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Administrative Manual Policy Manual Number: 200.040 Section: General Administrative Procedures and Compliance Chapter: Eligibility Determination

June 2, 2025 Division of TennCare 5

Eligibility begins on the first day the person was confined in a Medical Institution, or the first day of the third month prior to the Application File Date, or the date all eligibility requirements are met, whichever is latest. • Institutional Medicaid (Medical Institution) The effective date of eligibility is the first day of the month following the month in which the application is approved. • Qualified Medicare Beneficiary The effective date of eligibility must not begin prior to the date of the emergent service and must not begin prior to the date of application for all applicants who are not a pregnant woman or child under the age of 19. Applicants who are pregnant or a child under age 19 who are eligible for Emergency Medical Services (EMS) on the basis of Child MAGI, Pregnancy MAGI, or Caretaker Relative may be reviewed for EMS during the retroactive eligibility period. To qualify for EMS during the retroactive period on the basis of the Caretaker Relative category, the individual must be pregnant. • Emergency Medical Services

See The Application Process policy for more details about the date of application.

9. Reported Changes

a. Changes

Changes must be reported by an individual within 10 days of the changed circumstance. Changes may be reported using any of the acceptable modes of submission: telephone, mail, fax, or online. The change will be considered reported on the date the change is received. If sent to TennCare via U.S. mail, this will be the date the envelope is date-stamped.