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amount in the month the customer pays it, or divide the amount over the three months. Obtain verification of each Employment-Related Work Expense claimed, including the frequency of the payments. E-240.3 HIWA Income Determination a. Determine countable unearned income (MS 220). b. Subtract the general income exclusion of $20 to arrive at the net countable unearned income amount. c. Determine the gross earned income. d. Subtract any balance of the general income exclusion not offset by unearned income. e. Subtract the work expense exclusion of $65. f. Divide the remaining income by two and the remainder is considered the countable earned income. g. Subtract allowable Employment-Related Work Disregards (ERWD) from the countable earned income. The remainder is considered the net countable

earned income. h. Determine the total countable income by adding the net countable unearned income and the net countable earned income. i. Compare the total countable income to 250% FPL (see Appendix C). E-240.4 HIWA Premiums Individual applying for or receiving assistance under the HIWA program are required to pay a premium based on their monthly combined net income as a percentage of the Federal Poverty Level (FPL). At initial approval, the customer is “conditionally eligible,” awaiting verification from the Division of Health Care, Financing and Policy, the customer has paid their premium. Once verification is received, the customer is either approved for full Medicaid or denied for failing to pay the premium.  Individuals whose combined net income is less than 200% FPL will pay a monthly premium of 5% of their combined net income.  Individuals whose combined net income is between 200% and 250% FPL will pay a monthly premium of 7.5% of their combined net income. Prior medical month premiums are based on the combined net income for the months requested. The individual’s Medicaid premiums are recalculated any time a change in income is reported, but not less than once a year at the time of the annual eligibility redetermination. The Medicaid premiums are due on the first day of each month. If an individual fails to submit a premium payment, Nevada Medicaid will notify the Division around the 11th of the month, to terminate Medicaid effective the end of the month. If the customer subsequently pays their premium, they must submit an application to have the program reinstated. Individuals who are terminated from the HIWA program for failure to pay premiums will not be eligible for the HIWA program for two (2) years from the date of the past due premium(s) unless the past due premiums are paid in full. Division of Welfare and Supportive Services E-240.2 Medical Assistance Manual MAABD INCOME AND BUDGETING MTL 09/24 NOV 24 Computing Monthly Employment-Related Work Disregards