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Aged, Blind and Disabled Manual Section: Categories of Eligibility Policy Manual Number: 115.030 Chapter: Widow/Widower Categories
March 18, 2019 Division of TennCare 1 WIDOW/WIDOWER CATEGORIES Legal Authority: Social Security Act §1634(d); 42 CFR 435.137; 42 CFR 435.138; 1990 OBRA § 5103; Tenn. Comp. R. & Regs. 1200-13-20 1. Policy Statement
TennCare Medicaid benefits are available to certain widows/widowers who would be eligible for Supplemental Security Income (SSI) payments if initial entitlement to and/or increases in their Social Security widow/widower benefit were disregarded. Widows/widowers who are eligible for TennCare Medicaid on the basis of their widow/widower status must meet all other non-financial and financial eligibility conditions.
Widows/widowers may qualify for this category of TennCare Medicaid coverage under one of two categories: a. Widow/Widower Spousal Retirement; or b. Widow/Widower Actuarial Reduction.
The Social Security Widow/Widower benefit is based on the deceased spouse’s Title II Old-Age, Survivors and Disability Insurance (OASDI) benefit.
2. Eligibility Categories
a. Widow/Widower Spousal Retirement
A disabled widow/widower is eligible for TennCare Medicaid for any month in which he is entitled to a Social Security Widow/Widower benefit, but is not eligible for SSI, if he:
i. Was eligible for SSI based on his own disability; ii. Was entitled to the Social Security Widow/Widower benefit any time after the age of 50; iii. Received an SSI benefit the month before the Social Security Widow/Widower benefit began; iv. Would be eligible for SSI if the Widow/Widower entitlement and all subsequent COLAs were disregarded; v. Is not entitled to Medicare Part A; and vi. Is at least age 50 and up to age 65.
b. Widow/Widower Actuarial Reduction
NOTE: This category is closed to enrollment.
TennCare Medicaid benefits continued for certain disabled widows/widowers who lost SSI eligibility in 1984 due to an increase in the Social Security Widow/Widower benefit that occurred as a result of a change in the way the benefit was calculated. In order to receive TennCare Medicaid benefits in this category; the individual must: