4-004.01 Use of Budget Form DA-4M

469 NAC 4-004.01

The worker uses Form DA-4M or N-FOCUS for an eligible spouse in a specified living arrangement and an ineligible spouse in the community (see 469 NAC 4-007.01 ff.).

Side 2 of Form DA-4M is used to calculate the amount of income (if any) to be allocated from the eligible spouse to the ineligible spouse and/or family members.

Side 1 of Form DA-4M is used to calculate eligibility for medical assistance only or medical assistance with share of cost for the eligible spouse.