Navigating TennCare & the Marketplace Tennessee Justice Center 301 Charlotte Ave | Nashville, TN,...

Navigating TennCare & the Marketplace

Tennessee Justice Center301 Charlotte Ave | Nashville, TN, 37201

615-255-0331

Day 2: Puttin’ it to the Test

10/9/2014

AgendaDay 1• Pre-Test• Counting Income• Counting Household

Size• TennCare Categories

Day 2• Scenarios• Marketplace Basics• Scenarios• Wilson v. Gordon• Scenarios• Post-Test

10/9/2014

Scenario: Wally “Whitey” White• Whitey became disabled in his

late 20’s and has no children. • He used to receive SSI, but

started getting Social Security at $751/month when he turned 62 in November of 2013.

• He has $500 in a savings account. He rents his home and has no other assets.

10/9/2014

What is Wally

eligible for?

Step 1: Quick ScreenQuick mental screen: who are we looking at?

ChildrenPregnant women

Parents/Caretaker RelativesFolks with disabilities and Medicare recipients

Women with breast/cervical cancer

10/9/2014

Step 2: HouseholdWhat is the household size for each person for TennCare purposes?

What is the household size for each person for Marketplace purposes?

Same household counting as above.

10/9/2014

Whitey is in a household by himself.

Step 3: IncomeIncome for household of 1 is $751/month.

10/9/2014

So who’s eligible for what?• Whitey?– Gap– …or… maybe… could it be…

10/9/2014

Pickle Eligibility

$751 x .985 = $739.74

-$20 unearned income disregard = $719.74!

Whitey can get TennCare through Pickle!

10/9/2014

Advocacy Tips• Apply on the Marketplace and follow-up with

THC.• Many folks who are on Medicare don’t know

that they are eligible for pickle.

10/9/2014

Scenario: Lamar• Lamar is a 62 year old widow who retired

early. He gets a Social Security check of $950 per month. This is his only source of income.

• He has a Qualified Income Trust (QIT) worth $40,000. Also, he has a burial fund worth $5,500.

• Soon after he retired, he learned that he has progressive bone cancer. He’s getting some treatment through a hospital charity program, but he continues to deteriorate quickly.

• His daughter, Tandy, has moved in with him to take care of him.

10/9/2014

What is he eligible for?





10/9/2014




Lamar (poor fella, all on his own!)

10/9/2014


10/9/2014

So who’s eligible for what?• Lamar?– Maybe CHOICES – what else do we need to

know?

• Resources?QIT and burial fund (up to $6000) are non-countable resources.• Needs help with activities of daily living?Lamar says he needs help with mobility and transfer.

10/9/2014

How do you apply for CHOICES?• Call local Area Agency on Aging and Disability.• Need to go through an evaluation. Many

times, people “fail” this the first time. If that happens…

•Appeal!–Appeal form in back of toolkit.

10/9/2014

Practice Tips• CHOICES is a common alternative for people who are

in the Gap, because it is a doorway to Medicaid. If you have a client who needs help with even 1 activity of daily living and is within income and resource limits of CHOICES, he/she could qualify for CHOICES 3.

• If you’re denied the right to an assessment for CHOICES, you have the right to appeal.

• Counting resources for CHOICES can be tricky. Sometimes, folks may want to speak to an elder law lawyer about their resources.

10/9/2014

Marketplace Basics

10/9/2014

What’s my role?• Unless you are a CAC or Navigator, you cannot

hold yourself out as one.• You also cannot recommend a specific plan. • This is training does not provide you with any

type of certification (just tons of helpful info!).

