1. (a) Eligibility. Public Law 101-239, the Omnibus Budget Reconciliation Act of 1989, requires the department to pay Medicare Part A premiums for certain clients. The department uses Supplemental Security Income (SSI) policy to determine eligibility for Type Program 25. If a client is eligible for the QDWI program, the department pays only his monthly Medicare Part A premium. No other benefits are available to the client. The client does not receive the medical care identification card or the medical eligibility verification form. The department pays Medicare Part A premiums for clients who:

   1. (1) have not reached age 65;
   2. (2) are entitled to enroll in Medicare Part A under the Social Security Act, §1818A;
   3. (3) are not otherwise eligible for Medicaid;
   4. (4) have monthly incomes equal to or less than 200% of the federal poverty level; and
   5. (5) have countable resources equal to or less than twice the limits for the SSI program.

2. (b) Medical effective date. The medical effective date is influenced by whether the client enrolls for Medicare coverage during the initial enrollment period but before his present Medicare entitlement ends, after the initial enrollment period begins but after his entitlement ends, or following the initial enrollment period. The department considers the date the client enrolled for continuation of his Medicare entitlement when determining the medical effective date. The medical effective date does not precede the earliest date the client is entitled to reinstatement of his Part A coverage. The following applies when determining the medical effective date.

   1. (1) The initial enrollment period for a client who has been notified that his free entitlement to Medicare Part A coverage will end is a seven-month period. The enrollment period begins the month the client is notified.
   2. (2) In the case of an individual who enrolls in an initial enrollment period before meeting QDWI criteria and applies for QDWI benefits, the medical effective date is the first day of the month he meets the QDWI criteria.
   3. (3) If the client enrolls in the first month that he meets all QDWI criteria except for reinstatement (fourth month of the initial enrollment period) and applies for QDWI benefits, the medical effective date is the first of the following month.
   4. (4) If the client enrolls in the second month that he meets all QDWI criteria except for reinstatement (fifth month of the initial enrollment period) and applies for QDWI benefits, the medical effective date is the second month after enrollment.
   5. (5) If the client enrolls in the third or fourth month that he meets all QDWI criteria except for reinstatement (sixth or seventh month of the initial enrollment period) and applies for QDWI benefits, the medical effective date is the first day of the third month following the month he enrolled.
   6. (6) If the client enrolls during the general enrollment period, the medical effective date is always July 1.
3. (c) Notification. The department notifies QDWI clients of the eligibility decision on the eligibility notice--qualified disabled and working individuals form. The department also uses the eligibility notice form for active QDWI cases that involve adverse action. The requirements for the 12-day notification period and continuing benefits pending a hearing must be followed for adverse action on QDWI benefits.

Source Note:The provisions of this §358.203 adopted to be effective July 1, 1990, 15 TexReg 4030; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013.