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Families and Children Manual Section: Financial Eligibility Policy Manual Number: 010.040 Chapter: Medically Needy Eligibility Determination Group

MEDICALLY NEEDY ELIGIBILITY DETERMINATION GROUP

Legal Authority: 42 CFR 435.301; 42 CFR 435.601; 42 CFR 435.602; 42 CFR 435.603; 45 CFR 233.20

1. Policy Statement

The Eligibility Determination Group (EDG) for Medically Needy categories is based on the methods of the former AFDC program. The EDG determines the income and resource standards used for an applicant’s financial eligibility determination. Household income and resource inclusion for the EDG is governed by the principle of Financially Responsible Relatives (FRRs). Financial responsibility is limited to spouse to spouse and parent to child.

2. Definitions

Parents: Parents only include biological and adoptive parents. Siblings: Siblings include biological, adopted, half or stepsiblings. 3. Child Medically Needy Eligibility Determination Group For unmarried applicants, the EDG for Child Medically Needy includes the following individuals living in the home:

a. The applicant; b. The applicant’s children under 21; c. The applicant’s unborn child(ren); d. The applicant’s parents; and e. The applicant’s siblings under 21 (including unborn children).

Parents of an emancipated minor are not included in the EDG.

For married applicants, the EDG for Child Medically Needy includes the following individuals living in the home:

a. The applicant; b. The applicant’s children under 21; c. The applicant’s unborn child(ren); and d. The applicant’s spouse (if under 21 and applying for medical assistance).

If the in-home spouse is not included in the EDG, the spouse’s income and resources may be deemed to the applicant.

4. Qualified Pregnant Woman Medically Needy Eligibility Determination Group

The EDG for Qualified Pregnant Woman Medically Needy includes the following individuals living in the home:

March 18, 2019 Division of TennCare 1