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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

F-128 Substantial Gainful Activity (SGA) MS Manual 07/01/20 Substantial gainful activity (SGA) is defined as the performance of significant physical and/or mentalwork activities for pay or profit, or work activities generally performed for pay or profit. Countable monthly earnings are obtained by deducting any employer subsidy and any impairment related work expense (not payroll deductions) from the gross income (gross income includes payment in-kind for the performance of work in lieu of cash). Then, if earnings are irregular, they will be averaged over the period of months being consideredto obtain countable monthly earnings. Employer subsidy is the paymentof wages that is more than thevalue of the actual services performed. If the work is sheltered or if there is marked discrepancy between the amount of pay and the value of services, there exists the strong possibility of a subsidy that requires development of specific evidence. Sheltered Employment is work performed by individuals with disabilities in a protected environment under an institutional program; nonsheltered employment is any work performed by individuals in an unprotected environment. Impairment Related Work Expenses are items or services needed in order to maintain employment, such as attendant services, prostheses, or other devices. Drugs and medical services are not deductibleunless it can be shown they are necessary to control the disability to enable the individual to work. Deductible expenses must be paid for by the individual and cannot be reimbursable from any source. Legitimate expenses may include installation, repair, or maintenance. The payments may be deducted in one month or prorated over 12 months. The expenses must be considered “reasonable,” i.e., not more than Medicare would allow or than would ordinarily be charged in the individual’s community. Referto MS Appendix S for the current SGA amount for disability and blindness.

F-130 Child Support Enforcement Services MS Manual 04/01/26 The Office of Child Support Enforcement (OCSE) is mandated to provide services to all Health Care recipients who have assigned their rights to medical support to the State. Each applicant or recipient who is responsible for the care of a dependent child must cooperate with OCSE in establishing legal paternity and obtaining medical support for each child who has a parent absent from the home. (See exception below.)