10/9/2014

Premium Tax Credits

10/9/2014

Who is Eligible?Individuals and families with income between 100% and 400% FPL

• Must be lawfully present in the U.S.• Must not be eligible for other “minimum essential

coverage”

10/9/2014

FPL and Eligibility

FPL Affordability Program

Annual Income by Household Size

1 2 3 4

100% FPL Medicaid (?) $ 11,670 $ 15,730 $ 19,790 $ 23,850

138% FPL Medicaid (?) $ 16,105 $ 21,707 $ 27,310 $ 32,913

150% FPL PTC & CSR1 $ 17,505 $ 23,505 $ 29,685 $ 35,775

200% FPL PTC & CSR2 $ 23,340 $ 31,460 $ 39,580 $ 47,700

250% FPL PTC & CSR3 $ 29,175 $ 39,325 $ 49,475 $ 59,625

300% FPL PTC $ 35,016 $ 47,184 $ 59,376 $ 71,556

400% FPL PTC $ 46,680 $ 62,920 $ 79,160 $ 95,400

10/9/2014

Second-cheapest Silver plan –– expected contribution

____________________________________________

Premium Tax Credit amount

How is the Amount of the Tax Credit Determined?

10/9/2014

How is the Amount of the Tax Credit Determined?

Your PTC is based on your expected premium contribution. Everyone in the same FPL has the

same expected premium contribution.

10/9/2014

Annual Household Income Expected Premium Contribution% of FPL Income Amount % of Income Annual Dollar Amount

100-150% $11,490 - $16,755 2 - 4% $230 - $670

150-200% $16,755 - $22,340 4 - 6.3% $670 - $1,407

200-250% $22,340 - $27,925 6.3 – 8.05% $1,407 - $2,262

250-300% $27,925 - $33,510 8.05 – 9.5% $2,262 – $3,183

300-400% $33,510 - $44,680 9.5% $3,183 - $4,245

> 400% > $44,680 n/a n/a

2nd cheapest Silver plan, $5,000

Gunnar, Age 26 Coleman, Age 62$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$1,448 $1,448

$3,552

$13,552 Tax CreditContribution

2nd cheapest Silver plan, $15,000

10/9/2014

Why is this important?The expected premium contribution doesn’t change

with age, even though the cost of the plan does.

Offers of Employee Coverage & Eligibility

An individual is not eligible for premium tax credits if he is eligible

for other minimum essential coverage (MEC)

10/9/2014

Minimum Essential Coverage

• Most employer sponsored coverage is MEC

• An offer of coverage - even if it’s not taken - can make someone ineligible for premium tax credits

But wait…10/9/2014

Exception

An employee may be eligible for premium tax credits if the employer plan is

unaffordable or inadequate, and if the employee does not enroll in it

10/9/2014

Jumping the “Firewall” Between Employer Coverage and Premium Tax Credits

If unaffordable or inadequate

Offer of EmployerCoverage

Premium TaxCredits

10/9/2014

Is it Affordable?

• Affordable = employee contribution for self-only coverage is less than or equal to 9.5% of household income• Yes, that’s right! Cost of self-only coverage

used to determine affordability for both employee and dependents!!??!

10/9/2014

Affordability of Family Coverage (Conrad Family) Mom works at Edgehill. She earns $35,000. Dad is anpolitician and earns about $12,000.

Family Income: $47,000Premium Cost to Employee for Employee-Only Plan:$196/mo ($2,350/yr) 5% of incomePremium Cost to Employee for Family Plan: $509/mo($6,110/yr) 13% of income

Employee Only Family0%2%4%6%8%

10%12%14%

5% 5%

13%9.5% - - - - - - - - - - - - - - - - - - - - -

Bottom Line:No one is eligible for premium tax creditsbecause family coverageis considered affordable.

10/9/2014

Jumping the Firewall:When is Coverage Adequate?

Coverage is adequate if it has a minimum value (MV) of 60% o This generally means that the plan pays

at least 60% of spending for coverage of essential health benefits for a typical population, after accounting for cost-sharing charges required under the plan.

10/9/2014

How Will an Employee Know if his Offer is Affordable or Adequate?

• Application has an appendix to be completed by the applicant (with help from his employer to indicate value and cost of the plan)

• If your employer does not tell you, you can print off the Employer Coverage Tool from healthcare.gov.

10/9/2014

Cost-Sharing Reductions

10/9/2014

Marketplace Plans – Metal LevelsPlan Level Actuarial

Value Platinum 90%

Gold 80%

Silver 70%

Bronze 60%

Lower enrollee cost-sharing

Higher enrollee cost-sharing

10/9/2014

Same, but differentSILVER # 1(enrollee pays)

SILVER # 2(enrollee pays)

Deductible (individual) $2,000 $2,500

Maximum OOP Limit (individual)

$5,500 $6,350

Inpatient hospital (After deductible)

$1,500/admission 30%

Office visit(After deductible)

$30 $35

10/9/2014

Sample Cost-Sharing Reduction (CSR) PlansStandard Silver

Actuarial Value

70%

Deductible (Indiv)

$2,000

Max. OOP limit(Indiv)

$5,500

Inpatient hospital

$1,500 per admiss.

Office visit $30

10/9/2014

CSR for up to 150% FPL

94%

$0

$1,000

$100 per admiss.

$10

CSR for 151-200% FPL

87%

$250

$2,000

$250 per admiss.

$15

CSR for 201-250% FPL

73%

$1,750

$4,000

$1,500 per admiss.

$30

Go Silver!If your client falls between 100-250% of

FPL, she should pick a silver plan.

10/9/2014

Rule: No reconciliation at end of the year (for cost-sharing reductions)

10/9/2014

Scenario: Luke and Rayna• Rayna and Luke are married

with three children: ages 12, 7, and 2.

• Luke makes $3,000/mo.; Rayna $1500/mo.

• They have savings of $15,000.• Luke is insured with his

employer, who just announced that they will be offering healthcare for employees’ children next month.

• Luke pays $255/mo. for health insurance.

10/9/2014

What is everyone

eligible for?





10/9/2014


Counted in HH (for Medicaid)Luke Rayna Maddie Daphne Taylor

Luke

Rayna

Maddie

Daphne

Taylor

✔ ✔ ✔



✔

✔ ✔ ✔✔

✔ ✔ ✔✔

✔ ✔ ✔✔

10/9/2014

✔

✔

✔

✔

✔ ✔ ✔✔ ✔

Step 3: Income: WaylonIncome for household of 5 is $4500/month.

10/9/2014

Kids

Rayna

So who’s eligible for what?• Luke?– Not eligible to get PTCs, because he has an offer of

coverage.• Rayna?– Eligible for PTCs and CSRs!

• Kids?– CoverKids!

But, Luke wants to look at all his options… he doesn’t trust this “CoverKids” deal…10/9/2014

Luke is skeptical…• Luke currently pays $255/mo (8.5% in income) for

his healthcare.• To add his kids, it would be $510 (17% of his

income).

And Rayna is still uninsured…

A silver plan, with PTCs, could cost $167/mo

10/9/2014

The Family Glitch• Because of the family glitch, Rayna and Luke

would end up spending about $677/mo. (17% of their income) on healthcare without CoverKids.

• So… get those girls on CoverKids!

10/9/2014

Take-Aways and Practice Tips• Family glitch: health insurance that is

“affordable” can still be very expensive for the family.

• If one spouse has employee coverage, but the other spouse gets covered on the Marketplace, the employee coverage premiums do not count towards expected contribution.

10/9/2014

Scenario: Juliette• Juliette is a single mother. • Her son Garth is 12 years old. Juliette’s 61 year

old long-lost father, Waylon, lives with them. • Juliette earns $1,900/month. Waylon makes

$100/month working weekends at a hardware store.

• Juliette claims Waylon as a dependent, but Garth is claimed by his dad. Garth stays with his dad every other weekend.

• Garth has severe intellectual disabilities, and Waylon had diabetes. No one has insurance right now.

