1200-13-20-.04 - TECHNICAL ELIGIBILITY REQUIREMENTS

1200-13-20-.04. TECHNICAL ELIGIBILITY REQUIREMENTS

(1) State Residency. Individuals enrolled in TennCare must meet the requirements for State residency established in 42 C.F.R. § 435.403. Individuals applying for CoverKids must also meet the requirements specified at 42 C.F.R. § 457.320.

(a) Temporary absence. Individual may be "temporarily absent" from Tennessee but still considered a resident of the State for purposes of TennCare and CoverKids eligibility. An individual who wishes to be considered temporarily absent from the State for continued eligibility purposes must provide the Bureau with an anticipated date of return. The Bureau will assess the continuation of an individual's temporary absence status on the anticipated date of return. A temporary absence from the State will not preclude continued eligibility under the following circumstances:

1. The absence is for a specific purpose such as a temporary work assignment, visit, hospitalization, participation in an educational or rehabilitation program not available in Tennessee; or

2. The absence is for a child receiving specialized treatment out of state; and

3. The individual indicates his intent to return to Tennessee once the purpose for his absence is accomplished.

(b) Students.

1. Individuals who are dependents of a Tennessee resident and who attend school out of state will be considered Tennessee residents.

2. Individuals aged eighteen (18) to twenty-two (22) are not considered residents of the state if:

(i) Neither parent lives in the state;

(ii) The student is claimed as a tax dependent by someone in another state; and

(iii) The student is applying on his own behalf.

(2) Citizenship. Individuals enrolled in TennCare must meet the requirements for citizenship or qualified non-citizen status established in 42 C.F.R. § 435.406 and in Tennessee's Citizenship and Non-Citizen Eligibility State Plan Amendment. For CoverKids, unborn children are presumed to be U.S. citizens, regardless of the citizenship or immigration status of the mother.

(3) Social Security Number (SSN).

(a) Individuals enrolled in TennCare must meet the SSN requirements of 42 C.F.R. § 435.910.

(b) Unborn children enrolled in CoverKids Pregnant Women are not required to have an SSN.

(c) SSNs are not required for members of households who are not applying for TennCare coverage.

(4) Incarceration. Individuals who are incarcerated are eligible for TennCare in a suspended status pursuant to T.C.A. § 71-5-106(r), as long as all eligibility criteria are met. Individuals in a suspended status will be eligible for TennCare payments only for medical institution stays longer than twenty-four (24) hours. All other medical payments while in the suspended status are not subject to TennCare reimbursement. The suspended status will be removed once TennCare receives notice that the enrollee is no longer incarcerated. See also 42 C.F.R. § 435.1010.

(5) Residents of an Institution for Mental Disease (IMD). Individuals who are residents of an IMD are not eligible for FFP, except for those who are age sixty-five (65) or older and confined to an approved ward, or those who are under age twenty-two (22) and receiving inpatient psychiatric services. Confinement in an IMD does satisfy and establish institutional status for individuals under age sixty-five (65) and those confined to unapproved wards who are subsequently admitted to a nursing facility. See Section 1905 of the Social Security Act (42 U.S.C. § 1396d)

(Emergency rule filed June 16, 2016; effective through December 13, 2016. New rules filed September 14, 2016; effective December 13, 2016. Amendments filed May 24, 2019; effective August 22, 2019.)

Authority: T.C.A. §§ 4-5-202, 4-5-208, 71-5-105, 71-5-106, 71-5-110, 71-5-111, and 71-5-117.

The following state regulations pages link to this page.