Qualified Disabled Working Individuals (QDWI) Program

The Qualified Disabled Working Individuals (QDWI) Program requires the State to pay Medicare Part A premiums for disabled individuals who are under age 65 and who lost their Medicare benefits due to earned income in excess of the Substantial Gainful Activity (SGA) limit. QDWI does not pay any Medicare coinsurance, deductibles, or the Part B premium.

The State will notify counties of potential QDWI eligibles.

Effective Date

Eligibility begins the month of application if all eligibility requirements are met. Individuals may apply for 3-month retroactive QDWI if they were entitled to Medicare Part A in those months and are otherwise eligible.

Benefit

QDWI eligibles only receive state payment of their Medicare Part A premium. No Benefits Identification Card (BIC) is issued. QDWI eligibility can be viewed on MEDS, Aid Code 8A, on one of the Special Program screens.

Medicare Part A

QDWI applicants must enroll for the special 1818A Medicare program at Social Security. The initial enrollment period for this program is seven months from the date an individual receives notice from SSA that his/her Part A benefits under the regular Medicare program will end due to excess earnings. Individuals who do not enroll during this initial enrollment period must wait until the general enrollment period, January through March; their benefits will then start in July.

Eligibility Criteria

In order to qualify for QDWI, the applicant/recipient must not be otherwise eligible for any other MC program. That is, QDWI may not be approved for any individual who is active on MC without a SOC or whose SOC has been met. In addition, he/she must meet all of the following eligibility criteria:

Conditions

An individual must be eligible to enroll in Medicare Part A only under a special program (1818A) and meet all of the following conditions:

Has not yet attained age 65
Has been entitled to RSDI
Continues to have the same disabling physical or mental condition
Lost RSDI due to earnings in excess of the SGA limit.
Is not otherwise entitled to Medicare.

Other Requirements

QDWI applicants must meet all other Medi-Cal Program requirements.

Property Limit

The property limit is twice the Medi-Cal property limit, currently:

$4,000 for one individual
$6,000 for two individuals

Citizen/ Non-citizen Status

QDWI eligibles must be a citizen or a Non-citizen who would otherwise be entitled to full-scope benefits if applying for regular MC. An undocumented Non-citizen who would only get restricted MC benefits is not eligible for QDWI.

Income Limit

QDWI eligibles must have income at or below 200% of the Federal Poverty Level (FPL).

Important: Unlike the QMB/SLMB and other FPL programs, the RSDI COLA received in January is not disregarded from January through March. The actual gross RSDI income is used to determine QDWI eligibility.