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Health Care Finance and Administration Section: General Administrative Procedures and Compliance Policy Manual Number: 200.015 Chapter: Application for Other Program Benefits
5. Application of Good Cause Provision
Once good cause has been established, take one of the following actions depending on the circumstances of the case:
a. Hold the Application Pending
If the TennCare Medicaid application is held pending, give the individual a specific deadline for filing an application for other benefits.
If the deadline exceeds the processing time limits and the TennCare Medicaid application becomes overdue, document the case record with an explanation of the reasons the application continues in a pending status. An Eligibility Specialist is not considered at fault in this situation if the case record is well-documented.
If at expiration of the deadline the individual has failed to apply, and does not have good cause for his or her failure to apply, the application is denied.
6. Approve the Application If the individual is otherwise eligible, approve his or her application for benefits. Inform the applicant that the requirement to apply for other benefits has been temporarily waived, and he or she has an obligation to apply in the future. The time limit for that application and acceptable evidence of application for other benefits must be provided. Set up a case worker alert to follow up on the individual’s application for other benefits, and upload evidence of his or her application for other benefits to the case. 7. Applying the Provision at Redetermination
If all other conditions and eligibility criteria are satisfied, consider the redetermination complete and document the Case Notes with an explanation of the waiver of this requirement. Set up a case worker alert to follow-up on the individual’s application for other benefits if the requirement has been temporarily waived.
8. Verification
At application, self-attestation by an individual regarding application for other programs is accepted.
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