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4.4 Describe the procedures that assure that

4.4.1 Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low-income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including a state health benefits plan) are furnished child health assistance under the state child health plan. (Section 2102)(b)(3)(A)) (42CFR 457.350(a)(1) and 457.80(c)(3))

The State of Tennessee will assure through enrollment screening processes that applications of children who appear eligible for Medicaid are referred for a determination of Medicaid eligibility. The CoverKids eligibility system is being designed to be consistent with Medicaid eligibility rules in order to assure that the screening process identifies children who are potentially Medicaid eligible. For example, the family group composition used for determining CoverKids eligibility will be the same as that for Medicaid and income deductions will be consistent with those used by Medicaid. Additionally, the TPA eligibility staff will query the Medicaid eligibility system to ensure applicants are not currently enrolled in any Medicaid program. These screening processes will be used both at initial eligibility determination and at redetermination.

The CoverKids application will ask families about current health insurance coverage, as well as coverage within the past 3 months. The application also asks applicants whether the child or pregnant woman has access to State of Tennessee administered insurance as a result of a family member’s employment with a state or local government agency. This information is self-declared; however, the TPA eligibility staff may contact the family when information is not provided or clarification is needed. Using the responses to the application questions, TPA eligibility staff will deny coverage to children or pregnant women who: are currently insured, voluntarily dropped private health insurance coverage during the last 3 calendar months prior to application processing, and are eligible for a state-administered health benefits plan for state or local government employees. If necessary, TPA staff may contact the State Division of Insurance Administration for clarification of eligibility for a state health benefits plan. In addition, the Division of Insurance Administration is exploring the possibility

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