How to get or keep TennCare for your adult child with disabilities

by Tennessee Justice Center on June 13, 2012

For adult children with disabilities, their health insurance is often linked to Supplemental Security Income (SSI) payments.  Some adult children with disabilities can get SSI if their resources and income are low enough.  People in Tennessee who get an SSI check automatically get health insurance from the state. They get TennCare/Medicaid.

Some children with disabilities didn’t get SSI because their family made too much money or had too many resources (for instance, more than one car or money in savings). That child might be able to get SSI when he turns 18. The parents’ income and resources do not count after the child turns 18.

Adult children who already get SSI may also start getting Social Security Disability Income (SSDI).  This income is based on a parent’s work history. This can happen when a parent starts getting retirement or disability benefits, or if a parent dies.  These SSDI cash benefits are called disabled adult child benefits (DAC benefits).

Your child will lose her SSI check if that new SSDI/DAC income puts the adult child over the SSI limits.  She may  also lose TennCare. The next section will help you figure out if your child should still get TennCare once she starts getting DAC benefits.

What to do if your adult child’s income becomes too high for SSI?

If your adult child with disabilities lost SSI when he started getting SSDI because of a parent’s work history, he might still be able to keep TennCare/Medicaid.

The child should stay eligible for TennCare/Medicaid as long as:

1) the child with disabilities is 18 or over,

2) the child was diagnosed as disabled or blind before age 22,

3) the child would have stayed eligible for SSI except for the right to SSDI or an increase in the SSDI,

4) the child lost SSI after July 1, 1987.

These adult children are called DAC or CDB (childhood disability beneficiaries). The Department of Human Services (DHS) decides DAC eligibility for TennCare/Medicaid. Apply for your child to get TennCare through the DAC category if your child gets a letter (notice) that says her TennCare will end unless she is eligible for TennCare in another category.  The letter should include an application (called the Request for Information or RFI).  DHS will need this information to see if your child is still eligible for TennCare.  You will need to verify this information every year, if not more.  You have 10 days to tell DHS if  your child’s circumstances change (for example income, resources, address).

Example: A child is getting  $698 (SSI income). After age 18 the child starts getting $1,002 in an SSDI check because her parent retires or becomes disabled. The child’s income is now too high to keep getting SSI.  The child is a DAC.  When someone stops being eligible for SSI, he may no longer be eligible for TennCare.   But if the loss of SSI is because the DAC child gets SSDI, the child can get TennCare. The total SSDI cash benefit is disregarded, or the part of the SSDI benefit that caused the loss of SSI is disregarded. Remember, a DAC child would still be getting SSI, but that child now gets SSDI based on a parent’s work history instead. (

Keep coverage by applying.

What to do if the State sends you a notice that your child is no longer eligible for TennCare? Reapply. (Expect a notice annually.)

You’ve reapplied. What if you get a notice that your child is not eligible for TennCare?

You should appeal if you think your child should still get TennCare. In your appeal, say that you think your child should be able to stay on TennCare because your child is in the DAC category.

Next, check with Social Security to see how Social Security has coded your child’s benefits.  If Social Security made a mistake in their coding, your child could lose TennCare until the mistake is fixed. Social Security coding needs to show that the child is DAC or CDB and lost SSI benefits as a result of getting the SSDI.

What if you learn your child lost TennCare when you take him to the doctor or try to get his medicines?

Appeal-  You can call DHS to file an appeal.  Call your county DHS office.  You can also go online to find the phone number  and address.

Apply-  Get an application at your county DHS office or go online.  You can download an application to take or send to DHS or you can  apply online.  Here is the DHS website address: http://www.tn.gov/humanserv/.

What if your adult child lost SSI before she was 18 because she got Social Security dependent benefits?

Your adult child is not eligible for TennCare as a DAC child, but might still be eligible for TennCare in a different category.  Ask DHS to check your child for the  “Pickle” category.

What if she gets married?

The disabled adult child can even marry and continue to get benefits as a DAC child as long as the child marries a Social Security beneficiary who is over age 19.  A Social Security beneficiary could be someone who receives SSDI or SSI. To continue to get DAC benefits, the child can marry someone who is getting DAC, disability, widow/widower or regular retirement benefits. If she marries someone who is a Social Security beneficiary under age 19, or someone over age 19 who is not a Social Security beneficiary, then she will lose her benefits.

What if my adult child has never received SSI benefits?

Your adult child with disabilities may still be eligible for SSDI even if your child did not get SSI, but your child will not be eligible for TennCare in the DAC category. If you think your child will need TennCare/Medicaid, apply for SSI for your adult child.[1]

What if my adult child receives work income?

If your child earns too much to keep the SSI check, but needs to keep TennCare/Medicaid in order to work, your child could still be eligible for TennCare/Medicaid in the 1619(b) category.  The income level in Tennessee for that category in 2012 is $31,464.  Check with Social Security about that possibility.  Social Security decides who qualifies in that category.

MediCARE

Your child with disabilities might also be eligible for health insurance through MediCARE. Usually a person must receive two years of Social Security benefits prior to MediCARE eligibility.  There are two exceptions: MediCARE begins immediately for people of any age who have end stage renal disease, or for people who have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Once your child is eligible for MediCARE, your child may be eligible for one of the MediCARE savings programs, or eligible to purchase a MediCARE Supplement plan.  At that point you (or your child) can decide if your child needs to maintain eligibility for TennCare/Medicaid.  Keep in mind that TennCare covers transportation and home health care that MediCARE does not cover.


References:  Social Security Act 1634(c), POMS Section SI 01715.015, TennCare Medicaid and TennCare Standard Policy Manual December 2009.


[1]  CAUTION: Parents may want to avoid applying for their own Social Security benefits until after disabled child turns 18 if the only way the child can get SSI is after age 18.  Otherwise child may not be considered DAC eligible for TennCare/Medicaid.  Child may still be eligible for Social Security cash benefits. You have to lose SSI cash benefits because of SS cash benefits to be DAC eligible for TennCare.

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