22-01 Version of 40.1 Worksheets

The following is a list of Medicaid worksheets. Workers should come here each time a worksheet is needed to insure they are using the most up to date worksheets.

WORKSHEETS
NUMBER	NAME
Wkst 01	Medicaid Non-Financial (obsolete)
Wkst 02	Dependent Care (obsolete)
Wkst 03	Medicaid Deductible
Wkst 04	Medicaid Institution Determination
Wkst 05	Medicaid Extensions (obsolete)
Wkst 06	Supplemental Security Income-Related Determination Worksheet
Wkst 07	Spousal Impoverishment Income Allocation
Wkst 08	Medicaid Purchase Plan (MAPPMedicaid Purchase Plan) Eligibility as of 8/1/2020 Medicaid Purchase Plan (MAPP) Eligibility prior to 8/1/2020
Wkst 09	Medicaid Purchase Plan (MAPP) Premium Calculation as of 8/1/2020 Medicaid Purchase Plan (MAPP) Premium Calculation prior to 8/1/2020
Wkst 10	Medicaid Purchase Plan (MAPP) Work Expenses
Wkst 11	Medicaid Purchase Plan (MAPP) Medicaid/Remedial Expenses
Wkst 12	Family Care Eligibility – Non-MA Financial Determination (obsolete)
Wkst 13	FFU Income (obsolete)
Wkst 14	AFDC-Related Determination Worksheet

This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030