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MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD INSTRUCTIONS FOR FORM 2039-EE (2024) "VETERAN ADMINISTRATION (VA) UNUSUAL MEDICAL EXPENSE (UME) BUDGET" PURPOSE ⎯ To assist the case manager in determining the portion of a veteran's pension which is an UME reimbursement. UME is excluded as income for financial eligibility and patient liability. INSTRUCTIONS 1. Enter maximum VA annual rate in field "A". 2. Enter the customer’s/spouse's gross annual income as reported on VA award letter in field "B". CAUTION: Don’t use VA's indication of COUNTABLE ANNUAL INCOME as this amount is the result of "net countable income" less medical expenses. 3. Subtract the customer’s income from the VA rate. Enter the difference in field "C". If the answer is zero or a negative figure, the entire VA "payment" to the customer is UME. If the answer is greater than zero, a portion of the VA "payment" may be countable income. Divide this figure by twelve (12) to reach the monthly countable VA benefit. If the monthly countable VA income is less than the rate for Aid and Attendance (A&A) or House Bound (HB) payment, exclude this income in financial eligibility and patient liability. If the monthly countable VA income is greater than the A&A or HB rate: 1. Enter the monthly countable VA income in field "E". 2. Enter the maximum A&A or HB rate in field "F". 3. Subtract the A&A or HB rate from the monthly countable VA income. Enter the difference in field "G". NOTE: USE THE VA AWARD LETTER TO OBTAIN VA ANNUAL RATES AND THE CUSTOMER/SPOUSE'S INCOME. EXAMPLE #1 U . . .WE INCLUDED THE FOLLOWING SOURCES OF INCOME YOU REPORTED: SELF: EARNED $00000; SOCIAL SECURITY $06061; RETIREMENT $00000; INTEREST $00000: INSURANCE $00000; AND OTHER INCOME $00000. EXAMPLE #2  . . .OUR DETERMINATION THAT YOUR NET COUNTABLE INCOME IS $10367. WE ARE CONSIDERING YOUR OWN INCOME OF $0 FROM EARNINGS, $10297 FROM SOCIAL SECURITY BASED UPON A MONTHLY PAYMENT OF $858.10, $0 FROM ANNUITY/RETIREMENT AND $70 FROM OTHER SOURCES. APPENDIX F MAABD BUDGETS INSTRUCTIONS FOR FORM 2039-EE (2024) Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25