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Note For VA pensions, which are based on need, the A&A or housebound allowance amounts given above or the monthly unreimbursed medical expense (UME) amount shown on the award letter could be greater than the monthly VA pension amount. In this situation, disregard the entire pension. This page last updated in Release Number: 26-01 Release Date: 02/13/2026 Effective Date: 12/01/2025 40.1 Worksheets The following is a list of Medicaid financial worksheets. Worksheet Form Number Name 3 F-01298 Medicaid Deductible Worksheet 4 F-01297 Medicaid Institution Determination Worksheet 6 F-01305 Supplemental Security Income-Related Determination 7 F-01306 Spousal Impoverishment Income Allocation Worksheet 8 F-01307 Medicaid Purchase Plan (MAPP) Eligibility Worksheet (as of 8/1/2020) Click here for old version (prior to 8/1/2020) 9 F-01316 Medicaid Purchase Plan (MAPP) Premium Calculation Worksheet (as of 8/1/2020) Click here for old version (prior to 8/1/2020) 10 F-01317 Medicaid Purchase Plan (MAPP) Impairment Related Work Expenses (IRWE) Worksheet 11 F-01318 Medicaid Purchase Plan (MAPP) Medicaid and Remedial Expenses (MRE) Worksheet This page last updated in Release Number: 22-02 Release Date: 08/01/2022 Effective Date: 08/01/2022