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

August 1, 2024 Division of TennCare 4 4. The child is determined eligible in a TennCare Medicaid category. c. Ex Parte Review An ex parte review will be done for individuals during the redetermination process. The ex parte process attempts to redetermine eligibility without requesting additional information from individuals. The review is automatically processed and completed using information available to TennCare, including information from electronic data sources. The ex parte process considers eligibility for all categories of Medical Assistance. Individuals in the following categories do not go through the ex parte process: i. Presumptive Breast and Cervical Cancer; ii. Presumptive Pregnancy; iii. Hospital Presumptive Eligibility; iv. Emergency Medical Services; v. Supplemental Security Income (SSI) individuals (while still receiving SSI payments); and vi. Immediate Eligibility (IE) Foster Care. Recent and reliable incomes that are received from an electronic data source or considered stable do not need to be reverified during ex parte review. When an individual is redetermined eligible, TennCare will notify the individual of the eligibility determination. When TennCare is unable to auto-renew eligibility based on available information, a renewal form will be provided to the individual. 5. Renewal Form When TennCare is unable to auto-renew eligibility based on available information, TennCare will provide the individual with a prepopulated renewal form. The renewal form will request information necessary to consider the individual for all categories of Medical Assistance. Individuals will have 40 days from the date on the renewal form to complete, sign, and submit the renewal form to TennCare. The renewal form may be submitted online, by phone, in-person, by mail, or by fax. TennCare will request additional information, when needed, to redetermine eligibility. See the Verification policy. 6. Determination Individuals must receive notice of a renewal determination. If an individual fails to submit information needed for a determination or submits information and is no longer eligible for Medical Assistance, TennCare will provide advance notice of termination. An adverse action taken on an individual’s case requires advance notice. Adverse actions include termination of benefits or reduction of benefits.