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Aged, Blind and Disabled Manual Policy Manual Number: 115.010 Section: Categories of Eligibility Chapter: Disabled Adult Children March 18, 2019 Division of TennCare 4 General Deduction ($20) - $ 20.00 Child Support Disregard - $ 0.00 Widow/Widower Entitlement Disregard - N/A DAC Entitlement Disregard - $ 750.00 COLA Disregard - 0.00 Total Net Unearned Income = $ 0.00 Self-Employment Income

$ 0.00 Earned Income + $ 200.00 Irregular Earned Income Disregard - $ 0.00 Student Earned Income Exclusion - $ 0.00 Ineligible Spouse’s Deemed Earned Income + $ 0.00 Remaining General Deduction - $ 0.00 Earned Income Deduction - $ 65.00 Impairment Related Work Expense - $ 50.00 ½ Deduction - $ 42.50 Blind Work Expense - $ 0.00 Total Net Earned Income = $ 42.50 Total Countable Income (Total Net Unearned Income + Total Net Earned Income) = $ 42.50 Qualified Income Trust - $ 0.00 Net Countable Income

$ 0.00 Income Test Limit

$ 733.00 Income Test Result PASS Patient Liability $ 0.00 The above budget is current as of Januray 2017.