Medical Assistance

About

To qualify as QDWI, the individual must meet the following criteria:

·         Be less than 65 years old

·         Have earnings that caused their Social Security Benefits to end because their earned income exceeded the substantial gainful activity (SGA) amount

·         Continue to have the disabling physical or mental impairment (verified by SSA)

·         Must be eligible for or enrolled in Medicare part A

·         Have resources less than two times the SSI resource limit and

·         Not be eligible for other Medicaid Covered groups. 

How to Enter QDWI in VaCMS

Once you have determined the applicant is eligible as QDWI per policy in M0320.604

1.    End date the SSA Unearned income

2.    Add the earned income

3.    Be sure the TPL screen has been updated to reflect Medicare part A

4.    Go to the disability screen

5.    DO NOT select an end date for the disability as VaCMS will not evaluate for QDWI if there is no disability listed

6.    Select Payment Code

7.    Select Terminated  

8.    Select YES to the questions about losing SSA due to earnings exceeding the SGA

9.    Run EDBC

NOTE: After eligibility is run in VaCMS, if the AC is QI, QMB, or SLMB and they are not blind, override the AC to QDWI (55) before you authorize the case.  QDWI recipients are not entitled to these benefits unless they are blind. (M0320.601-604)