Tenn. Comp. R. & Regs. 1200-11-03-.03

Current through December 10, 2024

Section 1200-11-03-.03 - ELIGIBILITY REQUIREMENTS

(1) General Eligibility. To be eligible for the Program's services, a child shall:

(a) Be a resident of Tennessee;

(b) Not have reached his or her twenty-first birthday;

(c) Meet the diagnostic and financial eligibility requirements below;

(d) Complete and sign the application form approved by the Program; and

(e) Provide proof of application to Medicaid or CHIP within ninety (90) days of completing and signing the Program's application form (if Medicaid or CHIP eligible).

(2) Diagnostic Eligibility. To be eligible for the Program's services, a child shall provide a physician's certification that the child has an eligible diagnosis which causes the child to meet the definition of "child with a physical disability" defined by T.C.A. § 68-12-102. The physicians shall base the certification upon a physical examination conducted within the 12 months preceding the date of certification.

(3) Financial Eligibility. A child shall be financially eligible for services if his or her family's gross annual income as adjusted is at or below 200% of the Federal Poverty Guidelines. When a family has more than one (1) child with an eligible diagnosis(es), the program may add one person to the total number of family members when determining eligibility.

(a) For purposes of financial eligibility, a "family" is defined as two or more persons (including the child) related by birth, marriage or adoption who reside together, unless one of the following alternative scenarios applies.

1. If the parent or parents of a child under the age of eighteen (18) have voluntarily placed the child in another party's home to reside, the child and the parents are a "family."

2. If the parent or parents of a child under the age of eighteen (18) have been court-ordered to provide financial support to the child when the child lives in another party's home, the child and the parent or parents are a "family."

3. If a child eighteen (18) years of age or older does not live with a relative, the child alone is considered a "family."

4. A foster child alone is considered a "family" and the Department of Children's Services (DCS) foster care board payments to the foster parents are considered the family's income.

(b) The program shall determine the family's gross annual income and financial eligibility by calculating the following:

1. Wages, salaries, tips/gratuities, and/or commissions;

2. Income from rental property or equipment;

3. Profits from self-employment enterprises, including farms;

4. Alimony, maintenance and/or child support;

5. Inheritances, lottery winnings and/or other windfalls

6. Pensions and benefits;

7. DCS foster care board payments; and

8. Public assistance grants.

(c) After the program determines the family's gross annual income, the program may adjust income by taking into consideration the probable total cost of treatment and the family's other financial responsibilities, including but not limited to the following:

1. Verification of medical payments including medical or health insurance premiums made by the family for any family member during the previous twelve (12) months. The program shall deduct this amount from the gross annual income.

2. Verification of alimony, maintenance and/or child support paid to another household, which the program shall deduct from the gross annual income.

3. Number of dependents.

(d) The program shall review its available funding and historical spending annually. In any year in which, in the best judgment of the program, it appears that funds are available to serve families with gross annual income as adjusted greater than 200% of the Federal Poverty Guideline, the program may, in its sole discretion, post on its website an increased income eligibility limit and serve families with gross annual incomes as adjusted up to the posted limits.

(4) Subsequent determinations of eligibility. The program shall recertify enrolled children annually. A child shall meet all eligibility criteria in order to remain enrolled in the program.

Tenn. Comp. R. & Regs. 1200-11-03-.03

Original rule filed April 12, 1979; effective May 28, 1979. Repeal and new rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Amendments filed May 27, 2005; effective September 28, 2005. Repeal and new rules filed September 6, 2016; effective 12/5/2016.

Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., 68-12-103, 68-12-112, 42 U.S.C. § 701, and 42 U.S.C. § 705(a)(1)(C) and (a)(3)(B).