WORKSHEETS

NUMBER

NAME

Wkst 01

Medicaid Non-Financial

Wkst 02

Dependent Care

Wkst 03

Medicaid Deductible

Wkst 04

Medicaid Institution Determination

Wkst 05

Medicaid Extensions

Wkst 06

EBD – Related Determination Worksheet

Wkst 07

Spousal Impoverishment Income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. Allocation

Wkst 08

Medicaid Purchase Plan (MAPP The Medicaid Purchase Plan (MAPP) offers people with disabilities who are working or interested in working the opportunity to obtain health care coverage through the Wisconsin Medicaid Program.) Eligibility

Wkst 09

Medicaid Purchase Plan (MAPP) Premium Calculation

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

Wkst 13

FFU Income

Wkst 14

AFDC-Related Determination Worksheet