10/9/2014

What is everyone

eligible for?





10/9/2014


Counted in HH (for Medicaid)Juliette Garth Waylon

Juliette

Garth

Waylon

✔


Juliette and Waylon: Juliette, WaylonGarth: self, dad

✔ ✔

✔

✔

10/9/2014

Step 3: Income: Juliette & GarthIncome for household of 2 is $1900/month.

10/9/2014

Juliette

Garth

Step 3: Income: WaylonIncome for household of 1 is $100/month.

10/9/2014

What about his income for PTC purposes?

Since he is in Juliette’s household for PTC purposes, his income is high enough!

10/9/2014

Step 3: Income: Waylon

So who’s eligible for what?• Garth?– CoverKids– Maybe Medically Needy Spend Down?– Get on DIDD waiting list

• Juliette?– PTCs and CSRs!

• Could get a Silver plan at $35.37/month, with a $141.56 subsidy, and 94% CSRs.

• Waylon?– CHOICES?– PTCs and CSRs!10/9/2014

Practice Tips• Remember the exceptions for household

sizes!• Remember to look at someone’s household

for both PTCs and TennCare.• A quick note about insulin: CoverRx is a

resources for folks under 100% FPL.

10/9/2014

Coffee Break!!!

10/8/2014

TennCare Updates

10/9/2014

It took TennCare 8 months to process the application for Rusty and his family. During that time, Rusty couldn’t get on the list for a life-saving liver transplant, and his two

sons went to the ER without insurance: one for a broken arm, and one for an illness.

Wilson v. GordonOn July 27th, TJC, the Southern Poverty Law Center, and the National Health Law Program filed suit against TennCare on behalf of all Tennesseans who have been waiting for more than 45 days for TennCare to tell them whether or not they are eligible.

10/9/2014

“Reasonable Promptness”Federal law requires TennCare to determine an applicant’s eligibility “with reasonable promptness,” defined as no longer than 45 days (or 90 days for the CHOICES program).

10/9/2014

Applicants’ Right to a Hearing

Federal law requires TennCare to provide an opportunity for a fair hearing to anyone whose application is “denied or is not acted upon with reasonable promptness.”

10/9/2014

Wilson v. Gordon Class“All individuals who have applied for Medicaid (TennCare) on or after October 1, 2013, who have not received a final eligibility determination in 45 days (or in the case of disability, 90 days), and who have not been given the opportunity for a ‘fair hearing’ by the State Defendants after these time periods have run.”

http://www.tnjustice.org/tenncare-suit/class/

10/9/2014

http://www.tnjustice.org/tenncare-suit/class/

Wilson v. Gordon Order“The Defendants are ordered to provide the Plaintiff Class with an opportunity for a fair hearing on any delayed adjudication. Any fair hearing shall be held within 45 days after the Class Member requests a hearing and provides Defendants with proof that an application was filed.”

If the application is for CHOICES, the hearing must be held within 90 days of the request.

http://www.tnjustice.org/tenncare-suit/order/

10/9/2014

http://www.tnjustice.org/tenncare-suit/order/

4 Advocacy Tips from TJC1. Appeal! Appeal! Appeal!2. Refer to the Legal Aid Society for

representation at the hearing.– Refer to TJC for advocacy, if the state says they

are closing the applicant’s appeal.

3. Document the person’s application & eligibility

4. Be encouraging!

10/9/2014

Advocacy Tip #11. Help the class member appeal.

• Call Tennessee Health Connection: 1-855-259-0701 OR• Fax delayed appeal form to HCFA Eligibility Appeals: 1-844-563-1728 OR• Certified Mail, Return Receipt Requested, the delayed

appeal request form to: HCFA Eligibility Appeals:

P.O. Box 23650 Nashville, TN 37202-3650

10/9/2014

**Keep the fax/certified mail receipt, or write down date and time of phone call and who you spoke to.**

Advocacy Tip #1

• The appeal request form asks for proof of date of application.– If the applicant has correspondence from the Marketplace with the

date, send that. If not,– Call the Marketplace to ask for help with written proof.

