2674 Qualified Working Disabled (QWD) - Persons who qualify for Medicare benefits under the premium paying Part A program based on section 1818(a) of the Social Security Act shall be eligible for restricted medical assistance without a spenddown if:


  1. Their countable income does not exceed 200% of the appropriate federal poverty level, and
  2. Their countable resources do not exceed 2 times the allowable nonexempt resource level of 5130 (i.e., $4,000 for 1 person and $6,000 for 2 or more persons).

In addition to the above criteria, the individual must meet the general eligibility requirements of 2100.

Medical coverage for QWD only eligibles shall be limited to the payment of Medicare Part A premiums. Coverage can begin as early as the first month of Part A enrollment.

Individuals are limited to QWD coverage only. If other coverage is sought, there is no eligibility for QWD.


Eligibility for QWD coverage can be established in either the MA or MS program. The Special Medical Indicator Codes of DS is used.


2674.1 Medicare Part A Eligibility Under Section 1818(a) - Under section 1818(a) of the Social Security Act, persons who lose eligibility for regular OASDI disability benefits and Medicare because they are working and earning above the SGA level as described in 2634 can continue to receive Medicare coverage if they pay the applicable premiums. Such individuals will continue to meet disability criteria and must have qualified for Medicare prior to losing their cash benefits. They may enroll for either Part A and/or Part B coverage. However, under the QWD program, Medicaid coverage is only available for payment of the Part A premium. Only if the person qualifies for full Medicaid coverage based on meeting a spenddown would Part B premiums be covered.

A person must enroll in Medicare Part A to be eligible for QWD coverage. Eligibility would begin no earlier than the first month of Part A premium coverage. Documentation of their status under section 1818A and their Part A effective date will be required.


Persons who qualify for QWD will not be automatically enrolled and bought in to the Part A program. If they want Part A coverage, they would need to enroll for it on their own at the local SSA office. There is a 7-month initial enrollment period which begins with the month the person is notified concerning the loss of disability benefits. Part A premium coverage would begin in one of the following three months depending on when the person enrolls. If this initial period has passed, the person can normally only enroll during a general enrollment period which is limited to the months of January through March. Part A coverage would not begin until July 1 in these instances. There is also a special enrollment period connected with the premium Part A program for persons who did not enroll at their first opportunity because they were covered under an employer group health program. If that coverage ends, they have a 7-month period from the month the coverage ends to enroll for Part A. If the person applies for QWD outside of the permitted enrollment period, QWD eligibility would have to be denied until such time that the person can enroll for and begin receiving Part A benefits.


Part A premium coverage under section 1818A, and therefore QWD eligibility, ends in the month the individual turns 65.


2674.2 Income and Resource Methodologies - The income and resource methodologies of the MS program shall be applicable in determining eligibility with the exception of the 6 month base period rule and the allowable resource standards. Only the needs, income, and resources of the individual and his or her spouse or parent(s) shall be considered.


Countable income shall be determined using the independent living disregards as specified in 7240. This would also apply to persons in LTC living arrangements. Only that person's income would be considered including the amount of any income the person is allocating to a community spouse or other family members in accordance with 8243 (3) or 8244.2. This allocation would not be deducted in determining countable income for QWD purposes. However, if an individual applies for QWD status who is receiving such allocation, the amount of that allowance must be considered in determining that person's eligibility.


The general resource guidelines of 5200 shall be applicable in determining countable resources. A transfer of resources under the spousal impoverishment provisions of 8144, 8244 and subsections would not be recognized in the QWD determination until the resource has been formally transferred.


A 1 month base period shall be applicable to QWD-only determinations in accordance with 7330 (1). Total countable income to be considered in the eligibility base period shall be compared against the appropriate monthly 200% poverty level as referenced in the Standards section in the Appendix. Eligibility exists if the countable income does not exceed this level and resources are within allowable levels.


Eligibility for QWD coverage shall be determined separately for the qualifying individual except in instances in which there is more than one qualifying person in the family group. In such instance, a single determination for all qualifying persons would be applicable.


If the person's countable income exceeds the poverty level standard, there is no eligibility for QWD coverage. Persons who are not eligible for QWD may, however, be able to qualify for regular medical benefits based on a cash or spenddown determination.