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Aged, Blind and Disabled Manual Policy Manual Number: 120.020 Section: Medicare Savings Programs Chapter: Qualifying Individuals 1

January 5, 2026 Division of TennCare 4 Qualified Income Trust - N/A Net Countable Income

$1,260.00 Income Test Limit

$1761.00 Income Test Result PASS Patient Liability N/A The above budget is current as of April 2025. 7. QI1 and TennCare Medicaid Eligibility QI1 enrollees may not also enroll in TennCare Medicaid or TennCare Standard. If an applicant is eligible for a TennCare Medicaid category and QI1, she should be determined eligible in the TennCare Medicaid category.

Applicants/enrollees may not receive benefits in more than one Medicare Savings Program.