Page 85

Official source

Title 8: Medicaid Page 81 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

Name of Test: What this means: b. Substantial income When a person has:  Countable income over $1,690 per month.  Countable income that meets the community standard of livelihood for a self-employed person with a similar business. 2. Comparability of work If work activities are comparable to that of an unimpaired person in the community engaged in the same or similar business, the person is engaged in SGA. 3. Work activity If the value of the work is more than $1,690 per month based on the amount an employer would pay any employee to do the same job, the person engages in SGA. Procedure: To determine SGA for a self-employed person, consider the three tests in order, as explained in the following chart. EXCEPTION: Do not determine SGA for the Medicaid for Employed People with Disabilities (MEPD) group. If the earnings are comparable to unimpaired people in the community in the same business, there is substantial income and the person engages in SGA. If there is “material participation” and “substantial income,” this means there is SGA, unless material participation has been reduced or has stopped. Determine if the significant services are the same at the time of application as before the person’s impairment. If the self-employment was less than six months and has stopped, or the income level indicating substantial gainful activity continued for less than six months, there is no SGA. If there is reasonable doubt whether the person meets SGA, assume the person does not meet SGA criteria.

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Page 85

Official source

Title 8: Medicaid Page 81 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

Name of Test: What this means: b. Substantial income When a person has:  Countable income over $1,690 per month.  Countable income that meets the community standard of livelihood for a self-employed person with a similar business. 2. Comparability of work If work activities are comparable to that of an unimpaired person in the community engaged in the same or similar business, the person is engaged in SGA. 3. Work activity If the value of the work is more than $1,690 per month based on the amount an employer would pay any employee to do the same job, the person engages in SGA. Procedure: To determine SGA for a self-employed person, consider the three tests in order, as explained in the following chart. EXCEPTION: Do not determine SGA for the Medicaid for Employed People with Disabilities (MEPD) group. If the earnings are comparable to unimpaired people in the community in the same business, there is substantial income and the person engages in SGA. If there is “material participation” and “substantial income,” this means there is SGA, unless material participation has been reduced or has stopped. Determine if the significant services are the same at the time of application as before the person’s impairment. If the self-employment was less than six months and has stopped, or the income level indicating substantial gainful activity continued for less than six months, there is no SGA. If there is reasonable doubt whether the person meets SGA, assume the person does not meet SGA criteria.