SB 164

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."