Eligibility Policy and Procedures Manual
Appendices
A-2: Chart of Institutional Limits and Transfer Assets Divisors
A-3: Modified Adjusted Gross Income (MAGI) Limits Chart
A-4: Categories of Eligibility (COE) Chart
A-5: Sliding Scale for Working Disabled Premiums
A-6: Special Needs Trust and Pooled Trust Guidelines and Restrictions
A-7: Life Expectancy Tables
A-8-1: Long Term Care Income Trust Document
A-8-2: Long Term Care Income Trust Document and Help Sheet
A-9-1: Home and Community Based Services Income Trust Document
A-9-2: Home and Community Based Services Income Trust Document and Help Sheet
A-10: COL Computation History
A-11: Student Earned Income Exclusion
A-12: Request for Unofficial Medicaid Denial Letter
A-13: Non-MAGI Letter – DOM-304
A-14: Administrative Review Contact Documentation Form
A-15: Resource Assessment Notice
A-16: SSI Notices
A-17: ABD Handouts
A-18: Life Estate and Remainder Interest Tables
A-19: Required to File Worksheet
A-20: Lottery and Gambling Winnings