• If the consumer applied over the phone and never received an eligibility notice in the mail: – Help him/her create an online account.– Link the application to the online account using the application ID

number. – Print the eligibility notice.

10/9/2014

2. Have the class member call her local Legal Aid Society if she is in East Tennessee (1-800-821-1309) or in Middle Tennessee (1-800-238-1443). They may be able to help.

10/9/2014

Advocacy Tip #2

Advocacy Tip #2• Refer to TJC if TennCare says they are closing

your client’s appeal because he/she could not provide the requested information.

• We do not believe this should happen! We will help advocate for families who have no means to prove their application date.

10/9/2014

3. Help him/her gather documents• Other documents that they should bring if they have

them:– Anything that the Marketplace or TennCare has sent to

him/her– Anything that he/she has sent to the Marketplace or

TennCare

• But, at the end of the day, the most important thing is that they show up.

10/9/2014

Advocacy Tip #3

Advocacy Tip #3• The state will use an “administrative process”

to adjudicate applications before going to hearing. TennCare’s goal is to resolve eligibility without the need for a hearing.

• If you can provide documents to help the state process the application, then a hearing might not be necessary.

• This is good news!!!

10/9/2014

Be encouraging! We don’t want folks to be intimidated by this process.

Things are always changing: please check our website for updates

www.tnjustice.org/tenncare-suit 10/9/2014

Advocacy Tip #4

http://www.tnjustice.org/tenncare-suit

Scenario: Dolly & Travis• Dolly and Travis are married with two

kids, Porter (5) and Cash (11). Dolly has a child from a previous marriage, Zoey (20), who is a full-time college student living at school during the year.

• Dolly and Travis file taxes jointly, and claim all the kids.

• Travis makes $3400/month, and that is their only income. He does not have access to insurance through work.

10/9/2014

What is everyone

eligible for?





10/9/2014


Counted in HH (for Medicaid)Dolly Travis Porter Cash Zoey

Dolly

Travis

Porter

Cash

Zoey

✔ ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔ ✔


Same as above – 5 people in the household for each member.

10/9/2014


10/9/2014

Porter

Cash

Cash

Zooey

Dolly &Travis

So who’s eligible for what?• Porter? – TennCare

• Cash? – CoverKids (or Medically Needy Spend Down if the family has

a log of medical bills)• Zoey? – Medically Needy Spend Down if the family has a lot of

medical bills, and few resources. – If not, PTCs and CSRs

• Dolly and Travis? – PTCs and CSRs

10/9/2014

But then, reality strikes.• On March 30, 2014, Dolly and Travis applied

on the Marketplace by phone for the whole family.

• Dolly, Travis, and Zoey are on a silver plan with PTCs and CSRs!

• …but the kids still haven’t been enrolled in TennCare or CoverKids.

What should they do now?

10/9/2014

Appeal!• Call TNHC to ask to file a delay appeal.• The state may ask for more information:– If they ask for proof of application, send in any

information that the family has from the Marketplace with the application date.• If they have nothing in writing, they can try connecting

their application ID# with an online account.

– If they ask for income verification, send in pay stubs (month of application, and month before application).

• Go to covertn.gov to apply to CoverKids directly for Cash.

10/9/2014

Uh-oh… Dolly & Travis Split• Dolly and Travis had one too many

fights about who could eat the last pickle in the jar, so they got divorced.

• Travis has custody of Porter and Cash, and makes their day-to-day decisions. Zoey is still living at school, but stays with her mom when she’s home.

• Dolly claims all three children as tax dependents.

• Travis’s income is still $3400/month.• Dolly gets a job making

$1900/month.10/9/2014

What is everyone

eligible for?





10/9/2014


Counted in HH (for Medicaid)Dolly Travis Porter Cash Zoey

Dolly

Travis

Porter

Cash

Zoey

✔ ✔ ✔ ✔

✔

✔ ✔ ✔

✔ ✔ ✔

✔ ✔ ✔ ✔


Dolly, Porter, Cash, Zoey: Dolly, Porter, Cash, ZoeyTravis: Travis

10/9/2014

Step 3: Income – Porter & CashIncome for household of 3 is $3400/month.

10/9/2014

Cash & Porter

Step 3: Income – Zoey & DollyIncome for household of 4 is $1900/month.

10/9/2014

Step 3: Income – TravisIncome for household of 1 is $3400/month.

10/9/2014

Travis

So who’s eligible for what?• Porter?

– CoverKids (or Medically Needy Spend Down if the family has a lot of medical bills)

• Cash? – CoverKids (or Medically Needy Spend Down if the family has a lot of

medical bills)• Zoey?

– Medically Needy Spend Down if the family has a lot of medical bills. – If not, Coverage Gap

• Dolly?– Coverage Gap

• Travis? – PTCs

10/9/2014

Practice Tips• If kids are eligible for CoverKids, do a quick screen to

see if they might be Medically Needy Spend Down (high medical bills? resources?)

• If someone is in the gap:– If they are close to 100% FPL, see if they can pick up a few

extra hours– Refer them to Health Assist Tennessee for help getting

care– Encourage them to share their story: 615-900-GAP3– If their income has any chance of going up this year, have

them apply on the FFM anyway!10/9/2014

Scenario: Gunnar & Scarlett

• In July, Gunnar started working 4 nights a week at the Bluebird Cafe. He makes about $1800 in wages and tips each month.

• In July, Scarlett started working a part-time job, making $580/month.

• Their jobs don’t offer insurance, and neither of their parents’ have employer insurance.

• Gunnar and Scarlett are 22, graduated college in May, and just got married in June!

10/9/2014





10/9/2014

Probably not eligible for TennCare!


Counted in HH (for Medicaid)Gunnar Scarlett

Gunnar

Scarlett✔



✔

✔ ✔

10/9/2014

Step 3: IncomeWhen we count income for TennCare purposes, we want monthly income. But on the Marketplace, we estimate

yearly income.

Gunnar estimates that his gross income in 2014 will be $10,800.Scarlett estimates hers will be $3,480.Combined income = $14,280: under 100% of FPL

10/9/2014

So who’s eligible for what?• Gunnar and Scarlett?– They can buy insurance on the FFM, but they

aren’t eligible for PTCs or CSRs since they are under 100% FPL.

– The lowest cost silver plan would cost them about $284/month – they can’t afford this.

10/9/2014

Gunnar and Scarlett are in the Coverage Gap.

Practice Tips• For purposes of getting PTCs, the FFM looks at

yearly income. • TennCare looks at monthly income.• Remember, for folks in the gap:– Can they pick up extra hours if they’re close?– Health Assist Tennessee– 615-900-GAP3– Apply anyway!

• Young adults can stay their parents’ employer insurance – even if they are married.

10/9/2014

Woohoo—Scarlett Gets Preggo!• Scarlett finds out that

she’s pregnant!• Income stays the same:– Combined monthly

income: $2,380– Income for 2014: $14,280

Now who’s eligible for what?

10/9/2014





10/9/2014


Counted in HH (for Medicaid)Gunnar Scarlett

Gunnar

Scarlett✔


Gunnar and Scarlett are in a household by themselves. (Unborn babies don’t count on the FFM!)

✔

✔ ✔ ✔

Until the baby is born, Gunnar is in a household of 2, and is not considered a parent!

10/9/2014

Step 3: Income – ScarlettIncome for household of 3 is $2380/month.

10/9/2014

Scarlett

So who’s eligible for what?• Scarlett?– TennCare!

• Gunnar?– Same position he was in before… in the Gap.

What should Scarlett do now?Go to her local Health Department to get Presumptive

Eligibility, and apply on the FFM.

She must apply to the FFM by the end of the following month of getting PE, or she will lose her PE.10/9/2014

Look who’s here…Dierks pops out!• On March 14, 2015, Gunnar &

Scarlett have their first baby, Dierks!• Gunnar is still uninsured, and Scarlett

had TennCare when Dierks was born but will lose it at the end of May.

• Gunnar still makes $1800/month.• Scarlett worked in January and 2

weeks in February (made $580 in January, and $290 in February). She plans to go back to work on June 1, and will be making $580/month again.

10/9/2014

What is everyone eligible for?





10/9/2014


Counted in HH (for Medicaid)Gunnar Scarlett Dierks

Gunnar

Scarlett

Dierks

✔



✔

✔ ✔ ✔

✔

✔ ✔ ✔

10/9/2014

Step 3: IncomeIncome for household of 3 is currently $1800/month.

10/9/2014

Step 3: Income for the year• Gunnar will be making $1800/month

($21,600)• Scarlett made $870 in the beginning of the

year, and will make $580/month from June-Dec ($7,830)

• Combined income for 2014: $29,430 (under 150% FPL)

10/9/2014

So who’s eligible for what?• Dierks?– TennCare!– Call Tennessee Health Connection to get him on.

• Gunnar and Scarlett?– PTCs and CSRs!– Gunnar and Scarlett could get a plan that costs

$88/month.

10/9/2014

Practice Tips• A pregnant woman’s household includes herself and

all her unborn children – but only for her household.• A pregnant woman must complete her TennCare

application before her PE ends.• A baby born to a mom on TennCare should get

TennCare for 1 year, even if the family’s income changes.

• If a family doesn’t know if their income will change, they should think about taking less APTCs, so they won’t have to pay back at the end of the year.

10/9/2014

Scenario #5: Layla & Will• Layla and Will are married with 1 daughter,

Miranda. • Layla is 3 months pregnant and an undocumented

Canadian immigrant. Will has had his green card for 3 years and is also a Canadian immigrant.

• Miranda is 2 years old and was born in the U.S. • Layla is a stay-at-home mother. Will works full-time

as a bartender. He makes around $24,000 (gross) a year. This is the family’s only source of income.

• Layla and Will are uninsured. Miranda has had TennCare since birth, and she gets food stamps.

10/9/2014

What are Layla and

Will eligible for?





10/9/2014

TennCare is only available for

folks who have had legal status in the US for 5 years. Will is in

the “5-year-bar.”


Counted in HH (for Medicaid)Will Layla Miranda Baby

Will

Layla

Miranda

✔ ✔


Will, Layla, and Miranda are all in each other’s households.

✔

✔ ✔ ✔✔

✔ ✔✔

10/9/2014

Step 3: IncomeIncome for household of 3 is $24,000/year, or $2,000/month.

10/9/2014

Layla

Will

So who’s eligible for what?• Layla?– CoverKids!– She should apply on covertn.gov

• Will?– PTCs and CSRs!

10/9/2014

Advocacy Tips• When Layla’s baby is born, she should call

CoverKids to get the newborn on CoverKids for one year from when Layla got on CoverKids. – The newborn’s coverage will date back to date of birth. – CoverKids will determine whether the child should be

on TennCare or CoverKids, and will facilitate the enrollment in either category.

• Layla will lose her CoverKids 60 days after delivery. She should contact HAT for assistance getting affordable medical services and prescriptions.

10/9/2014

Y’all are amazing.Thank you all for joining us.

Post-test time!Then, stick around for lunch, and to ask any extra burning

questions.

We’re here to help!Katie: [email protected]: [email protected]: [email protected]: [email protected]: [email protected]

10/9/2014

www.facebook.com/tnjusticewww.twitter.com/tnjusticecenter

mailto:[email protected]





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