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Aged, Blind, and Disabled Manual Policy Manual Number: 115.015 Section: Categories of Eligibility Chapter: Institutional Medicaid

January 5, 2026 Division of TennCare 3 5. Financial Eligibility Requirements a. Eligibility Determination Group (EDG) The EDG for the Institutional Medicaid category is based on the principle of the Financially Responsible Relative (FRR). See the ABD Financially Responsible Relatives policy.

b. Resources Eligible individuals must have countable resources below the Institutional Medicaid Aged, Blind and Disabled (ABD) resource standard. The resource standard is $2,000.

The resources of an individual’s spouse or of an institutionalized child’s parent(s) may be deemed available to the individual. See the ABD Deeming of Income and Resources policy.

All individuals with a spouse must have a Resource Assessment completed prior to receiving an eligibility determination in the Institutional Medicaid category. Resources owned individually or jointly by members of a married couple are considered in the Resource Assessment and will be used to determine the Community Spouse Resource Maintenance Allowance (CSRMA). See the Resource Assessment policy.

Countable and excluded resources are determined using the ABD resource methodology as defined in the legal authority that governs SSI eligibility. See the ABD Countable and Excluded Resources policy.

c. Income i. General Rule Individuals must have countable income below the Medicaid Income Cap (MIC). The MIC is 300% of the SSI Federal Benefit Rate (SSI-FBR), a number which is annually updated by the SSA.

Income eligibility is determined by comparing the individual’s gross income to the MIC. If gross income is equal to or less than the MIC, the individual is income eligible in the Institutional Medicaid category. If gross income is greater than the MIC, the individual will be provided with the opportunity to establish a Qualified Income Trust (QIT). A QIT is a specific type of trust used only to establish Medicaid eligibility, in which an individual places certain types of monthly income. Once a QIT is established, the individual’s income eligibility is tested again to determine income eligibility. See the Qualified Income Trust (QIT) or Miller Trust section in the ABD Trusts policy. QIT deductions will not apply to Institutional Medicaid Hospital as a QIT is a trust that is created specifically for the purpose of becoming eligible for TennCare LTSS, and Institutional Medicaid Hospital does not provide LTSS benefits.