Page 2

Administrative Manual Policy Manual Number: 200.045 Section: General Administrative Procedures and Compliance Chapter: Redetermination

August 1, 2024 Division of TennCare 2 4. Redetermination Process a. Eligibility Period TennCare redeterminations occur for individuals currently eligible for Medical Assistance every 12 months. A redetermination of eligibility occurs during the 12-month eligibility period when a reported change, whether from a data source or individual, may affect eligibility. During the 12- month period individuals are required to report any change in circumstance. b. Continuous Eligibility i. Pregnant Women 1. TennCare Medicaid Women who have been determined eligible for and enrolled in TennCare Medicaid while pregnant and children under the age of 19 who have been determined eligible for TennCare Medicaid, TennCare Standard, or CoverKids Children while pregnant will remain eligible for that respective benefit through the last day of the month of a 12-month postpartum period, which begins on the day pregnancy ends, regardless of most changes in circumstance and regardless of how pregnancy ends. These women will generally remain in the same benefit category for the duration of the 12-month postpartum period, and they will not have their eligibility redetermined until the end of the 12-month postpartum period. This is true even if it has been greater than 12 months since their last eligibility determination. Women in a presumptive eligibility period are not eligible for continuous eligibility. NOTE: Women who are approved for the Pregnancy MAGI Category of Eligibility (COE) with an effective date of eligibility after the end of their pregnancy will remain eligible for benefits through the last day of the month of a 60-day postpartum period. The 12-month postpartum period will end prior to the end of the 12 months in the following circumstances: a. Coverage is voluntarily terminated; b. The individual is no longer a resident of Tennessee; c. The State determines that eligibility was erroneously granted at the most recent eligibility determination or renewal of eligibility because of state error, or fraud, abuse, or perjury attributed to the woman or her representative; or d. Death.