Page 10

10

3) Refer to IV. for information on converting the income.

4) Use the converted income amount to determine eligibility.

b. Unearned Income

1) Total the income from each full benefit/payment received.

2) Divide by the number benefit/payments received to determine the average income.

3) Refer to IV., for information on converting the income.

4) Use the converted income amount to determine eligibility.

EXAMPLE: Applicant applied on Sept. 10. He received a partial amount of changed income on Sept. 7 of $100 and is paid weekly. He received $200 which is the full changed benefit on Sept. 14 and Sept. 21. Exclude the $100 received on Sept. 7 in your calculation. Add the $200 received Sept. 14 and 21 together ($400). Divide $400 by 2 (number of pay periods you used to determine the total amount) = $200 (average income). Convert $200 to a monthly amount by multiplying by 4.3 = $860.00 (gross monthly income). Use this amount to determine eligibility.

4. Processing Requirements

a. If base period income results in a deductible and the change is a decrease in income, if the change is not verified, send a DHB-5097/DHB-5097S, Request for Information, requesting verification of the changed income.

1) Upon receipt of the verification of changed income, follow conversion steps to determine monthly income.

2) If changed income results in a reduced deductible and a DHB-5098 has previously been sent, send a revised DHB-5098, Your Application for Medicaid is Pending for a Deductible, informing the applicant of the new deductible amount.

3) If the revised deductible is met, authorize eligibility effective the day the deductible was met.

4) If the changed income plus the base period income results in eligibility with no deductible, authorize eligibility effective the first day of the month of application.