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□ □ □ □ □ □ □ □ □ □ □ MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD NEVADA STATE DIVISION OF SOCIAL SERVICES MEDICARE BENEFICIARY BUDGET Case Name Case Number Date Worker Name/Number CHECK WHICH APPLIES Member of a Couple, With Ineligible Spouse Individual Member of a Couple, With Eligible Spouse A. DEEMING COMPUTATION 1. Ineligible spouse’s unearned income…………………………………………………. Subtract allocation for ineligible children (children not applying for/receiving any type of public assistance) No. 1 No. 2 No. 3 Allocation $472.00 $472.00 $472.00 Subtract child’s (under 18) income - - - + + = a. Total Allocation…………………………………………………………………………… - b. Remaining unearned income………………………………………………………… 2. Ineligible spouse’s gross earned income……………………………………………… a. Subtract balance of allocation for ineligible child(ren) not offset by unearned income……………………………………………………………………. - b. Remaining earned income………………………….………………………………… c. Add remaining unearned income from 1.b.…………………………………… + 3. Total income after allocations……………………………………........................ LESS THAN $472.00, Deeming does NOT apply. Proceed to Part B, second column, using only the customer’s income $ 472.00 OR MORE, Deeming DOES apply. Proceed to Part B, first column, adding the figure in 1.b. to the customer’s unearned income in B.1. and using the figure in 2.b. to the customer’s earned income in B.2. START HERE START HERE B. ELIGIBILITY DETERMINATION Use combined income (customer and ineligible spouse after ineligible child allocations when deeming applies OR Title 54 of NRS (Nevada Revised Statutes) refers to "Professions, Occupations and Businesses," encompassing regulations for various professional licenses and practices within the state of Nevada, including architects, contractors, engineers, accountants, and healthcare practitioners. and eligible spouse) OR customer’s income if using INDIVIDUAL column. 1. Unearned income…………………………………………………………………………….. Customer and ineligible spouse’s deemed Customer Customer and eligible spouse a. Subtract general income exclusion………………………………………………. - 20.00 - 20.00 - 20.00 b. Remaining unearned income...…………………………………................... 2. Gross earned income……………………………………………………………………….. a. Subtract balance of general exclusion not offset by unearned income ……………………………………………………………………………………… - - - b. Remaining earned income…………………………………………………………… c. Subtract work expense exclusion………………………………………………… - 65.00 - 65.00 - 65.00 d. Remaining earned income……………………………………........................ e. Subtract 1/2 of 2.d. amount…………………………………………………………. ÷ 2 = ÷ 2 = ÷ 2 = 3. Total countable income (sum of 1.b. and 2.e.)……………………………………. 4. Compare 3. to the appropriate income limit from Appendix C. If the amount is greater than the limit for a couple in the first or third columns, or greater than the limit for an individual in the second column, the customer is ineligible for Medicaid. (If ineligible in the third column, proceed to the first column.)………………………………................. Compare to Couple Income Limit Compare to INDIVIDUAL Income Limit Compare to Couple Income Limit Income Month(s) ________________ Benefit Month(s) ________________ ELIGIBLE INELIGIBLE ELIGIBLE INELIGIBLE ELIGIBLE INELIGIBLE APPENDIX F MAABD BUDGETS MEDICARE BENEFICIARY BUDGET Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25