Got TennCare? You Need to Know About Redetermination.

If you are currently a recipient of TennCare benefits, you may have to prove your eligibility again this year through a process called “redetermination.”  This process may be every bit as challenging as your initial application, and if you are selected for redetermination, you will have a tight deadline for submitting evidence so as not to lose benefits.  Here’s what you need to know to protect yourself against loss of your benefits.

What is redetermination?

Federal law requires all Medicaid enrollees to have their eligibility re-assessed every 12 months. “Redetermination” is the process by which a person’s ongoing eligibility status is re-evaluated for TennCare Medicaid and Medicare Savings Programs.  It is conducted at specified intervals or when an enrollee’s circumstances change.  Although they announced the resumption of redeterminations in fall 2015, TennCare has not conducted a full redetermination process in almost four years.

This year, the Bureau of TennCare has again announced that they will resume redeterminations, which means current TennCare enrollees may have to prove their continued eligibility for benefits.

In the redetermination process, the State is required to:

  • Extend coverage for all enrollees whose current eligibility can be determined by review of records already available to the State
  • Send notices that are prepopulated with any information already available to the State
  • Afford enrollees an opportunity to provide any missing information
  • Provide assistance with the process
  • Assess enrollees’ eligibility in all open categories of TennCare
  • Notify enrollees of the State’s decision

The enrollee is required to:

  • Notify TennCare of changes in contact information
  • Report changes in income
  • Respond to redetermination notices within thirty (30) days
  • Provide supporting documentation

Who is subject to redetermination?

Anyone who currently receives TennCare benefits and has done so for at least one year may be subject to redetermination.  TennCare announced that redeterminations would begin for persons enrolled in Long-Term Services and Supports (the CHOICES program) in August of 2016, with additional waves in October and November 2016.  However, enrollees in other TennCare programs may also be affected.

What do I need to do?

1. If you currently receive benefits, verify your contact information with TennCare immediately. Current estimates show that TennCare does not have accurate contact information for at least one-third of all enrollees. As we have previously written, there are problems with the logging system for TennCare, and often reported changes are not accurately made in the system.  If you are selected but fail to receive your redetermination notice, you could lose benefits!  To protect yourself, follow these steps:

  • Keep copies of all documents sent to TennCare, and keep all proofs of sending (fax confirmation sheets or receipts from the Post Office).
  • You may also send in a Change of Address Form, available here: http://tn.gov/assets/entities/tenncare/attachments/ChangeOfAddressForm.pdf
  • Call Tennessee Health Connection at 1-855-259-0701 to verify that TennCare has your correct address on file. If they do not, update the address on file. You should do this even if you previously notified TennCare of a change of address. While on the phone, ask if you were supposed to receive a redetermination packet. If they say yes, then ask that the packet be resent.

2. Don’t delay. Act immediately if you receive a redetermination packet.  Completing a redetermination packet is no small feat.  It is approximately 119 pages long with 47 pages of instructions. It asks for the same information that was provided with the original application for services. Currently the packets from TennCare are not prepopulated, despite the State’s requirement to fill in all information already possessed by the State. This places an additional burden on the TennCare enrollee to complete the entire form in a short amount of time.

  • Complete and return the packet to TennCare within thirty days to avoid termination of benefits.
  • If you cannot complete your packet within the given time, ask for an extension. If the packet is not completed and returned to TennCare in a timely manner, you may lose your benefits.

3. Get the help you need.  TennCare has not been very forthcoming about the details of the redetermination process, which may be confusing.  If you feel overwhelmed, don’t try to go it alone.  Contact Elder Law of East Tennessee or another qualified law firm for assistance with your redetermination packet or with questions about the process.