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(MRG) UPDATED: APRIL 2008 38 CATEGORICAL FACTORS SSI-RELATED SUBSTANTIAL GAINFUL ACTIVITY (SGA) Description: Persons who are performing Substantial Gainful Activity (SGA) are not usually considered disabled. However, local districts must refer all such cases to the State Disability Review Team for a disability determination for the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD). Policy: SGA is work activity that involves performing significant physical and/or mental activities for pay or profit. Work can be substantial and gainful even if it is performed part-time or requires less responsibility than former work. Activities such as household tasks, hobbies, club activities or social programs generally are not considered substantial gainful activity. References: Dept. Reg. 360-5.2 Disability Manual GISs 06 MA/029 04 MA/031 Interpretation: The amount of gross monthly earnings from work activities (minus appropriate impairment-related work expenses) may establish that the individual is engaging in SGA. The maximum amount of gross earnings is identified in the REFERENCE SUBSTANTIAL GAINFUL ACTIVITY. When an individual’s gross earnings from work activities average in excess of the identified monthly amount, this generally demonstrates the ability to engage in SGA in the absence of evidence to the contrary (See DISABILITY MANUAL). Federal regulations provide for annual automatic cost of living adjustments to the SGA threshold amount. NOTE: When evaluating whether or not an individual is performing SGA, consider the nature of the work being done, the adequacy of the performance, any special employment conditions and the amount of time that is spent in work activity. When to Verify: When a potentially disabled A/R declares that s/he is employed.