Page 79

Title 8: Medicaid Page 75 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Nonfinancial Non-MAGI-Related Eligibility Revised October 10, 2025 When the Department Determines Disability Procedure: The Department’s process for determining disability is a shared responsibility of the IM worker and Disability Determination Services (DDS). NOTE: When the applicant has also applied for disability benefits from the SSA, wait on the SSA disability decision unless the applicant is eligible for only Medically Needy and the SSA is looking at SSDI (Title II) eligibility only. When the Department must determine disability, first decide if the person performs substantial gainful activity. EXCEPTION: Skip this step when determining eligibility under Medicaid for Employed People with Disabilities (MEPD). Make this decision within 15 calendar days of the application date. See Substantial Gainful Activity for an Employee and Substantial Gainful Activity for a Self- Employed Person for instructions. If the person is not engaged in substantial gainful activity (except for MEPD), send the medical evidence to the DDS. Do this no later than 15 calendar days from the application date. (See Submitting Medical Evidence to DDS.) Follow the steps listed below when an HHS determination is required. Step 1: IM worker determines if the client engages in substantial gainful activity (SGA). Clients whose current earnings are at or higher than the SGA level are earning too much to meet disability requirements. Determination:  Yes, the client engages in SGA. Deny disability. Determine if Medicaid eligibility exists under another coverage group.  No, the client does not engage in SGA Go to step 2. Step 2: DDS evaluates the client’s medical impairments and compares them to a list of qualifying impairments published in federal regulations. Determination:  Yes, impairment is listed. Go to step 3.