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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 8

ii. Children under the age of 19 Enrolled in Medicaid

Children under the age of 19 who are determined eligible for and enrolled in certain TennCare Medicaid categories will remain eligible for that respective benefit through a 12- month continuous eligibility period, regardless of most changes in circumstance. Continuous eligibility for children is not applicable to the following TennCare Medicaid categories: IE Foster Care, Widow/Widower, Medically Needy Child, Medically Needy Pregnancy, Katie Beckett Part B, Transitional Medicaid, Extended Medicaid, or EMS. Children in a presumptive eligibility period are not eligible for continuous eligibility. At the end of the 12-month continuous eligibility period, eligibility will be redetermined.

A child may transition to another TennCare Medicaid COE that provides continuous eligibility during the 12-month period. At that time, they will be granted a new 12-month continuous eligibility period. Exceptions to the 12-month continuous eligibility period are as follows:

1. The child turns 19; 2. Coverage is voluntarily terminated; 3. The child is no longer a resident of Tennessee; 4. The State determines that eligibility was erroneously granted at the most recent eligibility determination or renewal of eligibility because of state error, or fraud, abuse, or perjury attributed to the child or the child’s representative; or 5. Death.

If a child is enrolled in the Child MAGI COE and is confined in a hospital at the time they turn 19, their coverage will remain open until they have been discharged.

iii. CoverKids Children

Children under the age of 19 determined eligible for and enrolled in CoverKids Child are eligible for a 12-month continuous eligibility period, regardless of most changes in circumstance. At the end of the 12-month continuous eligibility period, eligibility will be redetermined. At that time, they will be granted a new 12-month continuous eligibility period. Exceptions to the 12-month continuous eligibility period are as follows:

1. The child turns 19; 2. Coverage is voluntarily terminated; 3. The child is no longer a resident of Tennessee; 4. The State determines that eligibility was erroneously granted at the most recent eligibility determination or renewal of eligibility because of state error, or fraud, abuse, or perjury attributed to the child or the child’s representative;