Page 3

2

3455.15.10.10 SPOUSAL ALLOCATION DEDUCTION (MED 1) ...................................... 34

3455.15.10.15 FAMILY ALLOCATION DEDUCTION (MED 1) .......................................... 36

3455.15.10.20 LIABILITY DEVIATIONS (MED 1)…………………………………………………………………….. 3455.15.15 LIABILITY EXCEEDS FACILITY PRIVATE RATE (MED 1) ............................. 37 3455.15.15.05 LIABILITY EXCEEDS MEDICAID RATE (MED 1) ......................................... 39 3455.15.20 MEDICARE INVOLVED IN NURSING FACILITY PAYMENT (MED 1) ............. 39 3455.20.00 FINANCIAL ELIGIBILITY FOR RBA-RELATED MEDICAID (MED 1) ................. 40 3455.25.00 BUDGETING INCOME-IN-KIND (MED 1, MED 4) ....................................... 40 3460.00.00 BENEFIT CALCULATION (MED 2) ............................................................. 40 3460.05.00 REFUGEE TANF AND CASH ASSISTANCE (MED 2) ..................................... 42

3465.00.00 BENEFIT CALCULATION (MED 3) ........................................................................ 42 3465.05.00 MEDICAL ASSISTANCE BUDGETING FOR MAGI CATEGORIES (MED 3) ....... 42 3470.00.00 BENEFIT CALCULATION (MED 4) ......................................................................... 42 3470.05.00 QMB/QDW/SLMB/QI BUDGETING PROCEDURE (MED 4) ......................... 43 3475.00.00 1619 MEDICAID BUDGETING (MED 1) ................................................................ 44 3480.00.00 BUY-IN PROCEDURES AND EFFECTIVE DATES (MED) ........................................... 45