us-tn/policy/tenncare/state-plan

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us-tn/policy/tenncare/state-plan — Axiom

(parents-and-other-caretaker-relatives)TennCare Medicaid State Plan: Eligibility Groups - Mandatory Coverage - Parents and Other Caretaker Relatives (TN-21-0010, approved 3/23/2022, effective 10/1/2021)#

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Records / Submission Packages - Your State TN - Submission Package - TN2020MS0002O - (TN-21-0010) - Eligibility Summary Reviewable Units Versions Correspondence Log Approval Letter News Related Actions CMS-10434 OMB 0938-1188 Medicaid State Plan Eligibility Eligibility Groups - Mandatory Coverage Parents and Other Caretaker Relatives MEDICAID | Medicaid State Plan | Eligibility | TN2020MS0002O | TN-21-0010 Parents and other caretaker relatives of dependent children with household income at or below a standard established by the state. Package Header Package ID TN2020MS0002O Submission Type Official Approval Date 3/23/2022 Superseded SPA ID TN 14-0005 System-Derived SPA ID TN-21-0010 Initial Submission Date 12/29/2021 Effective Date 10/1/2021 The state covers the mandatory parents and other caretaker relatives group in accordance with the following provisions: A. Characteristics Individuals qualifying under this eligibility group must meet the following criteria: 1. Are parents or other caretaker relatives (defined at 42 CFR 435.4), including pregnant women, of dependent children (defined at 42 CFR 435.4) under age 18. Spouses of parents and other caretaker relatives are also included. The state elects the following options: 2. Have household income at or below the standard established by the state. a. This eligibility group includes individuals who are parents or other caretakers of children who are 18 years old, provided the children are full-time students in a secondary school or the equivalent level of vocational or technical training. b. Options relating to the definition of caretaker relative: c. Options relating to the definition of dependent child: i. The state elects to eliminate the requirement that a dependent child must be deprived of parental support or care by reason of the death, physical or mental incapacity, or absence from the home or unemployment of at least one parent. ii. The child must be deprived of parental support or care, but a less restrictive standard is used to measure unemployment of the parent (select the one that applies):

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(parents-and-other-caretaker-relatives)TennCare Medicaid State Plan: Eligibility Groups - Mandatory Coverage - Parents and Other Caretaker Relatives (TN-21-0010, approved 3/23/2022, effective 10/1/2021)#

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Parents and Other Caretaker Relatives MEDICAID | Medicaid State Plan | Eligibility | TN2020MS0002O | TN-21-0010 Package Header Package ID TN2020MS0002O Submission Type Official Approval Date 3/23/2022 Superseded SPA ID TN 14-0005 System-Derived SPA ID TN-21-0010 Initial Submission Date 12/29/2021 Effective Date 10/1/2021 D. Basis for Income Standard 1. Minimum Income Standard a. The minimum income standard used for this group is the state's AFDC payment standard in effect as of May 1, 1988, converted to MAGI-equivalent amounts by household size. The standard is described in AFDC Income Standards. 2. Maximum income standard b. The state's maximum income standard for this eligibility group is: c. The amount of the maximum income standard is: b. The state certifies that it has submitted and received approval for its converted May 1, 1988 AFDC payment standard. a. The state certifies that it has submitted and received approval for its converted income standard(s) for parents and other caretaker relatives to MAGI- equivalent standards and the determination of the maximum income standard to be used for parents and other caretaker relatives under this eligibility group. i. The state's effective income level for section 1931 families under the Medicaid state plan as of March 23, 2010, converted to a MAGI-equivalent percent of FPL or amounts by household size. ii. The state's effective income level for section 1931 families under the Medicaid state plan as of December 31, 2013, converted to a MAGI-equivalent percent of FPL or amounts by household size. iii. The state's effective income level for any population of parents/caretaker relatives under a Medicaid 1115 demonstration as of March 23, 2010, converted to a MAGI-equivalent percent of FPL or amounts by household size. iv. The state's effective income level for any population of parents/caretaker relatives under a Medicaid 1115 demonstration as of December 31, 2013, converted to a MAGI-equivalent percent of FPL or amounts by household size. i. A percentage of the federal poverty level: ii. The state's AFDC payment standard in effect as of July 16, 1996, converted to a MAGI-equivalent standard. The standard is described in AFDC Income Standards. iii. The state's AFDC payment standard in effect as of July 16, 1996, increased by no more than the percentage increase in the Consumer Price Index for urban consumers (CPI-U) since such date, converted to a MAGI-equivalent standard. The standard is described in AFDC Income Standards. iv. The state's TANF payment standard, converted to a MAGI-equivalent standard. The standard is described in AFDC Income Standards. v. Other dollar amount

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Parents and Other Caretaker Relatives MEDICAID | Medicaid State Plan | Eligibility | TN2020MS0002O | TN-21-0010 Package Header Package ID TN2020MS0002O Submission Type Official Approval Date 3/23/2022 Superseded SPA ID TN 14-0005 System-Derived SPA ID TN-21-0010 Initial Submission Date 12/29/2021 Effective Date 10/1/2021 E. Additional Information (optional) PRA Disclosure Statement: Centers for Medicare & Medicaid Services (CMS) collects this mandatory information in accordance with (42 U.S.C. 1396a) and (42 CFR 430.12); which sets forth the authority for the submittal and collection of state plans and plan amendment information in a format defined by CMS for the purpose of improving the state application and federal review processes, improve federal program management of Medicaid programs and Children’s Health Insurance Program, and to standardize Medicaid program data which covers basic requirements, and individualized content that reflects the characteristics of the particular state’s program. The information will be used to monitor and analyze performance metrics related to the Medicaid and Children’s Health Insurance Program in efforts to boost program integrity efforts, improve performance and accountability across the programs. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1188. The time required to complete this information collection is estimated to range from 1 hour to 80 hours per response (see below), including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. This view was generated on 3/29/2022 1:02 PM EDT