OAR 461-135-0730: Specific Requirements; QDWI, QI, QMB, SLMB

(1) The following requirements apply to the Qualified and Disabled Individual (QDWI) program: (a) To qualify for QDWI, an individual must be eligible for Part A of Medicare as a qualified worker with a disability under Section 1818A of the Social Security Act (42 USC 1395i-2a). This is an individual under age 65 who has lost eligibility for Social Security Disability Insurance (SSDI) benefits because the individual has become substantially gainfully employed but can continue to receive Part A of Medicare by paying a premium. (b) A QDWI recipient is eligible only for payment of premiums for Part A of Medicare. If the individual is eligible for any other medical assistance program the individual is not eligible for QDWI. (2) The following requirements apply to the Qualifying Individual (QI) program: (a) To qualify for QI, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage. (b) An individual who is otherwise eligible for another Medicaid program offered by the Department or the Oregon Health Authority is not eligible for QI. (c) The QI program benefit is limited to payment for Medicare Part B premiums. (d) The QI program is subject to an enrollment cap based on the federal allocation. If the enrollment in this program exceeds the federal allocation, the program may be closed. (3) The following requirements apply to the Qualified Medicare Beneficiary (QMB) program: (a) To qualify for QMB, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage. (b) The QMB program benefits are limited to payments toward Medicare cost-sharing expenses. These expenses include the following: (A) Medicare Part A and Part B premiums. (B) Medicare Part A and Part B deductibles, co-pays, and coinsurance up to the Department's fee schedule. (4) The following requirements apply to the Specified Low-Income Medicare Beneficiary (SLMB) program: (a) To qualify for SLMB, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage. (b) The SLMB program benefit is limited to payment of Medicare Part B premiums.