TC Categories

Question 1

Receiving SSI (eligibility determined by SSA), auto enrolled in TennCare, auto buy-in for Medicare Pt A & B, no MSP

Answer 1

SSI Cash Recipient

Question 2

Age 65, blind, or disabled; require nursing facility level of care; income limit 300% FBR; Resource limit: $2000; PAE required

Answer 2

Institutional Medicaid

Question 3

Newborn babies through first year, children born to mothers that are receiving TennCare at the time of birth are auto eligible, no income or resource test required

Answer 3

Deemed Newborn

Question 4

In DCS custody until 18, aged out of DCS custody, receiving TennCare, maintains eligibility until age 26 if individual remains a TN resident, no income or resource test

Answer 4

Former Foster Care

Question 5

No SSN required, TN resident, US Citizen/National/Eligible non-citizen, 195% FPL, no resource test

Answer 5

Child MAGI Age 0-1

Question 6

Must have or applied for SSN, TN resident, US Citizen/National/Eligible non-citizen, 142% FPL, no resource test

Answer 6

Child MAGI Age 1-5

Question 7

Must have or applied for SSN, TN resident, US Citizen/National/Eligible non-citizen, 135% FPL, no resource test

Answer 7

Child MAGI Age 6-19

Question 8

Income must be at or below Income Standard, Child Support Cooperation, no resource test, non-financial requirements must be met

Answer 8

Caretaker Relative MAGI

Question 9

195% FPL, SSN req, no resource test, TN resident, US Citizen/National/Eligible non-citizen, verification of pregnancy is self-attestation, remain eligible through 60 day postpartum period

Answer 9

MAGI Pregnant Woman

Question 10

Lost Child MAGI or Caretaker Relative MAGI due to increase earnings. Must have received TennCare Medicaid benefits for 3 of the last 6 months prior to eligibility. Income was below the current Caretaker Relative income standard based on EDG size for 3 of the last 6 months prior to eligibility. Member receives 12 months of Medicaid.

Answer 10

Transitional

Question 11

Lost Child MAGI or Caretaker Relative Magi due to increase in spousal support. Must have received TennCare Medicaid benefits for 3 of the last 6 months prior to eligibility. Income was below current CR income standard based on EDG size for 3 of the last 6 months prior to eligibility. Member receives 12 months of Medicaid.

Answer 11

Extended

Question 12

Minimum age 18; lost SSI payments due to increase or entitlement to DAC benefits; receive SS benefit as a disabled adult child based on blindness or disability prior to age 22; lost SSI payments after July 1987; income equal to SSI FBR; resource limit $2000 for one and $3000 for couple; If married, spouse must be receiving SSI related coverage

Answer 12

Disabled Adult Child

Question 13

Eligible for SSI based on his/her own disability; Entitled to SSI after age 50; lost SSI when widow/widower benefits paid; Between ages 50 and 65; Not entitled to Medicare Pt A

Answer 13

Widow/Widower

Question 14

Named after Congressman JJ Pickle; Applicant received SSI and SSA in the same month and lost SSI due to COLA; At least 65

Answer 14

Pickle Passalong

Question 15

Under age 21; EDG includes applicant, siblings under 21 (including newborn), in-home parents, and spouse of applicant under 21; resource limit: $2000 for one and $3000 for couple, plus $100 for each additional individual; Income is determined by the AFDC methodology; less than or equal to MNIS based on EDG size. Can spend down resources to qualify; Count income of the applicant and FRR.

