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MEDICAID ELIGIBILITY MANUAL Revised 1/1/2026 APPENDIX A-19-2

Required to File Examples Earned Income Only - William is 16. His mother claims him as a tax dependent. He worked part time and earned $1,325 per month/ $15,900 annually. Compared to the chart for earned income only, his gross annual income is more than $15,750. William is required to file. His income counts in the Medicaid budget.

Earned Income Only - Billy is 15. His mother claims him as a dependent. He worked part-time and earned $1,000 per month/$12,000 annually. Compared to the chart for earned income only, his gross annual income is less than $15,750. Billy is not required to file. His income is not used in the Medicaid budget.

Unearned Income Only - Sarah is 18 and single. Her parents claim her as a dependent. She received taxable interest and dividend income of $165 per month/$1,980 annually. Compared to the chart for unearned income only, her gross annual income is more than $1,350. She is required to file a tax return. Her income counts in the Medicaid budget.

Combined Earned and Unearned Income Part 1: Joe is 20, single, not blind, and a full-time college student. He does not provide more than half of his own support. His parents claim him as a dependent. He received $200 taxable interest income and earned $247.50 per month/$2,750 annually from a part-time job. His gross income of $2,950 ($200 interest plus $2,750 in wages) is not more than $3,200, the amount on line 5 of “Required to File” worksheet. Joe is not required to file. His income does not count in the Medicaid budget. See Computation 1 below. Part 2: Same situation as above except Joe had $600 taxable interest income. His gross income of $3,350 ($600 interest plus $2,750 wages) is more than $3,200, which is the total of his wages plus $450 and the amount entered on line 5 of the “Required to File” worksheet. Joe is required to file. His income counts in the Medicaid budget. See Computation 2 below.

Computation 1 Computation 2 1. Earned Income + $450 = ($2,750 + $450) $3,200 1. Earned Income + $450 = ($2,750 + $450) $3,200 2. Minimum Amount $1,350 2. Minimum Amount $1,350 3. Enter Larger of Lines 1 & 2 $3,200 3. Enter Larger of Lines 1 & 2 $3,200 4. Maximum Amount $15,750 4. Maximum Amount $15,750 5. Enter Smaller of Lines 3 & 4 $3,200 5. Enter Smaller of Lines 3 & 4 $3,200 6. Dependent’s Gross Income ($2,750 + $200) $2,950 6. Dependent’s Gross Income ($2,750 + $600) $3,350 Joe is not required to file because $2,950 is less than $3,200 (Line 6 is less than Line 5). His income does not count in the Medicaid budget for his parents’ and/or siblings’ eligibility. Joe is required to file because $3,350 is more than $3,200 (Line 6 is greater than Line 5). His income counts in the Medicaid budget for his parents’ and/or siblings’ eligibility.