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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 5 7. Advance Notification If an individual reports a change that will reduce or terminate Medical Assistance benefits, is determined ineligible, or fails to submit necessary information during the renewal process, a 20-day advance notice will be sent. Adverse action is not taken until the 20-day adverse action period has expired. The adverse action notice period allows the individual to provide any information that will alter the decision to reduce or terminate benefits. If the individual submits information requested during the advance notice period, eligibility will continue until a determination of eligibility is completed. Advance notice of termination is not required in the following situations: a. Verified report of the individual’s death; b. Written statement from the individual waiving his right to advance notification; c. The individual’s whereabouts are unknown and the post office returns mail directed to him indicating no forwarding address; d. Confirmed report that individual is receiving Medicaid or CHIP in another state; e. Individual has been admitted to an institution where he is not eligible to receive benefits; f. To an enrolled child that is removed from the home as a result of a judicial determination or is voluntarily placed in foster care by her parents or guardian, and the child’s eligibility category is changed; or g. Assistance is to be discontinued or reduced as the result of an appeal decision. Note: A two-day advance termination is provided for voluntary termination requests. 8. Reconsideration Period If the individual fails to submit the renewal form or requested information and eligibility is terminated, TennCare will reconsider eligibility without requiring a new application if the requested information is provided within 90 days of the termination date. Unless an exemption applies, TennCare will fill a gap in coverage when the information provided during the 90-day reconsideration period results in an approval. In accordance with federal law, an exception is the Qualified Medicare Beneficiary (QMB) group, which can only be effective the first day of the month after the individual is approved. 9. In-person Interview Individuals are not required to complete in-person interviews for redetermination. 10. Redetermination for Individuals Losing SSI Eligibility SSI recipients who lose their SSI coverage will undergo a redetermination of eligibility for Medical Assistance upon notification of SSI termination after all SSI appeal rights have been exhausted. If an individual has an open SSI appeal, TennCare Medicaid coverage will continue until the resolution of the SSI appeal and redetermination of eligibility takes place. There will be a 75-day wait period before redetermination can begin after loss of SSI and between each level of SSA appeals.