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Administrative Manual Policy Manual Number: 200.112 Section: General Administrative Procedures and Compliance Subject: Eligibility of Inmates of Public Institutions

October 3, 2016 TennCare 3

example, an individual must continue to meet the requirements as a caretaker relative to be considered for eligibility in the Caretaker Relative category. Inmates of public institutions must also meet financial requirements for the individual to receive eligibility in a Medicaid category. Tax filer rules should be used for tax filers and tax dependents when making a Modified Adjusted Gross Income (MAGI) eligibility determination, unless there is evidence to the contrary. 5. Suspended Status The need for suspended status can be determined by asking the following two questions: • Is the individual considered an inmate? Refer to the inmate definition above. • Is the individual involuntarily confined in a public institution? Refer to the public institution definition above. When the answer to both questions is yes, the individual should be placed in suspended enrollment status. If the answer to either of these questions is no, the individual is not an inmate living in a public institution, is eligible for FFP and should not be placed in suspended status. Eligibility of an applicant/enrollee in a jail is placed in suspended status when he has been in the jail for more than 90 days. There is no 90 day wait for an individual in state or federal prison. When an individual is placed in a suspended status, the individual’s MCO will temporarily be changed to TennCare Select. An individual is removed from suspended status when he remains Medicaid eligible and is no longer considered an inmate living in a public institution. When an individual’s suspended status is removed, the individual’s MCO will revert back to an at-risk MCO. Note: Department for Children’s Services (DCS) and Programs for All-Inclusive Care for the Elderly (PACE) enrollees are currently not placed in suspended status and maintain Medicaid eligibility. Examples of individuals not considered inmates in a public institution include: • Infants living with the inmate in a public institution; • Paroled individuals; • Individuals on probation; • Individuals on home release except when reporting to a public institution for overnight stay; • Individuals living voluntarily in a detention center, jail or county penal facility after adjudication while determining other living arrangements; • Individuals released to the community pending trial, including those under pre-trial supervision; and