The Substantial Gainful Activity (SGA) limit is defined by the Social Security Administration and is usually updated annually. Refer to Appendix D – Substantial Gainful Activity for information regarding Substantial Gainful Activity.
Submitting information to MRT is:
- Required, when the applicant is employed and earning enough to be considered engaged in SGA, if the applicant claims to incur impairment-related work expenses (IRWE)
- Not required, if the applicant earns over the Ticket to Work (TWHA) limit and is not claiming any IRWE necessary to enable him or her to work
For applicants who claim to incur IRWE, it is important to gather accurate documentation regarding these expenses and income so that the MRT can make an appropriate decision regarding MHABD or Ticket to Work Health Assurance (TWHA) eligibility.
IRWE are expenses related to the participant’s disabilities that are necessary to enable him/her to work. IRWE may include, but are not limited to:
- Attendant care services
- Transportation costs
- Medical devices including durable medical equipment such as wheelchairs and braces
- The cost of drugs and medical services that are directly related to the individual’s impairment. Examples include but are not limited to: anticonvulsant drugs to control epilepsy; antidepressant medication for mental disorders; medication used to allay the side effects of certain treatments; radiation treatment or chemotherapy for cancer patients; immunosuppressive medications that kidney transplant patients regularly take to protect against graft rejection ; anticonvulsant blood level monitoring; corrective surgery for spinal disorders; electroencephalograms and brain scans related to a disabling epileptic condition; and tests to determine the efficacy of medication on a diabetic condition
- Prosthetic devices
- Work-related equipment and assistive devices such as one-handed typewriters, vision aids, helper animals, and sensory aids
It is the responsibility of the local FSD to obtain Verified Earned Income and Verified Medical Expenses. The FSD will exclude sick leave and vacation pay from the determination of SGA for disability purposes. For the Medical Review Team (MRT) to make an accurate determination of SGA:
- When income is known to be vacation or sick leave pay, the eligibility specialist (ES) must include the dates and amounts on the Social Information Summary (IM-61) in the Work History/Income section.
- When discovered at a date after the submission of the MRT Packet the income included vacation or sick leave pay, the ES should notify MRT per standard office procedures.
For offices using the MRT-PC, ensure that income recorded on the MRT Checklist has been converted to monthly amounts.
EXAMPLE: Mr. Smith’s pay stubs show he works 40 hours per week at a rate of pay of $7.00 per hour. 40 hours x $7.00 = $280.00 per week x 4.333= $1213.24. Mr. Smith does not claim impairment-related work expenses. $1213.24 is recorded on the Checklist.
NOTE: Do not hold submission of the MRT-PC Packet awaiting verification of earned income and medical expenses as the packet is time sensitive. There is a field to indicate that the income and/or expenses are pending at the time of submission. Provide the verification of either/both upon receipt.
If the income and expenses are not verified at the time the packet is submitted, they are emailed to MRT Processing Center at MRT.Personnel@dss.mo.gov when received. The email should be titled “Additional Information” and should include the individual’s name, date of birth, and DCN in the body of the email. If the ES chooses to submit the MRT Checklist form again in this email, including the updated/verified information, the ES must clearly indicate on the form that it is a duplicate submission with updated information.
EXAMPLE: Ms. Jones applied for MO HealthNet for the Aged, Blind, Disabled on February 2. During the discussion with the ES, she claims work-related equipment and assistive devices totaling $590.00 necessary to maintain employment. At the point of the application, Ms. Jones does not have verification of the income or expenses. The ES completes the MRT-PC packet, marking the box that the verification is pending, and submits it within 5 business days to the MRT Processing Center. Ms. Jones submits her paystubs and verification of her expenses. Ms. Jones’ pay stubs show she works 40 hours per week at a rate of pay of $7.00 per hour. 40 hours x $7.00 = $280.00 per week x 4.333 = $1213.24. She provides verification of the expenses for the total $590. The ES submits this verification by email to the MRT Processing Center.