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Aged, Blind and Disabled Manual Policy Manual Number: 115.035 Section: Categories of Eligibility Chapter: Katie Beckett

January 5, 2026 Division of TennCare 3

a. Hardship Exception for Premium Assistance A hardship exception for premium assistance can only be requested if a child does not have private or employer-sponsored insurance when the child is first enrolled in Katie Beckett Part A. A hardship is considered to exist if: i. The cost of the child’s portion of available private or employer-sponsored insurance, including the cost of coverage for the parent when the parent is required to purchase health coverage in order to obtain coverage for the child, exceeds 5% of the family’s Modified Adjusted Gross Income (MAGI); or ii. The family’s MAGI is less than 400% of the Federal Poverty Level (FPL) and the child does not have access to employer-sponsored insurance through either parent’s employer.

A family who meets hardship criteria must still purchase health insurance for the child but may be granted premium assistance to help cover the child’s portion of the cost of insurance. For more information on premium assistance see section 8.

b. Loss of Health Insurance Children enrolled in Katie Beckett Part A who lose their private or employer-sponsored insurance will have 60 days to be enrolled in and submit proof of other insurance. A hardship exception for premium assistance is not available to children who have lost insurance but had private or employer-sponsored insurance at the time of enrollment in Katie Beckett.

5. Financial Eligibility Requirements Financial eligibility for the Katie Beckett COE is determined using Institutional Medicaid rules. Parent to child deeming of income and resources does not apply.

a. Eligibility Determination Group (EDG) Financial eligibility is determined based on an EDG size of one. The only EDG member included is the applicant.

b. Income Limit The income of the child must be no more than 300% of the SSI Federal Benefit Rate (SSI-FBR).

c. Resource Limit The child’s resources must not exceed $2,000.