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Section 4. Eligibility Standards and Methodology (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5.

4.1 The following standards may be used to determine eligibility of targeted low-income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a))

4.1.1 Geographic area served by the Plan: Tennessee’s Title XXI plan is available statewide. 4.1.2 Age: CoverKids: Children under 19 years of age. CoverKids Healthy Babies Program: Unborn children from conception through birth. 4.1.3. Income: 1. For the unborn from conception: from 0 percent to 250 percent of the FPL and not eligible for Medicaid; 2. For the child from birth to the child’s first birthday: above 185 percent to 250 percent of the FPL; 3. For the child from age 1 to the child’s 6th birthday: above 133 percent to 250 percent of the FPL; and 4. For the child from age 6 to the child’s 19th birthday: above 100 percent to 250 percent of the FPL.

CoverKids’ nominal income eligibility level will be 200 percent of the FPL, although the State will disregard income amounts above 200 percent FPL up to 250 percent FPL. Thus our effective income eligibility level will be 250 percent of the FPL.

4.1.4 Resources (including any standards relating to spend downs and disposition of resources): None 4.1.5 Residency (so long as residency requirement is not based on length of time in state): Must reside in the State of Tennessee. 4.1.6 Disability Status (so long as any standard relating to disability status does not restrict eligibility): None 4.1.7 Access to or coverage under other health coverage:

Comprehensive employer-based coverage or other creditable health insurance will preclude enrollment in CoverKids. CoverKids enrollment will also be precluded if the applicant was covered by creditable employer-based or individual health insurance within three months of application for CoverKids.

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