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Official source

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| TN2020MS0002O | TN-21-0010 Package Header Package ID TN2020MS0002O Submission Type Official Approval Date 3/23/2022 Superseded SPA ID TN 14-0005 System-Derived SPA ID TN-21-0010 Initial Submission Date 12/29/2021 Effective Date 10/1/2021 B. Financial Methodologies MAGI-based methodologies are used in calculating household income. Please refer as necessary to MAGI-Based Methodologies, completed by the state. C. Income Standard Used 1. The income standard for this group is based on a percentage of the federal poverty level. 2. The state uses the following income standard for this group: Yes No g. The state's TANF payment standard, converted to a MAGI-equivalent standard. The standard is described in AFDC Income Standards.

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Page 2

Official source

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| TN2020MS0002O | TN-21-0010 Package Header Package ID TN2020MS0002O Submission Type Official Approval Date 3/23/2022 Superseded SPA ID TN 14-0005 System-Derived SPA ID TN-21-0010 Initial Submission Date 12/29/2021 Effective Date 10/1/2021 B. Financial Methodologies MAGI-based methodologies are used in calculating household income. Please refer as necessary to MAGI-Based Methodologies, completed by the state. C. Income Standard Used 1. The income standard for this group is based on a percentage of the federal poverty level. 2. The state uses the following income standard for this group: Yes No g. The state's TANF payment standard, converted to a MAGI-equivalent standard. The standard is described in AFDC Income Standards.