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MEDICAID ELIGIBILITY MANUAL Revised 1/1/2026 APPENDIX A-19-1

REQUIRED TO FILE WORKSHEET (Source: 2025 IRS Publication 501, Table 2)

Determine Required to File status of a dependent whose gross income is earned income only or unearned income using the amount listed in the table below for each income type applicable to the individual. Marital Status Condition EARNED Income only UNEARNED Income Only Annual Income Limit Annual Income Limit Single Under 65 and not blind $15,750 $1,350 Single Either 65 or older or blind $17,750 $3,350 Single 65 or older and blind $19,750 $5,350 Married Under 65 and not blind $15,750 $1,350 Married Either 65 or older or blind $17,350 $2,950 Married 65 or older and blind $18,950 $4,550

Use Table Below for Individuals with Both Earned and Unearned Income Annual Income Limits Use this worksheet when a dependent has both earned and unearned income. A dependent is generally Required to File if the dependent's gross income is more than line 5. The following worksheet is pre-filled for a single individual under age 65 and not blind. If other conditions exist, the minimum and maximum amounts will change. If only one type of income is received compare gross to the chart above. 1. Enter dependent's earned income plus $450 2. Minimum amount 1,350 3. Compare lines 1 and 2. Enter the larger amount 4. Maximum amount 15,750 5. Compare lines 3 and 4. Enter the smaller amount 6. Enter the dependent's gross income. If line 6 is more than line 5, the dependent is Required to File an income tax return. (Examples on page A -19-2)

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MEDICAID ELIGIBILITY MANUAL Revised 1/1/2026 APPENDIX A-19-1

REQUIRED TO FILE WORKSHEET (Source: 2025 IRS Publication 501, Table 2)

Determine Required to File status of a dependent whose gross income is earned income only or unearned income using the amount listed in the table below for each income type applicable to the individual. Marital Status Condition EARNED Income only UNEARNED Income Only Annual Income Limit Annual Income Limit Single Under 65 and not blind $15,750 $1,350 Single Either 65 or older or blind $17,750 $3,350 Single 65 or older and blind $19,750 $5,350 Married Under 65 and not blind $15,750 $1,350 Married Either 65 or older or blind $17,350 $2,950 Married 65 or older and blind $18,950 $4,550

Use Table Below for Individuals with Both Earned and Unearned Income Annual Income Limits Use this worksheet when a dependent has both earned and unearned income. A dependent is generally Required to File if the dependent's gross income is more than line 5. The following worksheet is pre-filled for a single individual under age 65 and not blind. If other conditions exist, the minimum and maximum amounts will change. If only one type of income is received compare gross to the chart above. 1. Enter dependent's earned income plus $450 2. Minimum amount 1,350 3. Compare lines 1 and 2. Enter the larger amount 4. Maximum amount 15,750 5. Compare lines 3 and 4. Enter the smaller amount 6. Enter the dependent's gross income. If line 6 is more than line 5, the dependent is Required to File an income tax return. (Examples on page A -19-2)