FAQ Assister Tool:

For the Tennessee Enrollment Community

Pregnancy FAQs:
Presumptive eligibility
Coverage choice
Minor applicant

Parent Caretaker Relative FAQs:

Primary parent
Acceptable relationships
Loss of eligibility

Grandparent and Senior FAQs:

TennCare
MSP redetermination

TennCare FAQs:
Dual coverage
Moving from other states
Child not living with parents
MNSD without medical bills
Redeterminations
Child support cooperation
Minor applicant
Aging out

Newborn FAQs:
Mom on TennCare
Mom on CoverKids
Mom not on TennCare or CoverKids

Income:
SS vs. SSI vs. SSDI
Countable income types
Child support

Special Enrollment Period:

Loss of coverage
Plan start date
Changing plans
 Pregnancy:
Q: Can a pregnant woman get presumptive eligibility more than once during her pregnancy?
A: No. She cannot go back to the health department during the same pregnancy to get more than one presumptive
eligibility. If eligible, her TennCare effective date will be the day she submitted her presumptive application and her
presumptive eligibility coverage will terminate as soon as she receives a decision regarding her full TennCare eligibility
as long as she files a full healthcare.gov/FFM application by the end of the month following the month in which the
presumptive eligibility was granted.

Q: Can a pregnant woman stay on her Marketplace plan even if she becomes eligible for TennCare or CoverKids
because of her pregnancy?
A: Yes. Reporting pregnancy to the Marketplace is optional. However, she will not be able to also enroll in TennCare
/CoverKids and keep her Marketplace plan (she cannot have both). Note: for a pregnant woman who is not currently
enrolled in Marketplace, there is no option to forego TennCare/CoverKids and receive premium tax credits. The applicant
should answer the question, Are you currently pregnant? accurately in order for her application to be forwarded to
TennCare or CoverKids as appropriate

Q: How does a pregnant minor (under 18) apply for TennCare or CoverKids?
A: If under 18, the Marketplace account should be created under the name of an adult who lives in the home with the
applicant, if the applicant is a minor. This may be the applicants biological, step or adopted parent, a family member who
claims the applicant as a tax dependent, or another individual who is in a position to know the applicants circumstances
(such as a partner or the childs father).

Parent Caretaker Relatives:

Q: Who is the primary caretaker (TennCare) for divorced/unmarried parents living in separate households?
A: The custodial parent, also known as the primary residential parent, is the parent with whom the child spends most
nights. Custodial/primary parent depends on physical custody specified in a court order/divorce decree, binding
separation, divorce, or parenting plan. If it is not specified, the mother is primary.

Q: At what age of the child will a caretaker relative no longer qualify for TennCare?
A: The parent or caretaker relative will lose TennCare eligibility on the youngest childs 18th birthday unless that child is a
full-time student (under 19 years).

Q: Who qualifies as a caretaker relative for TennCare category?

A: A caretaker relative of a child is a relative by blood, adoption, or marriage with whom a dependent child, under 18 or
18 and full-time student, who assumes primary responsibility for the childs care, and is the childs father/mother,
grandfather/mother, brother/sister, stepfather/mother, stepbrother/sister, uncle/aunt, first cousin, nephew, or niece; or the
spouse of such parent or relative, even after the marriage is terminated by death or divorce. This means the boyfriend or
girlfriend of the childs parent cannot qualify, even if that person is the main financial provider for the family.

Grandparents and Seniors:

Q: Can grandparents (and other non-parental family members) get TennCare as caretaker relatives without
having legal custody/power of attorney?
A: Yes. As long as the child lives more than 50% of the time with the grandparent and the grandparent is the primary
adult caring for the child, the grandparent may qualify for TennCare as a caretaker relative. However, if the parent of the
child has qualified because of the child and has TennCare, it is possible that the parent will lose TennCare coverage.

Q: What if an individual loses their Medicare Savings Program (QMB/SLMB/QI/QWDI?

