Wednesday, January 20, 2016

TennCare Redetermination

What is redetermination and how will it affect millions of Tennesseans healthcare coverage?

Allison DonaldBy Allison Donald

Redetermination is the process by which the Tennessee Department of Human Services (DHS) evaluates the ongoing eligibility status of TennCare Medicaid and TennCare Standard enrollees. Starting in December, TennCare entered into the final phase of the redetermination process. 

There have been many challenges during this process that has left many Tennesseans confused and without medical coverage. This year’s redetermination process will look different than in previous years.  DHS workers are said to be helping fill out and fax renewal packets.  Enrollees who do not have a caseworker they can contact, may call the Tennessee HealthCare Campaign (THCC) with basic questions about the Renewal Packet, but there may lengthy wait times.

The state is required to extend coverage for all enrollees who can be determined by review of records already available to the state.  Also, the state is required to send enrollees notices that are pre-populated with any information already available to the state to give enrollees an opportunity to provide any missing information. 

The state must also provide assistance in person or by phone for the redetermination.  The enrollee is required to keep TennCare informed of any changes in contact information.  The enrollee must report any changes in income, household composition and must respond to the redetermination notice within 30 days. Enrollees also must provide supporting documentation, as requested by the state. 
According to TennCare Division of Healthcare Finance and Administration, “All Medicaid agencies like TennCare are required to redetermine the eligibility of members on at least an annual basis. Due to the many complicated changes to Medicaid that took place starting January 1, 2014, the federal government encouraged Medicaid agencies to suspend redetermination efforts in order to focus on other tasks. Most Medicaid agencies – including TennCare suspended redetermination efforts.”

Phase one of the redetermination process began in May and September for approximately 720,000 individuals.  TennCare used SNAP data (food stamps) data gathered by DHS to redetermine eligibility.  No one lost eligibility as part of phase one.

ADAPT Marches for Medicaid equalityOctober through December was the start of phase 2 of the redetermination process TennCare sent notice to 300,000 selected enrollees.  The notice asked individuals to sign and return a form if their circumstances changed since their last eligibility review.   Phase 2 involves a confirmation mailing in which,  enrollees must complete the form and fax or mail it to TennCare to complete the redetermination process. It is especially important that all notices are returned to the address and fax number noted on the notice.  In Phase 2, even if individuals are not able to complete the forms he or she will remain in TennCare.

Phase 3 started in November of 2015 with a pilot group of 10,000.  This step will require enrollees to respond to extensive requests for information (RFI).  It will affect people due for redetermination, whose eligibility was not redetermined in phase 1 or 2.  If the enrollee fails to respond to the notices in Phase 3, TennCare will be terminated.

The initial barrier that has complicated this process is that the state is three years behind with its review of enrollees. The challenges vary; they may include the individuals not having their current address in the state system to ensure the state mails these notices to the correct address.  Notices are very confusing and must be read carefully to understand what steps to take. 

If a person has had a change in either their household income or family size since last applied for TennCare, they will need to sign the notice and return it to the state within 30 days.  For families with multiple members on TennCare, they will need to complete each form and return it to the state. 

Individuals may find it difficulty mailing or faxing information back to the state.  If a person fails to complete Phase 3 they will lose their TennCare.  If this should happen and they are still eligible, they will have to reapply through the Federal Marketplace System. Keep in mind that the Federal Marketplace doesn’t properly screen for every TennCare and Medicaid category.  This will make it very difficult for many who are currently on TennCare to get their coverage back. 

If you are experiencing any difficulty during the process please feel free to contact the Tennessee Justice Center (TJC) at