LIS Calculation Chart - WIPA NTDC



LIS Calculation SheetCustomer Name____________________________________ Date ________________________Work Incentives Counselor__________________________________________Scenario Description:Beneficiaries who are dually eligible (also have Medicaid of any type) are deemed eligible for full LIS with no additional financial assessment. Do not use this chart for those beneficiaries.StepCalculationsUnearned IncomeGeneral Income Exclusion (GIE) $20?Countable Unearned Income= Gross Earned IncomeStudent Earned Income Exclusion?RemainderGIE (if not used above) $20?RemainderEarned Income Exclusion (EIE) $65?RemainderImpairment Related Work Expense (IRWE) (16.3% of gross wages or actual amount if higher)?RemainderDivide by 2Blind Work Expenses (BWE) ( 25% of gross wages or actual amount if higher)?Total Countable Earned Income=Total Countable Unearned IncomeTotal Countable Earned Income+PASS Deduction?Total Countable Income=Compare the Total Countable Income to the Federal Poverty Level ChartLIS LevelsFull LIS: No more than 135% FPLPartial LIS: No more than 150% FPL ................
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