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March 18, 2019 Division of TennCare 2

Families and Children Manual Policy Manual Numb1er: 010.030 Section: Financial Eligibility Chapter: The 5 Percent Federal Poverty Limit Disregard for MAGI

b. Children Aged 1-5 Years Old: Household income is between 142% and 147% FPL; c. Children Aged 6-18 Years Old: Household income is between 133% and 138% FPL; d. Pregnant Women: Household income is between 195% and 200% FPL; e. TennCare Standard Uninsured: Household income is between 211% and 216% FPL; and f. Caretaker Relatives: The 5% disregard is the individual’s Modified Adjusted Gross Income amount minus the actual dollar amount of 5% of 100% FPL for the appropriate household size. 4. Disregard Budget Examples a. Example 1 A pregnant woman applies for TennCare Medicaid. She has no spouse or other children living in the home. The income standard for the Pregnancy MAGI category is $2,748 (195% FPL, EDG size of 2). The 5% FPL disregard equals $71 ($1,410 x 0.05 = $70.50 or $71). The applicant’s monthly household modified adjusted gross income is $2,800. The applicant will receive the disregard, $2,800 - $71 = $2,729, making her eligible for the Pregnancy MAGI category. b. Example 2 Mary and her two children Steven, age 4, and Carrie, age 9, apply for coverage. Mary is pregnant and expecting one baby. Mary pays taxes and claims Steven and Carrie as dependents. Since she is pregnant, Mary’s EDG size is 4 and the two children’s EDG sizes are 3. Mary earns $2,400 per month at her job. Mary is determined eligible in the Pregnancy MAGI category, Steven is determined eligible in the Child MAGI 1-5 category, but Carrie is ineligible for the Child MAGI 6-18 category because her income is over the income eligibility threshold. The 5% FPL disregard is applied to Carrie’s household income, which brings her under the income eligibility threshold for the Child MAGI 6-18 category and she is determined eligible. i. Mary: Income eligibility threshold in the Pregnancy MAGI category for EDG size of 4 = $4,185. Household income is $2,400 which is less than $4,185, so she is eligible. ii. Steven: Income eligibility threshold in the Child MAGI 1-5 for EDG size 3 = $2,525. Household income is $2,400 which is less than $2,525, so he is eligible. iii. Carrie: Income eligibility threshold in the Child MAGI 6-18 for EDG size 3 = $2,365. Household income is $2,400 which is greater than $2,365. Without the disregard, Carrie would be ineligible due to being over income. We determine the disregard amount by taking 5% of $1,778 (100% FPL for EDG size of 3), which is $88.90 or $89. The 5% disregard reduces her household income to $2,311 ($2,400 - $89). Her household income is now less than the income eligibility threshold, so she is determined eligible. The above examples are current as of February 2019