A: If the consumer lost their MSP as a result of redetermination, and they have outstanding medical bills or expenses since
they lost their MSP, they can call TN Health Connection and request a new packet. If they complete and send the packet
back within 90 days of losing their coverage, it will be restored. If the consumer has not had any medical expenses since
their loss of MSP coverage, the consumer can fill out an LTSS application which can be found on the Tennessee State
Government Website homepage: https://www.tn.gov/assets/entities/tenncare/attachments/LTSSMedicaidApplication.pdf
An FFM application will not pick up on this category, so do not use the Marketplace application. They can get assistance
with this through SHIP or from a navigator assuming the LTSS application does not take away from enrollments.
 TennCare:
Q: Can a consumer have both TennCare and another insurance?
A: Yes. A consumer can have both TennCare and another plan such as employer-sponsored coverage. The consumer
cannot have TennCare and receive tax credits or cost sharing reductions on a Marketplace plan. If a TennCare enrollee has
another plan, TennCare will become "secondary," which means the other (primary) plan will be billed first and TennCare
will not pay for anything already covered by the primary insuranceeven if the primary plan has high copays.

Q: When can you apply for TennCare or CoverKids when you move from a different state?
A: Immediately. According to the TennCare policy manual: an individual must be a Tennessee resident to be eligible for
TennCare Medicaid or CoverKids. An individual is considered a Tennessee resident if the individual attests to living in
Tennessee, intends to reside in Tennessee and there is no information to indicate otherwise. Individuals will not be
required to reside in Tennessee for a specific amount of time to claim residency. Recommend the consumer apply as soon
as possible since the effective date will be the date of submission and call the other state Medicaid agency to terminate
coverage.

Q: Can a child living with a non-parent or non-stepparent be eligible for TennCare even if the caregivers income
is above TennCare limits?
A: Yes. The Marketplace application will not catch this however since non-filer rules apply. You will need to manually
send to Medicaid (button on eligibility screen at end of MP application). You can also appeal immediately after since we
are a determination state and therefore do not need to wait the 45 days. Recommendation: use the paper TennCare appeal
form and then fax it with a copy of the MAGI Household Composition policy from the policy manual which is found on
tn.gov/tenncare under Policy & Guidelines.

Q: Can a non-disabled and non-medically needy individual under 21 qualify for TennCare?
A: Yes! The individual may qualify under Medically Needy Spend Down if she or he has no or very low income. The
Marketplace application will not catch this, so manually send to Medicaid and appeal immediately. Fax appeal form with
excerpt from TennCare Policy Manual (pg. 169): "TennCare Medicaid benefits are available to children under age 21
who are not eligible for a MAGI category, who have resources under the Medically Needy resource limit based on
household size, and who have countable income equal to or less than the Medically Needy Income Standard based on
household size, or have met the spend down requirement. Eligible children must meet all of the Child Medically Needy
non-financial eligibility requirements."

Q: TennCare redeterminations best practices:

A: Individuals have 90 days from the day TennCare terminates their policy to submit verifications. Consumers should
call Tennessee Health Connection to request a redetermination packet if they have unpaid medical bills. If they do not
have any medical expenses, they should fill out a new application using the FFM.

Q: Cooperating with Child Support?

A: An eligible parent or caretaker relative must agree to cooperate with Child Support Services in establishing paternity of
a child born out of wedlock and in obtaining medical support and payments for himself or herself and anyone for whom
the individual can legally assign rights. There are exceptions to cooperating with Child Support for domestic violence and
similar situations. If the consumer is in doubt about cooperating, they can agree of the FFM application and then explain
their reasons for not cooperating when they are contacted by Child Support. If they do not agree on the FFM application,
their application will not be sent to TennCare. Proof of non-compliance from the Department of Human Services Child
Support Enforcement Office may lead to ineligibility.

Q: How can a minor (under 18) that is living alone or not living with parents apply for TennCare?
A: Same process as for pregnant minors applying. If under 18, the Marketplace account should be created under the name
of an adult who lives in the home with the applicant, if the applicant is a minor. This may be the applicants biological,
step or adopted parent, a family member who claims the applicant as a tax dependent, or another individual who is in a
position to know the applicants circumstances.

Q: At what age does a child lose MAGI TennCare eligibility?

