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Form: Patient Liability Worksheet

The worksheet below is not intended as a substitute for legal advice. It requires an understanding of the Medicaid budgeting process in the State where the applicant is applying for Medicaid. However, if the user knows how that process works, then this worksheet is designed to provide a “quick and dirty” estimate of the patient liability amount (a/k/a patient cost share) and includes an estimate of the Community Spouse income diversion.

The 2024 maximum Community Spouse Monthly Income Allowance is $3,853.50.

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