5160:1-3-02.2 Medicare qualified disabled and working individuals (QDWI).  

  • Text Box: ACTION: Final Text Box: DATE: 06/20/2016 3:29 PM

     

     

     

    TO BE RESCINDED

     

    5160:1-3-02.2              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.

     

    (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 December 1, 2013). 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 December 1, 2013). 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 December 1, 2013) 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 5160:1-3 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 5160:1-3 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 5160:1-2 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 5160:1-3-02.6 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 5160:1-2-01 and 5160:1-2-10 of the Administrative Code are met; or

    (2)    Terminate benefits under this rule if any of the conditions for termination set forth in rules 5160:1-2-01 and 5160:1-2-10 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 5160:1-3-02.6 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:                                                              5160:1-3-02.1

    Effective:                                                             07/01/2016

    Five Year Review (FYR) Dates:                         04/15/2016

    CERTIFIED ELECTRONICALLY

     

    Certification

     

    06/20/2016

    Date

     

    Promulgated Under:

     

    111.15

    Statutory Authority:

    5160.02, 5163.02

    Rule Amplifies:

    Prior Effective Dates:

    5160.02, 5163.02

    7/1/1990 (Emer.), 9/8/1990, 1/1/1991, 10/1/2002,

    1/1/2010, 1/22/2015

Document Information

Effective Date:
7/1/2016
File Date:
2016-06-20
Last Day in Effect:
2016-07-01
Five Year Review:
Yes
Rule File:
5160$1-3-02$2_FF_R_RU_20160620_1529.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160:1-3-02.2. Medicare: qualified disabled and working individuals (QDWI)