A: On their 19th birthday. That child might be able to re-qualify for Medically Needy Spend Down category until age 21 if
he or she has no or very low income (see above). Note also, if the child aged out of Foster Care at age 18, he or she will
maintain TennCare eligibility until age 26 regardless of income.
 Newborns:
Q: How do you enroll a baby who was born to a mother on TennCare?
A: Infants born to a mother eligible for and receiving TennCare Medicaid or Emergency Medical Services (EMS) at the
time of birth are deemed automatically eligible (no income test) for TennCare Medicaid. Deemed Newborns remain
eligible for one year from the date of birth as long as the infant is included in the mothers household, and the mother
remains eligible for Medicaid or would remain eligible if pregnant. An application is not required to enroll a child as a
Deemed Newborn. They will have to fax a copy of the social security card and birth certificate to 855-315-0669 when
they receive those documents.

Q: How do you enroll a baby who was born to a mother on CoverKids?

A: If a pregnant woman is already enrolled in CoverKids when she gives birth, call CoverKids at 1-866-620-8864 to
report the birth. CoverKids will determine whether the baby is eligible for TennCare or CoverKids and will take the
appropriate action to facilitate coverage for the newborn. They will have to fax a copy of the social security card and birth
certificate to 855-315-0669 when they receive those documents.

Q: How do you enroll a baby who is born to a mother who was not enrolled in TennCare or CoverKids at time of
birth?
A: A newborn or child under age one whose mother was not eligible for or receiving TennCare or CoverKids at the time
of birth is not automatically eligible and must apply for benefits. In that case, mothers can call to fill out "Newborn
Presumptive Eligibility" with the Tennessee Health Connection, which will be good for only 45 days until they apply for
coverage using the FFM application. They will have to fax the SSN and birth certificate to 855-315-0669.

Income:
Q: Are Social Security (SS), Supplemental Security Income (SSI), Social Security Disability income (SSDI),
Survivor's benefits, and unemployment considered countable income?
A: All except for SSI is considered countable income. Income received from Social Security each month is not counted
for tax dependents who are not required to file taxes. Social Security income is also not counted for children included in
a natural or biological, adopted or step parents household when the childs income other than Social Security is under the
tax filing threshold

Q: Are retirement, pensions, and annuities considered countable income?

A: Short answer: it depends. The amount of distributions received from a pension account should be provided on the
application, even if the individual is not retired. Qualified income from a designated Roth account is not countable

Q: Are capital gains, alimony received, and investment income considered countable income?
A: Yes.

Q: Is child support considered income on the FFM application?

A: No. Do not count child support as income. Conversely, child support paid out does not count as a deduction on the
FFM application.

Special Enrollment Periods:

Q: What if a consumer switches from full-time to part-time work and loses offer of health insurance?
A: If the consumer has employer-sponsored coverage and the employer is no longer offering coverage, the consumer
should be eligible for a Marketplace plan with subsidies if eligible. If the consumer does not already have a MP plan, he
or she will likely need to submit verification to the MP proving loss of coverage. If the consumer already has a MP plan
but had been ineligible for tax credits due to an offer of employer coverage and then loses that offer, the consumer should
be newly eligible for tax credits. The consumer may have to provide verification for the change in income but there should
be no delay for enrollment due to the existing plan.
Q: When will a consumers plan start when they have an SEP?
A: General timeline overview: the consumer should pick a plan once their application is submitted (must be within 60
days of the life-changing event), which starts a 30-day SVI timer. Note: this SVI is only for those who are not currently
enrolled in a Marketplace plan. The consumer needs to submit verification within the 30-day timer. If the consumer is
having issues submitting within 30 days, they can request an extension through the Marketplace Call Center. As soon as
the Marketplace resolved the SVI, the Marketplace will send their enrollment to the health insurance company. Per usual,
the consumer must make the first premium payment to effectuate the plan. Note: coverage effective date is still dependent
on the type of SEP and the date the plan is selected (i.e., loss of coverage starts first day of the following month vs.
moving starts depending on 15th of the month rules). For more specific information, please refer to the SEP Reference
Chart in the Navigator Manual.

Q: Can a consumer change their plan or information during the 30-day SVI timer?
A: Yes. The consumer has until the SVI is resolved to change plans. Note: this does not apply if the consumer is beyond
the 60-day mark from their life-changing event.