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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 6

b. Who May Report Changes

A change and any documentation required to determine eligibility may be reported by the following individuals:

i. The individual who is requesting assistance (the enrollee or applicant) - 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.”

1. Under the age of seven, there is no capacity. The change and any documentation required to determine eligibility must be reported by an adult who lives in the home with the enrollee or applicant, an authorized representative, or an individual acting responsibly for the enrollee or applicant (unless a statutory exception applies). 2. Between the ages of seven and fourteen, there is a rebuttable presumption that there is no capacity. The change and any documentation required to determine eligibility generally should be reported by an adult who lives in the home with the enrollee or applicant, an authorized representative, or an individual acting responsibly for the enrollee or applicant (unless a statutory exception applies). 3. Between the ages of fourteen and eighteen, there is a rebuttable presumption of capacity. The enrollee or applicant may report a change 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. ii. An adult who lives in the home with the enrollee or applicant, if the enrollee or applicant is a minor. This may be the enrollee’s or 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 enrollee’s or applicant’s circumstances. iii. The primary residential parent or either parent when there is equally shared joint custody. iv. An authorized representative. v. An individual acting responsibly for the enrollee or applicant, if the enrollee or 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. vi. A representative of the long-term care facility where the individual resides.

c. What Changes Should Be Reported

The following are examples of changes that should be reported to TennCare:

i. Address changes.