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F-110.2 Net Income Determination (Form 2203-EM: Side 1, Column 2) a. Enter the countable amount of all unearned income (or one-half of marital unearned income) from Column 1. b. Subtract the $20 general income exclusion from countable unearned income. c. Enter the gross amount of all earned income or one-half of the marital earned income (from Column 1) and subtract the following: 1. Any remaining general exclusion amount not offset by unearned income (example: unearned income is $16, leaving $4 left of the general exclusion); and 2. The earnings exclusion of $65; and 3. Impairment–related work expenses (IRWE). This exclusion only applies to earned income of disabled (but not blind) individuals under age 65. o The expense must be reasonable for items and/or services directly related to enabling an impaired individual to work and are necessarily incurred by the individual because of a physical or mental impairment. o IRWE’s are excludable if the cost is paid by the disabled individual and is not reimbursable from another source. 4. One-half of the remaining earned income. d. Determine total countable net income by adding Column 2, A-2 and B-2. e. Aid Code Determination – See appendix D for current benefit levels. SSI Institutional (SS) – These individuals are receiving the institutional $30.00 SSI payment. Would be SSI Eligible (WB) – These individuals have countable net income greater than $30.00 but less than the SSI payment level and would be receiving SSI or a state supplement if not residing in long-term care. Special Income (SI) – These individuals have countable net income between the SSI payment level and 142% of the SSI payment level. County Match (CM) – These individuals have countable net income exceeding the county match income limit (142% of the SSI payment level). The County pays the non-federal amount of assistance. F-115 RESOURCES FOR PERSONS INSTITUTIONALIZED AT LEAST 30 CONSECUTIVE DAYS Resources are assets, both real and personal, which an individual owns and can apply, either directly or by sale, to meet basic needs of food, clothing, shelter, and medical costs. Real property is land, including buildings or immovable objects attached permanently to the land. F-110.2 LONG TERM CARE SERVICES Net Income Determination Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25