The Family Support Division (FSD) uses the Social Security Administration's (SSA) procedures when determining disability for MO HealthNet for participants who are not receiving Social Security Disability or Supplemental Security Income.
To be eligible for Social Security disability benefits, a person must be unable to engage in substantial gainful activity (SGA). A person who is earning more than a certain monthly amount (net of impairment-related work expenses) is ordinarily considered to be engaging in SGA. SSA has updated their policy to exclude any income from sick leave or vacation pay in determining the SGA.
Effective immediately, 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.
NOTE: This DOES NOT change how sick leave and vacation pay are considered for budget. Sick leave and vacation pay are still part of the gross earned income and must be entered in FAMIS.
- Review this memorandum with appropriate staff.
- Staff should begin noting sick leave and/or vacation pay on the IM-61 or notifying the Medical Review Team when they become aware of it.