Answer 15

Child Medically Needy

Question 16

EDG includes applicant, siblings under 21 (including newborn), in-home parents, and spouse of applicant under 21; Coverage through 60 days following the end of pregnancy (self-attestation regarding pregnancy); resource limit: $2000 for one and $3000 for couple, plus $100 for each additional individual; Income is determined by the AFDC methodology; less than or equal to MNIS based on EDG size

Answer 16

Pregnant Medically Needy

Question 17

Covers cancer and precancerous conditions that require ongoing treatment; Must have verified diagnosis; Under age 65; Uninsured; Participate in the schedule of care plan; Income under 250% FPL; No resource test; Apply through DOH or Memphis Health Center

Answer 17

Breast or Cervical Cancer (BCC)

Question 18

Losing TennCare Medicaid, Under 19, Income at or BELOW 211% FPL, does not have access to insurance

Answer 18

TennCare Standard

Question 19

Losing TennCare Medicaid, under 19, Income ABOVE 211% FPL, no access to insurance, qualifying medical condition

Answer 19

TennCare Standard Medically Eligible

Question 20

Child under 19, unborn babies of pregnant women, ineligible for TennCare Medicaid, income at or below 250% FPL, meets non-financial requirements

Answer 20

CoverKids Child

Question 21

For women with no other coverage for maternity benefits, 60-day postpartum period, The pregnant woman does not have to meet the citizenship or immigration requirements, Income at or below 250% FPL, Receives 60-day post- partum coverage, Must be the only health insurance plan unless plan doesn’t cover pregnancy

Answer 21

CoverKids Pregnant

Question 22

For individuals who meet all requirements in a MAGI or Medically Needy category except citizenship or immigration; Coverage only lasts the duration of the emergent episode (until stabilization)

Answer 22

Emergency Medical Services (EMS)

Question 23

For people who had rec SSI payments from the SSA and lost SSI before they tested for other categories of TennCare eligibility; Referred to as Cluster Daniels coverage

Answer 23

SSI Transitional

Question 24

Allow eligible elderly and/or disabled to remain in homes and communities; 3 groups: Medicaid-reimbursed LTSS in a NF; age 65 and older or adults 21 and older with physical disabilities who meet the NF LOC criteria; and SSI rec not meeting NF LOC but are “at risk” for NF care

Answer 24

CHOICES LTSS

Question 25

Provides HCBS to four target populations: i. Children under age 21 with I/DD living at home with family who meet the NF LOC; ii. Children under age 21 with I/DD living at home with family who do not meet the NF LOC, but who, in the absence of HCBS, are at risk of NF placement; iii. Adults age 21 and older with I/DD who meet the NF LOC and need specialized services for I/DD; or iv. Adults age 21 and older with I/DD who do not meet the NF LOC, but who, in the absence of HCBS, are at risk of NF placement.

Answer 25

CHOICES Employment & Community First (ECF)

Question 26

Can be eligible either premium free Medicare Pt A or purchase PT A. Income cannot exceed 100% of FPL. Resource Limit: $7970 for one or $11960 for 2. Benefits from TC include payment of Pt A & Pt B premiums, Medicare deductibles, and Medicare coinsurance. May be eligible for both TC Medicaid & QMB. HH comp governed by principle of FRR.

Answer 26

QMB - Qualified Medicare Beneficiary

Question 27

Must be enrolled in Medicare Pt A. Income must be at least 100% FPL, but less than 120% FPL. Resource Limit: $7970 for one or $11960 for 2. Benefits only include payment of Pt B premiums. May be eligible for both TC Medicaid and SLMB. HH comp governed by principle of FRR.

Answer 27

SLMB - Specified Low-Income Medicare Beneficiary

Question 28

Must be enrolled in Medicare Pt A. Income must be at least 120% FPL, but less than 135% FPL. Resource Limit: $7970 for one or $11960 for 2. Benefits only include payment of Pt B premiums. Must not be enrolled in TC Medicaid or TC Standard. HH comp governed by principle of FRR.

Answer 28

QI1 - Qualified Individual 1

Question 29

Must be eligible to enroll in Medicare Pt A but not free Medicare. Income up to 200% FPL. Resource Limit: $4000 for 1 and $6000 for 2. Benefits include payments of Medicare Pt A premiums only. Must not be enrolled in TC Medicaid or TC Standard. HH comp governed by principle of FRR.

Answer 29

QDWI - Qualified Disabled Working Individual