What is Redetermination?

[fusion_builder_container type="flex" hundred_percent="no" equal_height_columns="no" hide_on_mobile="small-visibility,medium-visibility,large-visibility" background_position="center center" background_repeat="no-repeat" fade="no" background_parallax="none" parallax_speed="0.3" video_aspect_ratio="16:9" video_loop="yes" video_mute="yes" border_style="solid"][fusion_builder_row][fusion_builder_column type="1_1" type="1_1" background_position="left top" border_style="solid" border_position="all" spacing="yes" background_repeat="no-repeat" margin_top="20px" margin_bottom="0px" animation_speed="0.3" animation_direction="left" hide_on_mobile="small-visibility,medium-visibility,large-visibility" center_content="no" last="no" hover_type="none" min_height="" link=""][fusion_text]“Redetermination” is the process by which Medicaid agencies (TennCare in Tennessee) redetermine a person’s eligibility for coverage. Federal law requires that it be conducted every twelve months or when an enrollee’s circumstances change.The TennCare redetermination process has been disrupted by the COVID-19 pandemic.  Due to the public health emergency created by COVID, TennCare placed a hold on redetermination that was set to end July 15, 2022. However, due to the rise of the Omicron Variant BA.5, the US Department of Health and Human Services officially renewed the declaration of a public health emergency. This extended the hold on redetermination through October 13, 2022.While the hold on redetermination has been extended, it remains important that you are aware of what to do once TennCare redetermination resumes. If you are currently a recipient of TennCare benefits, it is important to know that you may have to prove your eligibility again.  This renewal or redetermination 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 the loss of your benefits.

 In March 2019, TennCare launched TennCare Connect – a website, mobile app, and call center eligibility system. With TennCare Connect, members can choose to receive notifications electronically through the TennCare Connect website or mobile app or choose to receive communications from TennCare via postal mail. Under this system, account balances are entered into a calculator and the system generates an eligibility approval or denial. This system has caused inaccurate denials for initial eligibility, and we anticipate it may even cause disenrollment for current recipients during the redetermination process.

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 to enrollees that are prepopulated with any information already available to the State
• Afford enrollees an opportunity to provide any missing information
• Assess enrollees’ eligibility in all open categories of TennCare
• Provide assistance with the process
• 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.

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. Changes that have been reported often are not accurately made in the system.  If you are selected for redetermination but fail to receive your notice, you could lose benefits!  To protect yourself, follow these steps:

• Call the TennCare Connect call center 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.
• You may also update your personal information in real time online by visiting tenncareconnect.tn.gov.
• Keep copies of all documents sent to TennCare, and keep all proof of sending (fax confirmation sheets or receipts from the Post Office).

1. Don’t delay. Act immediately if you receive a redetermination packet.  Completing a redetermination packet is no small feat. The packet is very lengthy with several pages of instructions. It asks for the same information that was provided with the original application for services. Set up an account with TennCare Connect to see exactly when you are up for renewal.

• Once you receive the packet, complete and return it to TennCare by the due date included with the letter.
• 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.

For married applicants, there is an additional layer of complexity. Married applicants must submit financial information for their spouses during their initial application. To determine eligibility, TennCare conducts a Resource Assessment, which is an initial “snapshot” of the applicant and spouse’s resources.  Depending on the household resources, a spend down may be necessary for the applicant to become eligible. At this point, the applicant’s spouse is allocated a portion of the household resources for their support. The renewal packet now requests documentation of the marital household resources, which makes it unclear about continued eligibility for benefits. You may or may not be required to submit this documentation.

1. 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. Help from a trusted advocate can improve your redetermination outcome.

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