Appendix B - CAMA budget worksheet
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Appendix B

 

Department of Health 

Division of Public Assistance

CAMAChronic and Acute Medical Assistance BudgetThe EIS screen or document used to measure an applicant's income (less certain cost and mandatory deductions) against an assistance program's need standard. The budget is used to determine eligibility. Worksheet

 

Case Name                                                                                                   Case Number

   

 

 

  1. Income
  

Gross Earned Income

 $

 

  

Mandatory Deductions (or 20%)

 -

 

  

Net Earned Income

 =

 

  

Unearned Income

 +

 

  

Total Net Income

 =

 

 

 

  1. Need Standard
     
 

Number of Individuals

  
     

Need Standard

 

 $


 

 

 

Financial eligibility exists only if the Need Standard Total exceeds Average Monthly Income

 

 

 

III.  Finding of Eligibility

 

   Yes? _______       No?   _______  

 

 

 

 

Notes        

 

 

Caseworker Date

 

 

 

 

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