A    Calculation for the Customer Only Examples

 

Examples

1)    Eligible under the 100% FBR Standard

The customer, a 65-year-old single individual, resides with her two adopted children ages 10 and 12.  The customer applies for AHCCCS Medical Assistance for herself in January 2023.

The customer receives $1,100.00 for Social Security Retirement per month.  She also works part-time to make extra money and received $780.00 in January 2023.  The two children do not have any income.

Calculate the customer’s eligibility as follows:

Step

Action

1

Calculate net unearned income:

$1,100.00 (customer’s total countable unearned income that is not needs based)

-$0.00 1/3 child support deduction (not applicable)

=$1,100.00 (subtotal)

-$20.00 (general income deduction)

=$1,080.00 (subtotal)

+$0.00 income based on need (not applicable)

=$1,080.00 (net unearned income)

2

Calculate net earned income:

$780.00 customer’s total countable earned income

-$0.00 (unused portion of the $20.00 general income deduction)

-$65.00 (standard work expense deduction)

-$0.00 (IRWE deduction)

=$715.00 (subtotal of earned income)

-$357.50 (one-half of the subtotal of earned income)

-$0.00 (blind work expense deduction)

=$357.50 (net earned income)

3

Calculate total net income:

$1,080.00 (net unearned income from Step 1 above)

+$357.50 (net earned income from Step 2 above)

=$1,437.50 (subtotal of net income)

-$914.00 child allocation ($457.00 per child, two children)

=$523.50 (total net income)

4

Compare the result in Step 3 above to $914.00 (100% of the FBR for an individual for 2023).

Because $523.50 is less than $914.00, the customer is income eligible for AHCCCS Medical Assistance under SSI-MAO using the 100% FBR standard.

 

2)    Eligible under the 100% FPL Standard

 

The customer is a 70-year-old single individual. The customer applies for AHCCCS Medical Assistance in February 2023.

The customer receives monthly income of $1,050.00 Social Security retirement.  He also works part time and made $125.00 in February 2023 from his job.

The customer’s eligibility is calculated as follows:

Step

Action

1

Calculate net unearned income as follows:

$1,050.00 customer’s total countable unearned income that is not needs based

-$0.00 1/3 child support deduction (not applicable)

=$1,050.00 subtotal

-$20.00 (general income deduction)

=$1,030.00 subtotal

+$0.00 income based on need (not applicable)

=$1,030.00 net unearned income

2

Calculate net earned income as follows:

$125.00 (customer’s total countable earned income)

-$0.00 (unused portion of the $20.00 general income deduction)

-$65.00 (standard work expense deduction)

-$0.00 (IRWE deduction)

=$60.00 (subtotal of earned income)

-$30.00 (one-half of the subtotal of earned income)

-$0.00 (blind work expense deduction)

=$30.00 (net earned income)

3

Calculate total net income as follows:

$1,030.00 (net unearned income from Step 1 above)

+$30.00 (net earned income from Step 2 above)

=$1,060.00 subtotal of net income

-$ 0.00 child allocation (not applicable)

=$1,060.00 (total net income)

4

Compare the result in Step 3 above to $914.00 (100% of the FBR for an individual).

Because $1,060.00 is greater than $914.00, Mr. Gray is income ineligible for AHCCCS Medical Assistance using the FBR standard. Continue to Step 5 to determine eligibility using the 100% FPL standard.

5

Take the total net income result from Step 3 and add the one-half subtotal of earned income from Step 2 back in:
$1,060.00 (total net income from FBR test)
+$30.00 (one-half subtotal of earned income)
=$1,090.00 (total net income)

6

Compare the result in Step 5 above to $1,215.00 (100% of the FPL for an individual):
Because $1,090.00 is less than $1,215.00, the customer is income eligible for SSI-MAO using the FPL standard.