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Aged, Blind and Disabled Manual Policy Manual Number: 110.010 Section: Financial Eligibility Requirements Chapter: ABD Eligibility Determination Group October 1, 2020 Division of TennCare 3 3. SSI-Related Eligibility Determination Group Financial eligibility in the SSI-Related COEs is determined based on an EDG size of one or two. Included EDG members are the applicant/enrollee and, if applicable, his eligible spouse if they have the same living arrangement. Otherwise, if there are additional household members, they will be considered in deeming budgets, if appropriate. For example, an ineligible spouse’s income and resources may be deemed into the budget. If an ineligible spouse’s income and resources are deemed into an applicant’s budget, the EDG size will be two. See the ABD Deeming of Income and Resources policy for additional information. If the applicant is a child, her parent’s assets and needs, e.g. financial responsibility to other children in the home, are considered in the deeming budget. 4. Institutional Medicaid Eligibility Determination Group Financial eligibility for Institutional Medicaid COEs is determined based on an EDG size of one. The only included EDG member is the applicant/enrollee. However, the community spouse and dependents do impact budgeting of the post-eligibility treatment of income (i.e. patient liability), and the community spouse’s resources are considered in the resource assessment. See the Post-Eligibility Treatment of Income and Resource Assessment policies. 5. Medicare Savings Program Eligibility Determination Group MSP household composition is governed by the principle of Financially Responsible Relatives (FRR) and the applicant/enrollee’s living arrangements. Financial responsibility is limited to spouse to spouse and parent to child. The living arrangement of each MSP applicant and, if applicable, his spouse and children, must be considered in determining EDG size. The following potential living arrangements should be taken into consideration for MSP applicants: a. A married individual living alone in the community, separated from her spouse is treated as an individual for MSP. b. A single or widowed individual living alone in the community is treated as an individual for MSP. c. A married couple living together in the community will be included in the EDG of one another, except when one or both spouses are eligible for HCBS. When an individual is eligible for HCBS and has a spouse living in the home, his spouse will not be included in the EDG. The institutionalized spouse will be treated as an individual and will have an EDG size of 1 for MSP. The community spouse’s EDG will include the institutionalized spouse and will be an EDG size of 2. d. A couple who lives separately because one is in the community and one is in a nursing facility will have an EDG size of 1 because they do not live together. e. A couple in which both spouses reside in a nursing facility will have an EDG size of 1 for MSPs, even if they share the same room.