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4.1.9 Other standards (identify and describe):

Applicants are required to provide a social security number (SSN) or they must have applied for an SSN. Non-applicant family members are not required to provide an SSN.

The CoverKids Healthy Babies program is available to unborn children (from conception through birth) of pregnant women (of any age) with incomes at or below 250% FPL who are not otherwise eligible for TennCare. This program provides maternity benefits and pregnancy-related services consistent with those available under the CoverKids program. The following eligibility standards will apply: • The pregnant woman is not Medicaid eligible. A pregnant woman applying for CoverKids will be screened first for eligibility in TennCare. If she is not TennCare eligible, a CoverKids eligibility determination will be performed for the unborn child. • The unborn child or children are counted as if born and living with the mother in determining family group size. • The unborn child may not have creditable health insurance coverage, i.e., the mother is either uninsured or her coverage does not include prenatal care; and she has not voluntarily dropped comprehensive private health insurance coverage during the last 3 calendar months prior to application processing.

4.2 The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42CFR 457.320(b))

4.2.1 These standards do not discriminate on the basis of diagnosis. 4.2.2 Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3 These standards do not deny eligibility based on a child having a pre-existing medical condition.

4.3 Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

Start Up: The CoverKids eligibility and enrollment third party administrator (TPA) will develop an application form that is short, easy to understand and easy to complete; and will develop the necessary approval/denial eligibility letters. The TPA will be responsible for the mailing of applications/letters/etc., telephone access (e.g., a 1-800

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