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Title 8: Medicaid Page 80 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Nonfinancial Non-MAGI-Related Eligibility Revised May 22, 2026 When the Department Determines Disability

Mrs. P applies for Medicaid based on disability. She states that her disability is fibromyalgia. The worker evaluates Mrs. P’s employment status for SGA. Mrs. P continues to work at the same job with the same duties (meeting the Comparability Test), but her medical condition has caused her to reduce her work schedule from 40 hours per week to 20 hours per week, which has cut her earnings in half (the Worth Test). Her hourly wage is $21 per hour. Her average monthly pay is $1,806. The worker determines that Mrs. P does not meet the SGA test for disability for most Medicaid coverage groups because she continues to do the same work and her earnings were over $1,690. However, because Mrs. P is still employed, she appears to be eligible for MEPD. The worker makes a referral to DDS for a disability determination; noting on the Disability Transmittal to skip the step of determining SGA. Substantial Gainful Activity for a Self-Employed Person Legal reference: 20 CFR 416.975, 441 IAC 75 (Rules in Process) Policy: There are three tests for “substantial gainful activity” (SGA) for a self- employed person. If the person does not meet the criteria in all three tests, the person is not engaged in SGA, and a HHS disability determination must be done.

Name of Test: What this means: 1. Significant services and substantial income This test is met if significant services are combined with substantial income. a. Significant services When a person (with the exception of a farm landlord who rents farmland to another farmer) gives significant services by participating in the following:  Gets a social security earnings credit on the federal income tax return.  Advises or consults with the renter and inspects production periodically.  Furnishes a large portion of the machinery and financing.