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Administrative Manual Section: General Administrative Procedures and Compliance Policy Manual Number: 200.030 Chapter: The Application Process

May 1, 2024

Division of TennCare 1

APPLICATION PROCESS Legal Authority: 42 CFR 435.906; 42 CFR 435.907; 42 CFR 435.909; 42 CFR 435.910; 42 CFR 457.330; 42 CFR 457.340; Tenn. Comp R & Regs 1200-13-20-.05 1. Overview

The Affordable Care Act (ACA) of 2010 reformed the Medicaid application process. The ACA provides that a single, streamlined application must be used to collect information sufficient to determine an individual’s eligibility for Medicaid, Children’s Health Insurance Program (CHIP, or CoverKids in Tennessee) and subsidies available for insurance policies sold on the Marketplaces. If the information collected in the single, streamlined application is not sufficient to determine an individual’s eligibility for Medicaid and CHIP (e.g. an individual applying for Long-Term Services and Supports - LTSS) then supplemental application materials may be used.

The ACA reformed the application process for TennCare Medicaid and CoverKids, establishing a no wrong door approach between the state and federal government. Applications may be submitted electronically, by phone or by mail. Individuals may also apply in person at local Department of Human Services (DHS) offices using a TennCare kiosk. Applications may also be submitted through the Federally Facilitated Marketplace (FFM). Under the ACA, all of these methods of application are acceptable and will be processed accordingly.

2. Policy Statement

An individual who wants to file an application for TennCare Medicaid or CoverKids must have the opportunity to do so without delay. Applications must be voluntary and initiated by the person in need, or if the applicant is incompetent or incapacitated, someone responsible for acting on her behalf.

Individuals are not required to provide proof of eligibility prior to applying for assistance. However, proof of eligibility is required before assistance can be granted. Proof of eligibility may be secured by TennCare when information is readily available, or provided by the applicant, depending on the information type and circumstances. 3. TennCare Application

The TennCare application is used to determine eligibility for TennCare Medicaid categories, CoverKids, and Medicare Savings Programs (MSPs). Information collected on the TennCare application may also be used to determine eligibility for federal subsidies for other Insurance Affordability Programs (IAPs). Applications for individuals ineligible for TennCare Medicaid and CoverKids, but potentially eligible for other IAPs will be transferred to the FFM.

4. Application Forms

Acceptable application forms include the: