TennCare

Plain English Breakdown

The bill did not pass the Insurance Committee and has no legal effect.

TennCare Temporary Benefits Program

This bill requires the bureau of TennCare to submit a waiver application by December 31, 2025, for a temporary medical assistance program for individuals who are ineligible based on income.

What This Bill Does

• Requires the bureau of TennCare to submit a waiver application by December 31, 2025, to provide temporary medical benefits to those who are ineligible based on income.
• Establishes that individuals under 21 with family incomes up to 138% of the federal poverty level can receive up to 60 months of assistance before their 21st birthday.
• Allows individuals aged 21 and older, with similar income limits, to also receive temporary medical benefits for a cumulative maximum of 60 months over their lifetime.
• Requires that these temporary benefits do not replace enrollment in TennCare or CoverKids if the individual becomes eligible later.
• Funds the program using 90% federal funds and 10% state funds.

Who It Names or Affects

• Individuals under 21 with family incomes up to 138% of the federal poverty level who are not currently eligible for TennCare or CoverKids.
• Individuals aged 21 and older, with similar income limits, who are also not currently eligible for TennCare.

Terms To Know

CoverKids program

A health insurance coverage program for children in Tennessee.

TennCare block grant financing agreement

An agreement between the state and federal government that provides funding for TennCare services.

Limits and Unknowns

• The bill did not pass, so it has no legal effect.
• The exact number of people who will benefit from this program cannot be determined yet.

Official Summary Text

This bill requires the bureau of TennCare ("bureau") to submit by December 31, 2025, a waiver application to the fe
deral centers for medicare and medicaid services that establishes medical assistance provided on a temporary basis to an individual who is otherwise ineligible on the basis of income for enrollment in TennCare or in the CoverKids program ("program"). The

program must include provisions for
all of
the following:



That medical assistance must be available for a period not to exceed 12 months in a period of 24 months, up to a cumulative maximum of 60 months during the years prior to the individual's 21st birthday, for an individual who: (i) is less than 21; (ii) is from a family that has income not greater than 138% of the federal poverty level; and (iii) is not currently eligible for medical assistance under this part, enrollment in the CoverKids program, or a successor program



That medical assistance must be available for a period not to exceed 12 months in a period of 24 months, up to a cumulative maximum of 60 months during the individual's remaining lifetime, for an individual who: (i) is 21 or older; (ii) has an income not greater than 138% of the federal poverty level; and (iii) is not currently eligible for TennCare; provided that the 60-month limit resets upon the individual's 21st birthday and that any remaining time does not carry forward from prior to the individual's 21st birthday



That temporary benefits do not replace or substitute for enrollment in TennCare, the CoverKids program, or successor programs if the individual becomes eligible for one or more of those programs while the individual is enrolled in the program



That receipt of the temporary benefits does not preclude an individual who becomes eligible for medical assistance, the CoverKids program, or a successor program from applying for enrollment in those programs



That, if an individual becomes enrolled in medical assistance, the CoverKids program, or a successor program while the individual is receiving temporary benefits, then the temporary benefits are paused



That, enrollment in the program must begin six months following the date of federal approval of a necessary waiver



That the program is funded using 90% federal funds and 10% state funds



That the program and any federal waiver sought to enable the program must leave unchanged the TennCare block grant financing agreement that was negotiated pursuant to law and subsequently approved by the federal centers for medicare and medicaid services and by joint resolution of the general assembly

This bill requires the bureau to promulgate rules, which must include
all of
the following:



An application system for new and returning beneficiaries


A record of beneficiaries


A time-tracking system that maintains a record of a beneficiary's use of the program and that makes the record available to the beneficiary

This bill requires the bureau
to strive to enable applicants for temporary benefits to access benefits in a timely fashion. However, the program does not constitute an entitlement to coverage for eligible individuals, and the availability of program benefits is subject to appropriati
o
ns made in the annual appropriations act for that purpose.

LATER APPROVAL BY GENERAL ASSEMBLY NOT REQUIRED

Present law prohibits the governor from making any decision or obligating the state with regard to the expansion of optional enrollment in TennCar
e, pursuant to the federal Patient Protection and Affordable Care Act, unless authorized by joint resolution of the general assembly. However, this bill clarifies that this provision does not apply to actions by the governor that are necessary to establi
s
h the program described in the bill.

Current Bill Text

SENATE BILL 164
By Yarbro

HOUSE BILL 18
By Baum

HB0018
000491
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 71,
Chapter 5, relative to TennCare.

WHEREAS, it is the desire of the General Assembly to assist Tennesseans in times of
need; and
WHEREAS, such assistance should be provided in a manner that does not foster long-
term, chronic dependency on government assistance; and
WHEREAS, the temporary provision of high-quality healthcare coverage is one form of
that assistance; now, therefore,
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "CoverKids program" means the program established pursuant to the
CoverKids Act of 2006, compiled in chapter 3, part 11 of this title, to provide
health insurance coverage to children; and
(2) "Temporary TennCare benefits program" means medical assistance
provided on a temporary basis to an individual who is otherwise ineligible on the
basis of income for enrollment in medical assistance under this part or in the
CoverKids program.
(b) The bureau of TennCare shall submit by December 31, 2025, a waiver
application to the federal centers for medicare and medicaid services that establishes a
temporary TennCare benefits program.

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(c) The temporary TennCare benefits program must include provisions for the
following:
(1) Medical assistance must be available for a period not to exceed
twelve (12) months in a period of twenty-four (24) months, up to a cumulative
maximum of sixty (60) months during the years prior to the individual's twenty-
first birthday, for an individual who:
(A) Is less than twenty-one (21) years of age;
(B) Is from a family that has income not greater than one hundred
thirty-eight percent (138%) of the federal poverty level; and
(C) Is not currently eligible for medical assistance under this part,
enrollment in the CoverKids program, or a successor program;
(2) Medical assistance must be available for a period not to exceed
twelve (12) months in a period of twenty-four (24) months, up to a cumulative
maximum of sixty (60) months during the individual's remaining lifetime, for an
individual who:
(A) Is twenty-one (21) years of age or older;
(B) Has an income not greater than one hundred thirty-eight
percent (138%) of the federal poverty level; and
(C) Is not currently eligible for medical assistance under this part;
(3)
(A) The temporary benefits provided in subdivisions (c)(1) and
(c)(2) do not replace or substitute for enrollment in medical assistance
under this part, the CoverKids program, or successor programs if the
individual becomes eligible for one (1) or more of those programs while
the individual is enrolled in the temporary TennCare benefits program;

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(B) Receipt of the temporary benefits provided in this subsection
(c) does not preclude an individual who becomes eligible for medical
assistance, the CoverKids program, or a successor program from
applying for enrollment in those programs;
(C) If an individual becomes enrolled in medical assistance, the
CoverKids program, or a successor program while the individual is
receiving temporary benefits, then the temporary benefits are paused;
(D) For an individual contemplated in subdivision (c)(2), the sixty-
month limit resets upon the individual's twenty-first birthday. Any
remaining time does not carry forward from prior to the individual's
twenty-first birthday; and
(E) Enrollment in the temporary TennCare benefits program must
begin six (6) months following the date of federal approval of a necessary
waiver;
(4) The program is funded using ninety percent (90%) federal funds and
ten percent (10%) state funds; and
(5) The program and any federal waiver sought to enable the program
must leave unchanged the TennCare block grant financing agreement that was
negotiated pursuant to § 71-5-163 and subsequently approved by the federal
centers for medicare and medicaid services and by joint resolution of the general
assembly.
(d) The bureau of TennCare shall promulgate rules in accordance with the
Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to administer the
temporary TennCare benefits program. The rules must include:
(1) An application system for new and returning beneficiaries;

- 4 - 000491

(2) A record of beneficiaries, including:
(A) A beneficiary who becomes eligible for medical assistance,
the CoverKids program, or a successor program while the beneficiary is
receiving temporary benefits; and
(B) A beneficiary who was previously enrolled in medical
assistance, the CoverKids program, or a successor program; and
(3) A time-tracking system that maintains a record of a beneficiary's use
of the program and that makes the record available to the beneficiary.
(e) The bureau shall strive to enable applicants for temporary benefits to access
benefits in a timely fashion.
(f) The temporary TennCare benefits program does not constitute an entitlement
to coverage for eligible individuals, and the availability of program benefits is subject to
appropriations made in the annual appropriations act for that purpose.
SECTION 2. Tennessee Code Annotated, Section 71-5-126, is amended by designating
the existing language as subsection (a) and adding the following as a new subsection:
(b) Subsection (a) does not apply to actions by the governor that are necessary
to establish the temporary TennCare benefits program pursuant to SECTION 1.
SECTION 3. This act takes effect upon becoming a law, the public welfare requiring it.