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State Readies for Third Round of Standard Spend Down

Phone Lines will open 6:00pm CST September 12th

The Seal of the State of TennesseeNashville, TN – The TennCare Standard Spend Down program will again offer open enrollment opportunities to new applicants on Monday, September 12th, 2011 beginning at 6:00pm CST.

Standard Spend Down is available through a waiver to the Medicaid program for a limited number of qualified low income individuals, or those with high, unpaid medical bills who are aged, blind, disabled, or the caretaker relative of a Medicaid eligible child. Eligible individuals must have enough unpaid medical bills to meet the “spend down” threshold to qualify for coverage.

“We are pleased to again work in this collaborative effort with several entities including TennCare, the Tennessee Department of Human Services (DHS), the Tennessee Hospital Association, advocacy groups and the federal government in offering Standard Spend Down,” said DHS Commissioner Raquel Hatter. “This program offers additional assistance to qualified low-income individuals or those with very high medical bills who are not already on TennCare.” 

A special call-in phone line through DHS has been set up for interested applicants. The only way to request an application is by calling the toll-free number — 1.866.358.3230 — which will be open between 6:00pm and 8:30pm CST on September 12th. The phone lines will be open from 6:00pm to 8:30pm on subsequent weekdays until 2,500 interested applicants call in. 

Prospective applicants are encouraged to check eligibility qualifications before calling in. More information on the Standard Spend Down program and more detailed eligibility criteria are available on TennCare’s website: www.tn.gov/TennCare.

The toll-free number system is used to ensure equal access to Tennessee citizens interested in this program. After the first 2,500 calls are taken, the phone lines will be closed. The Tennessee Department of Human Services will send applications to all callers who are not already on TennCare and will review their eligibility for any open Medicaid categories and the newly opened Standard Spend Down category.  Advanced notifications will be made to the public and other stakeholders prior to subsequent openings of the application request line.

Legislation called for the “expansion of the Standard Spend Down category for TennCare enrollment up to a maximum of seven thousand (7,000) individuals in FY 2010-2011.” The program will continue to open and close on a rolling basis.

The Standard Spend Down category first opened to applicants on October 4th, 2010.  It was opened a second time on February 22nd, 2011. The 2,500 call limit was reached in approximately one hour during both enrollment periods.

Standard Spend Down Eligibility

In addition to being aged (65 or older), blind*, disabled,* or a caretaker relative,

An individual must meet certain income restrictions, or be able to “spend down” qualifying unpaid medical bills to that limit. (*To be considered blind or disabled, an individual must meet standards set by the Social Security Administration.)

The following chart shows the income limits:

Household Size

 

1

 

2

 

3

 

4

 

5

 

6

 

Monthly Income

 

$241

 

$258

 

$317

 

$325

 

$392

 

$408

 

Applicants also must not have resources that:

Exceed $2,000 for a family of one and $3,000 for a family of two with an additional $100.00 added per additional individual in the family.

A person’s unpaid medical bill must have been accrued within the past 90 days.  Medical bills paid by the applicant within the past 30 days may count towards meeting an applicant’s spend down requirement.

Pregnant women and children still are eligible for the Medically Needy Spend Down program which has never closed and does not have an enrollment cap.

The ONLY way to request an application for the TennCare Standard Spend Down Program is through the toll free number (1.866.358.3230). Those wishing to apply for other TennCare categories should contact their local Department of Human Services county office, call the Family Assistance Service Center at 1.866.311.4287 during normal business hours, or visit www.tennessee.gov/humanserv/.

Standard Spend Down Program

1. Who is eligible for the Adult Standard Spend Down Category?

 To be eligible for the Standard Spend Down (or SSD) program, you must meet all of the following criteria:

You must be age 21 or older and not pregnant.
AND
You must be US citizens or legal resident alien.
AND
You must be Tennessee resident.
AND
You must not be incarcerated.
AND
You must be either aged (65 or older), blind, or disabled, or you must be a caretaker relative of a Medicaid eligible child. To be considered blind or disabled, you must meet standards set by the Social Security Administration (SSA).
AND
You must have a sufficient amount of medical bills that have not been written off by the provider and that are your responsibility.  The sum of these bills, when subtracted from your income, must be enough to “spend down” to the state’s Medically Needy Income Standard, which is $241 for a family of 1, $258.00 for a family of 2, $317.00 for a family of 3, etc. 
AND
You must have resources that do not exceed $2,000 for a family of 1 and $3,000 for a family of 2, with an additional $100 added per additional individual in the family.

*Children and pregnant women have a similar eligibility category under Medicaid.
(Access to insurance does not prevent a person from qualifying)

2. When will the program be open again to applicants?

The program is scheduled to be open for enrollment September 12th, 2011. A dedicated DHS phone line will be available on Monday September 12th, 2011 from 6:00pm to 8:30pm Central Standard Time. The number for that line is 1.866.358.3230.  The phone line will close after approximately 2,500 calls are received.

3. What is the cap on enrollment?

7,000 enrollees. On September 12th, 2011, the program will again open enrollment to approximately 2,500 applicants.  Once those applicants are processed, enrollment will once again be opened up to more applicants.  We cannot take in more applications at one time than we can process within the “timeliness” standards that CMS requires.

4. When do I apply and will I apply at the county DHS offices?

New applicants will apply initially over the phone during established open enrollment periods.  The first of those periods was October 4th, 2010, the second on February 22nd, 2011, and the next period is scheduled for September 12th, 2011  from 6:00pm to 8:30pm Central Standard Time. The call-in line will be available until approximately 2,500 calls are received.  (As stated above, we cannot accept more applications at one time than DHS can process within CMS’s timeliness standards.)  The number for this dedicated call center is 1.866.358.3230.

Staff persons on the call-in line will collect basic demographic information from callers. Those who are not already on TennCare will be sent a written application to be returned to DHS within 30 days.  DHS will process those applications as they come in.  Once all the applications from one open enrollment period have been processed, the state will conduct another enrollment period.  These open enrollment periods will continue to occur until the target enrollment (7,000) is reached. The public and other stakeholders will be notified in advance before the next open enrollment period.

5. Does having access to health insurance prevent me from qualifying?

No.

6. How much coverage will I receive?  Will the start date for coverage be three months retroactive to the date of application?  If not, what will be the first date of coverage?

Enrollees in the SSD program will be eligible for all TennCare benefits for adults except long-term care (meaning Nursing Facility care and care in a Home and Community Based Services Waiver).  If you are a Medicare beneficiary, you will be eligible for TennCare to participate in payment of your Medicare deductibles and coinsurance. 

The start date of coverage for the SSD program will be the later of:
 
a. The date your call was received by the call-in line; or
b. The date spend-down is met (which must be no later than the end of the month of the original call to the call-in line).

7. How is this program different from the Medically Needy Spend Down Program for pregnant women and children?

The application process is somewhat different, in that pregnant women and children apply at DHS offices, whereas applicants for the SSD program apply through the Call-in Line discussed above. The benefits for all children enrolled in TennCare, including those enrolled in the Medically Needy Spend Down program, exceed benefits that are available for adults, since children are entitled to EPSDT. Otherwise, the SSD program is very much like the Medically Needy Spend Down program for pregnant women and children.

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