Page 8

□ □ □ □ □ □ □ □ □ □ □ MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD NEVADA STATE DIVISION OF SOCIAL SERVICES Case Name: ________________________ SSI BUDGET Case No.: __________________________ 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. $472.00OR 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. SSI ELIGIBILITY DETERMINATION Use combined income (customer and ineligible spouse after ineligible child allocations when deeming applies OR customer 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 SPA. If amount is equal or greater than the SPA in the first and second columns, the customer is ineligible for Medicaid. If ineligible in the third column, proceed to the first column……………………………………………………………………. Compare to Couple (SPA) Compare to INDIVIDUAL (SPA) Compare to Couple (SPA) Income Month(s) ________________ Benefit Month(s) ________________ ELIGIBLE INELIGIBLE ELIGIBLE INELIGIBLE ELIGIBLE INELIGIBLE Worker: ______________________________ Date: ________________________________ SSI PAYMENT AMOUNTS (SPA) Effective 1/1/24 through 12/31/24 Aged $979.40 $1,489.46 Blind $1,052.30 $1,789.60 Disabled $943.00 $1,415.00 Aged person and Blind spouse $1,639.53 Aged person and Disabled spouse $1,452.23 Blind person and Disabled spouse $1,602.30 APPENDIX F MAABD BUDGETS Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25 SSI BUDGET