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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 3 i. Nursing Facility Subtract a $70 PNA from the total income of an individual in a nursing facility or in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). For an individual with greater need who participates in a sheltered workshop, subtract up to $100 of earnings plus $70 for the PNA. ii. HCBS (including ECF CHOICES), PACE and Self-Determination ID Waivers Subtract 300% of the Supplemental Security Income Federal Benefits Rate (SSI-FBR) from the total income of an individual receiving HCBS, PACE or Self-Determination ID Waiver services. iii. Statewide ID and Comprehensive Aggregate Cap Waivers Subtract 300% of the SSI-FBR from the total income of an individual receiving Statewide ID and Comprehensive Aggregate Cap (CAC) Waiver services. c. Mandatory Expenses Mandatory expenses are expenses an individual is legally obligated to pay. Verified mandatory expenses may be deducted from total income when determining patient liability. Mandatory expenses include but are not limited to: garnishments and other withholdings, conservatorship or guardianship fees, court-ordered bankruptcy, court-ordered child support, court-ordered alimony, and QIT fees. i. Garnishments and Other Withholdings A garnishment is a withholding from earned or unearned income to satisfy a debt or legal obligation. Most garnishments are court-ordered. A court order is not required for collection of unpaid taxes owed to the IRS or non-tax debts owed to other federal agencies. When an institutionalized individual’s income is being garnished, a deduction for the garnishment is allowed in the patient liability calculation until the debt has been paid in full or the garnishment has been withdrawn. Other withholdings that are required by law, such as federal income tax, FICA, state and/or local taxes are subtracted from total income when determining patient liability. A deduction is not allowed when the withholding is voluntary. ii. Conservatorship or Guardianship Fees A conservator or guardian is a third party appointed by a court to manage the property, financial affairs, and well-being of an individual. A conservatorship or guardianship fee paid by an individual may be deducted if the individual has a legally appointed guardian or conservator, the guardian or conservator charges a fee, and the fee is court-ordered.