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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 2

a. TennCare Paper Application; b. TennCare Electronic Application; or c. FFM Application for Assistance (Health Insurance Marketplace, Application for Health Coverage & Help Paying Costs).

5. Who May Submit an Application

An application and any documentation required to determine eligibility may be submitted by the following individuals:

a. The individual who is requesting assistance (the applicant) b. A minor child must be a “mature minor” to submit his application. In determining who is a “mature minor,” Tennessee common law follows the “Rule of Sevens.”

i. Under the age of seven, there is no capacity. The application and any documentation required to determine eligibility must be submitted by an adult who lives in the home with the applicant, an authorized representative, or an individual acting responsibly for the applicant (unless a statutory exception applies). ii. Between the ages of seven and fourteen, there is a rebuttable presumption that there is no capacity. The application and any documentation required to determine eligibility generally should be submitted by an adult who lives in the home with the applicant, an authorized representative, or an individual acting responsibly for the applicant (unless a statutory exception applies). iii. Between the ages of fourteen and eighteen, there is a rebuttable presumption of capacity. The applicant may submit an application and any documentation required to determine eligibility, unless it is determined that the minor is not sufficiently mature to make her own health care decisions.

c. An adult who lives in the home with the applicant, if the applicant is a minor. This may be the applicant’s biological, step or adopted parent, a family member who claims the applicant as a tax dependent, or another individual who is in a position to know the applicant’s circumstances. d. The primary residential parent or either parent when there is equally shared joint custody. e. An authorized representative. f. An individual acting responsibly for the applicant, if the applicant is a minor or incapacitated. A responsible party may be a relative, friend, guardian, conservator or other individual who is in a position to know of the applicant’s circumstances. g. A representative of the long term care facility where the individual resides.

NOTE: When an applicant cannot sign an application, TennCare may accept an application signed by the social worker, hospital, or nursing home facilitator. The signing individual must include a statement on the application indicating why the applicant is unable to sign the application. Valid reasons include: applicant is comatose, in emergency surgery or physically unable to sign and there are no family