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Administrative Manual Policy Manual Number: 200.040 Section: General Administrative Procedures and Compliance Chapter: Eligibility Determination

June 2, 2025 Division of TennCare 4

Effective Date Child and Families Categories Aged, Blind and Disabled Categories The effective date of eligibility is the date determined by the Social Security Administration. • SSI Cash Recipient The effective date of eligibility is the date determined by the qualified entity. • Presumptively Eligible Pregnant Women • Hospital Presumptive Eligibility • Presumptive Breast or Cervical Cancer The effective date of eligibility is the child’s date of birth, if the mother was eligible for and receiving TennCare Medicaid at the time of birth. • Deemed Newborns The effective date of eligibility is the application file date or the date all eligibility requirements are met, whichever is later.

Note: For pregnant women and children under age 19 who attest to receiving a service covered under the Medicaid state plan in the retroactive eligibility period, the effective date of eligibility is the first of the month up to three months prior to the month of application, or the application file date if the individual does not meet all eligibility requirements in the retroactive eligibility period. This is applicable for pregnant women and children eligible in the following categories: Child MAGI, Pregnancy MAGI, and Caretaker Relative. To be eligible for retroactive coverage in the Caretaker Relative category, the individual must be pregnant. • Former Foster Care • Child MAGI • Pregnancy MAGI • Caretaker Relative • Child Medically Needy • Qualified Pregnant Women Medically Needy • TennCare Standard • Transitional and Extended Medicaid • CoverKids • Disabled Adult Child • Institutional Medicaid (Home and Community Based Services) • Pickle Passalong • Widow/Widower • Breast or Cervical Cancer • Specified Low-Income Medicare Beneficiaries • Qualifying Individuals 1 • Qualified Disabled Working Individuals