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Monthly Maintenance Needs Allowance – Nevada allows the Federal Maximum Maintenance Need Standard for all Spousal Impoverishment cases. No Court Order is required. Housing Costs (principal place of residence) - the community spouse's expenses for rent or mortgage payment (including principal and interest), property taxes and mortgage/rental insurance. In situations where a maintenance charge is required, allow only that portion which does not include personal or individual utility expenses. Standard Utility Allowance (SUA) – an amount established under SNAP which is the statewide average of total monthly utility costs. o Do not allow SUA if utilities are included with the rent and cannot be separately identified. o If the telephone service is the only utility, allow the telephone allowance instead of the full SUA. Excess Shelter Allowance - An amount (if any) determined by subtracting the Federal Excess Shelter Deduction (30% of 150% poverty for two persons) from the community spouse's housing costs, plus the SUA. F-110 BUDGETING PROCEDURES FOR FINANCIAL ELIGIBILITY-FORM 2203-EM Perform the gross income test to determine if an individual is eligible as an institutional case. Perform the net income test to determine which aid code is applicable. F-110.1 Gross Countable Income Test (Form 2203-EM: Side 1, Column 1) – Unearned Income, Earned Income and Division of Income. a. Enter the countable amount of all unearned income of the institutionalized individual. b. Enter the gross earned income of the institutionalized individual. c. Determine the total gross countable income by adding items A. and B. d. Compare the total gross countable income to the income limit. If the gross countable income is less than or equal to the income limit, the customer is eligible as a state institutional case. If gross countable income exceeds the income limit and the customer is married, apply the equal division of income rules using column 1, item C. If one-half of the countable gross marital income exceeds the income limit, the customer is ineligible for Medicaid. Example 1: Mary is a single individual living in a skilled nursing facility and her only income is $950 gross RSDI. Her total countable income (Side 1, Column 1, total of A and B) is $950. The institutional income limit is $2,313. Mary is income eligible. Example 2: Mary is a married individual living in a skilled nursing facility. Her income is $2150 gross RSDI. Her spouse’s income is $750 gross RSDI. Using Side 1, Column 1, C - the gross community income is $2900 ($2150 + $750= $2900/2=$1450). The institutional income limit is $2,313. Mary is income eligible. F-105 LONG TERM CARE SERVICES Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25 DEFINITIONS