Qualified Disabled Working Individual (QWDI) (S04)

Created on: 
Apr 06 2017

Qualified Disabled Working Individual (QDWI) (S04)

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is the Qualified Disabled Working Individual (QDWI) (S04) medical program?

The S04 medical is a Medicare Savings Program that pays clients Medicare Part A premium only. For additional information see Apple Health Eligibility manual - Apple Health Medicare Savings Programs.

Who is eligible for Qualified Disabled Working Individual (QDWI) (S04) medical?

A person who meets the following criteria may be eligible to receive S04 Medical:

  • Is eligible for or receiving Medicare Part A.
  • Be a U.S citizen, U.S national, qualified American Indian born abroad, or a qualified alien who satisfies or is exempt from the five-year bar.
  • Has countable income below 200% of the Federal Poverty Level (FPL) and countable resources at or below the resources standards. 
  • Is not receiving Categorically Needy (CN) or Medically Needy (MN) medical coverage under any other programs.
  • Is under the age of 65.

For additional information see Apple Health Eligibility manual WAC 182-517-0100 - Federal Medicare Savings Program.

How long is the Qualified Disabled Working Individual (QDWI) (S04) certification period?

S04 medical is certified for 12 months. For additional information see Apple Health Eligibility manual – WAC 182-504-0025 Medicare savings program certification periods.

Online Processing

How do I Screen a Qualified Disabled Working Individual (QDWI) (S04) Assistance Unit (AU)?

To screen in a S04 AU, take the following steps:

  1. Follow the instructions in Screening an Application.
  • On the Programs page, select the checkbox next to Medical.
  • In the Program Determination Criteria section, click the checkbox next to Medicare Part A Eligible
  • On the Finalize page, click Specify Program 
  • On the Finalize - Program Details page select the following:
    • Program drop down - Select Medical Assistance (MA)
    • Medical Coverage Group drop down - Select Qual Medicare Disabled Worker (S04)
    • ​​Program Type drop down - Select the appropriate option from the list

How do I process a pending Qualified Disabled Working Individual (QDWI) (S04) Assistance Unit (AU)?

To process a pending S04 AU, take the following steps:

  1. On the Assistance Unit Detail page, use one of the following financial responsibility codes to complete the Financial Responsibility field(s):
  • Applicant (PN) for the applicant and an applying spouse (if applicable).
  • Ineligible Spouse (SP) for an ineligible or non-applying spouse.
  • Child - SSI/Of SSI-related Parent/Used for HH size (SC) for any children.
  1. On the Client Details page, complete the following fields:
  • Disability/Incapacity Type field - Select the applicant's disability type from the drop down menu.
  • Approval Source field - Select the disability approval source from the drop down menu.
  • Approval Date field - Enter the [disability approval date].
  • Established Date field - Enter the [disability established date].
  • End Date: [MM/YYYY] field - Enter the [date the disability approval ends], if applicable.
NOTE: If S04 program eligibility is based on age, coding the Disability / Incapacitated / Psychiatric section is optional.
  1. On the Third Party Liability page, complete the following:
  • Organization Code field - Enter [MEDA] or [MEDB].
NOTE: Complete a second Third Party Liability page if the client has both Medicare Part A and Medicare Part B.
  • Policy Effective Dates field - Enter [Medicare Enrollment Date].
  • Policy Number field - Enter [Social Security claim number].
  1. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  2. Once the pending months have been processed, follow the instructions in the Finalize Application chapter.

What if the client is active on a Qualified Disabled Working Individual (QDWI) (S04) medical and they apply for Categorically Needy (CN) or Medically Needy (MN) Assistance Unit (AU)?

Client cannot be receiving CN or MN medical programs. User must close the S04 medical for all months that client is requesting CN or MN medical. See Apple Health Eligibility manual – WAC 182-517-0300 Federal Medicare savings and state-funded Medicare buy-in programs.

How do I close a Qualified Disabled Working Individual (QDWI) (S04) medical to open a Categorically Needy (CN) or Medically Needy (MN) Assistance Unit (AU)?

You must manually close the S04 AU with a 500-level reason code in all historical months where a CN or MN medical program is opened for the client. The S04 medical must be closed before the CN or MN medical is finalized. For additional information see How do I deny or terminate a case with a 500 level Reason Code?.

Mainframe Processing

How do I screen a Qualified Disabled Working Individual (QDWI) (S04) Assistance Unit (AU)?

To screen S02 medical, see Online Processing - How do I screen a Qualified Disabled Working Individual (QDWI) (S04) medical?

How do I process a pending Qualified Disabled Working Individual (QDWI) (S04) Assistance Unit (AU)?

To process a pending S04 AU, take the following steps:

  1. On the AMEN screen, select Option O – Interview.
  2. On the STAT screen, complete the Finl Resp fields as follows:
  • [PN] – Applicant for applicant.
  • [SP] – Ineligible Spouse for an ineligible or non-applying spouse.
  • [SC] – Child used to determine family size for any children (documented or undocumented).
  1. On the DEM2 screen:
  • Enter the applicant’s disability information in the Disability/Incapacity fields if applicable. See <F1> Help.
  • Enter a [Y] in the Entitled Medicare field.
  • Press <F22> to access the TPL1 screen.
  1. On the TPL1 screen:
  • Enter [MEDA] or [MEDB] in the Org field.
  • Enter [Medicare Enrollment Date] in the Policy Effective Dates From field.
  • Enter [Number on Medicare Card] in the Policy Number field.
Note: Complete a second TPL1 screen if the client has Medicare Part A and Medicare Part B.
  1. On the MISC screen:
  • Enter [Y] or [N] in the Retro Med field.
  • For SSI related clients, enter a [1] or [2] in the ABD Area field.
NOTE: Effective 01/01/05, Apple Health Eligibility manual – WAC 182-512-0010 Supplemental Security Income (SSI) standards was modified (Revision 389) to eliminate Area 1 and Area 2 standards, there is now only one standard instead of two.
  1. After committing the interview data, follow the instructions in Process Application Month chapter for all pending months.
  2. After all pending months have been processed; follow the instructions in Finalize Application to complete the S04 eligibility determination.

What if the client is active on a Qualified Disabled Working Individual (QDWI) (S04) medical and they apply for Categorically Needy (CN) or Medically Needy (MN) Assistance Unit (AU)?

Client cannot be receiving CN or MN medical programs. See Apple Health Eligibility manual – WAC 182-517-0300 Federal Medicare savings and state-funded Medicare buy-in programs. User must close the S04 medical for all months that client is requesting CN or MN medical.

How do I close a Qualified Disabled Working Individual (QDWI) (S04) medical to open a Categorically Needy (CN) or Medically Needy (MN) Assistance Unit (AU)?

You must manually close the S04 AU with a 500-level reason code in all historical months where a CN or MN medical program is opened for the client. The S04 medical must be closed before the CN or MN medical is finalized. For additional information see How do I deny or terminate a case with a 500 level Reason Code?.

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.