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Aged, Blind and Disabled Manual Section: Institutional Medicaid Policy Manual Number: 125.020 Chapter: Post-Eligibility Treatment of Income

July 1, 2026 Division of TennCare 19 Revision Date Section Section Title Page Number(s) Reason for Revision Reviser 07.01.2021 3.d.ii.1-3; 3.e.ii.2 Terms and Standards; CSIMA Calculation; CSIMA Example; Calculate DIMA 3-9 Non- Substantive Change TN 01.04.2022 3.d.ii.1. c.i; 3.d.ii.3.a-c Terms and Standards; CSIMA Example 6; 8 Non- Substantive Change TN 07.01.2022 3.d.ii.1-3; 3.e.ii.2. Terms and Standards; CSIMA Calculation; CSIMA Example; Calculate DIMA 6-9 Non- Substantive Change TN 11.01.2022 3.d.ii.1. c; 3.d.ii.3. Terms and Standards; CSIMA Example 6; 8 Non- Substantive Change TN 07.03.2023 3.d.ii.1-3.; 3.e.ii.2. Terms and Standards; CSIMA Calculation; CSIMA Example; Calculate DIMA 6-9 Non- Substantive Change TC 10.02.2023 3.d.ii.1.c;3.d.ii.3.a Terms and Standards; CSIMA Example 6;8 Non- Substantive Change CE 1.02.2024 3.g.iii.3. Dental services 13 Policy Change LW 07.01.2024 3.b.iii. PETI Deductions from Total Income 3 Non- Substantive Change BP 07.01.2024 3.d.ii.1.a; 3.d.ii.1.d; 2.c; 3.a; 3.c; 3.e.ii.2. Terms and Standards; CSIMA Calculation; CSIMA Example; Calculate DIMA 6-9 Non- Substantive Change BP 10.01.2024 7. Patient Liability Changes 16 Policy Clarification BP 10.01.2024 1.c.i.ii.iii.; 3.a. Terms and Standards; CSIMA Example 6; 8 Non- Substantive Change BP 02.03.2025 3.b.i; 3.d.3 PETI Deductions from Total Income; 2;8 Non- Substantive Change SA