Page 6

6 c. M-QB (Q, B or E): If the M-QB (Q, B or E) amount was entered on Line 12 and there is no excess income on Line 13, the a/b is income eligible for M-QB provided they have Medicare.

C. Medicaid Couple (Both Applying)

Complete Section C, of the DHB-5008aAdult Budget Sheet to determine whether the couple is financially eligible for N or if there is a M deductible, or if they are eligible for M-QB (Q, B or E).

1. Total the couple's gross unearned income from all sources. Enter total GROSS unearned income on Line 1.a.

2. On Line 2 subtract the $20 General Exclusion unless all of the income is from a VA pension.

3. Enter the net unearned income on Line 3 (Line 1 minus Line 2). Go to line 11 if no earned income.

4. Earned Income - Enter total gross earned income of the couple on Line 4.a. (For certain incomes this is the amount after operational expenses.)

5. On Line 5 subtract remainder of the $20 General Exclusion if any used by unearned income. If there is only earned income, subtract the $20 from earned income.

6. Line 6 is the subtotal of earned income (Line 4 minus Line 5).

7. On Line 7 subtract the $65 work expense exclusion from earned income.

8. Enter the difference by subtotaling Line 8 (Line 6 minus Line 7).

9. On Line 9 subtract 1/2 of Line 8.

10. The result on Line 10 is the Net Earned Income (Line 8 minus Line 9).

11. The amount on Line 11 is the Total Net (countable) Income (Line 3 plus Line 10).

12. On Line 12 subtract the couple income maintenance amount for the aid program/category in which eligibility is being evaluated (CN/MN/M-QB/M-WD).

13. Determination of Eligibility for Appropriate Coverage Group

a. Categorically Needy:

(1) If the couple's income on Line 11 is equal to or less than N income level for a couple, the couple is financially eligible for N coverage.