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• The child must be a resident of Tennessee, a documented alien, or the family has come to Tennessee with the intent to stay or work in Tennessee. Some legal immigrants are not eligible for the first five years of residency. Excepted groups include refugees and children of veterans. Alien status can be verified by the I-551 or I-94. CoverKids will notify the enrollment vendor of the appropriate methods for verifying alien status. • The child must reside in a family with a countable income of less than or equal to 250 percent of poverty. No asset test is used. Income will be self-declared. The TPA or the state will periodically audit a sample of enrollees for verification. • The child must be between the ages of 0 and 19 (a child who turns age 19 is no longer eligible for CoverKids after the month he turns 19). • Emancipated minors are considered as a family in their own right. • The child must currently have no comprehensive, creditable health insurance coverage and have had no comprehensive, creditable employer-based or individual health insurance coverage for the past three months. (Specialty insurance coverage such as dental only coverage is not considered a comprehensive insurance.)

Excluded Children: The following individuals are not eligible for CoverKids. • Children who appear to be eligible for Medicaid (even if not enrolled in Medicaid). This includes: o Children who are eligible for TennCare Medicaid at the following levels: Infants to 185 percent of the FPL; ages 1 through 5 to 133 percent of the FPL; ages 6 through 18 to 100 percent of the FPL. o Children who are eligible for the grandfathered or rollover groups in TennCare Standard. • Children who are involuntarily admitted to a non-medical public institution (A public institution means a government-operated facility that does not provide medical care, e.g., jail or prison). • Children who are admitted to an institution for the mentally disabled (e.g., IMD). • Children who are members of a family that is eligible for health coverage under a state health benefits plan on the basis of a family member’s employment by a public agency in Tennessee. • Children who have had comprehensive employer-based or individual insurance in the past three months, including Medicare, with exceptions allowed for non-voluntary loss of insurance. • Children who are covered under a group health plan or other creditable health insurance coverage.

4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b)(7)) (42CFR 457.305(b))

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