Review the file to determine that the earnings requirement is met on or after the
time the claimant began a course of dialysis or received a kidney transplant, (e.g.,
a WE born in 1938, began dialysis in 9/78 requires 19 QC's to be fully insured or
6 QC's in the 13 calendar quarters ending in 9/ 79 to be currently insured, see RS 00301.105, RS 00301.110 and HI 00801.201B. Also see RS 01702.510C. for gratuitous Military Service Wage Credits (MSWCs) and DI 45001.200 and DI 11035.001 for Federal Quarters of Coverage (FQCs).
The claimant may be insured on his/her own earnings record, on a spouse's earnings
record, or on the earnings record of a parent or grandparent (see HI 00801.201C.) on whom the claimant is dependent. Care should be taken not to deny a claim for
lack of insured status until entitlement on all possible earnings record has been
considered, e.g., do not deny a married individual for lack of insured status without
investigating possible insured status of the spouse. When determining whether the
earnings requirement is met based on the earnings record of a deceased worker always
figure the insured status by using the date of birth of the deceased worker and the earlier of
1 ) the date the worker dies, 2) the date the worker attained age 62, or 3) the date
the ESRD claimant began a course of dialysis or received a kidney transplant.
If an earnings record is necessary to resolve the insured status requirement, follow
procedures in DI 11010.015 and RM 01403.015. MSWCs, FQCs, and railroad compensation are creditable for purposes
of R-HI insured status even though they may not be creditable for purposes of monthly
RSDI benefit entitlement (see HI 00801.201, HI 00801.400, and RS 01702.510). If there is an unresolved earnings discrepancy in file, refer the case to a claims
authorizer for handling per DI 40105.055 and RM 03844.020. Indicate the problem on a Form SSA-559 and request priority handling.
There will be instances when some individuals will seek re-entitlement to R-HI after
failure to receive a transplant which functioned effectively in excess of 36 months.
HI 00801.261 explains the special “HI Freeze” afforded these individuals.
An adult child who has been disabled since before age 22 shall be insured for “ESRD Medicare Purposes Only” if the parent meets the insured status requirements. ESRD insured status exists for
a disabled adult child regardless of the benefit status of either the insured parent
or the adult child.