However, in some situations only one member of the couple may be TennCare eligible. For example, one spouse may be insured and not meet any of the requirements for eligibility in any of the TennCare categories. Ordinarily, family members with Medicaid or other insurance will not be counted in determining family size for premium and copayment purposes. Nor will their income be counted in determining family income in relation to family size. Income for the purpose of determining premium and copayment amounts is defined as the total gross income of all family members who are included in family size.
Gross income is income before any deductions for taxes or other purposes is made.
Some income, such as child support, is not counted according to IRS guidelines. The appropriate family size and countable family income are compared to the enrollee cost sharing charts to arrive at the amount of cost sharing required by the family, if any. These charts are on a sliding scale, with the amount of premiums and copayments increasing as family income increases.