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Families and Children Manual Section: Financial Eligibility Policy Manual Number: 010.010 Chapter: Income Overview

May 01, 2019 Division of TennCare 2 iv. Cash Support v. Gambling, prizes or awards

3. Exceptions

The MAGI methodology is used to determine income eligibility for all insurance affordability programs: Medicaid, CHIP (CoverKids) and the APTCs offered through the Exchange. The income counting rules are generally the same, except for 3 types of income (retained Medicaid policy):

a. Amounts received as lump sums are counted as income only in the month received; b. Scholarships, awards or fellowship grants used for education purposes and not for living expenses are excluded from income; and c. American Indian/Alaska native exceptions.

4. Medicaid Safe Harbor

Legal Authority: 42 CFR 435.603(i)

If an individual is determined financially ineligible for a MAGI TennCare Medicaid category, and is then determined to have household income below 100 percent FPL by the Federally Facilitated Marketplace (FFM), Medicaid financial eligibility will be determined in strict accordance with the income counting rules in the FFM.

Income determinations for Medicaid Safe Harbor individuals is accepted as determined by the FFM and TennCare Medicaid eligibility is granted as long as the individual meets all non-financial requirements.

5. Counting Income

Eligibility is determined based on monthly income. All income must be converted to a monthly figure. The following formulas are used to convert income to a monthly amount.

a. Hourly Work: Multiply the hourly wage by the number of hours the individual worked or is expected to work in a week to determine the weekly earnings figure.

b. Weekly Income: Multiply weekly income by 4.3333 to determine monthly income.

c. Bi-Weekly Income: Multiply the amount received every two weeks by 2.1666 to determine the monthly amount.

d. Semi-Monthly Income: Add the two semi-monthly amounts together to determine the monthly amount.