lost premium-free Part A Medicare coverage because they returned to work. Medicaid will pay the Part A premium for Qualified Disabled and Working Individuals (QDWIs) who meet the income requirements.
A QDWI is an individual:
| · | who is entitled to enroll in Medicare Part A under § 1818A of the Social Security Act; |
| · | whose income does not exceed 200% of the Federal Poverty Level; and |
| · | who is not otherwise eligible for Medicaid. |
Social Security Administration will notify these individuals that they may be eligible to purchase Part A. If the individual is eligible for premium Part A, the SSA representative will determine potential QDWI status and refer the individual to the Medicaid office.
The individual and his spouse, if married, must complete a Medicaid application and provide the necessary verifications.
Applicants MUST apply for Medicare Part A. The individual must apply for Medicare Part A during their initial enrollment period which is identified in the notice they receive from SSA. If they do not apply during the specified time frame, they must wait until the general enrollment period - January, February and March.
The income methodologies of the SSI program will be used to determine eligibility for this program. See the QMB section for definitions of income. (DSSM 17300)
In order to be eligible, a QDWI's income cannot exceed 200% of the Federal Poverty Level. Follow the income deductions described in the QMB section.
Eligibility as a QDWI cannot be effective prior to July 1, 1990. The effective date of benefits is based on the date of application and the date on which all eligibility criteria are met, including enrollment in Part A.
Retroactive coverage is available under this program.
For example, an individual applies for benefits on October 1 and is already enrolled in Part A. Eligibility could be effective back to July 1. If this individual's Part A enrollment was not effective until November 1, then eligibility as a QDWI cannot be effective until November 1.
A redetermination of eligibility must be completed at least every 12 months. We will promptly redetermine eligibility when information is received about changes in circumstances that may affect eligibility.
16 Del. Admin. Code § 17000-17700