Page 4

Aged, Blind and Disabled Manual Policy Manual Number: 120.015 Section: Medicare Savings Programs Chapter: Specified Low Income Medicare Beneficiary

January 5, 2026 Division of TennCare 4

The above budget is current as of April 2025.

7. SLMB and TennCare Medicaid Eligibility Individuals may be eligible for both TennCare Medicaid and SLMB, with the exception of TennCare Standard. Only individuals with “grandfathered status” in TennCare Standard may be eligible for both TennCare Standard and SLMB. Applicants/enrollees may not receive benefits in more than one Medicare Savings Program.

Total Countable Income (Total Net Unearned Income + Total Net Earned Income) = $ 1,747.50 Qualified Income Trust - $ 0.00 Net Countable Income

$ 1,747.50 Income Test Limit

$2,115.00 Income Test Result PASS Patient Liability N/A