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However, if the applicant was terminated from employer-based health insurance within three months of making the CoverKids application for reasons such as layoff, business closing, or similar circumstance that resulted in the involuntary loss of previous insurance, then CoverKids enrollment will not be precluded. CoverKids enrollment will also be precluded if the applicant has access to coverage under a state employee health benefit plan.

4.1.8 Duration of eligibility:

With approval of the CoverKids application, the child will be eligible for twelve months. CoverKids eligibility may end prior to twelve months of coverage if the child is found ineligible at random review or at audit, turns age 19, or moves from the State. Because of the desire to simplify the application process as much as possible, upfront verification has been minimized but reasonable audit to detect errors or fraud is planned. There will be a sample of applications audited with application information fully verified. Families will be notified of the audit by letter as they would be requested to provide documentation to verify information given. If an audit shows that a child or children in the family were not, in fact, eligible for CoverKids, the TPA will contact the family to give them the opportunity to provide information establishing eligibility within 10 days. Families who do not provide information that establishes eligibility will be notified by letter of termination of eligibility, subject to the appeal rights described in section 12 of the State plan. Timeframes for disenrollment will be consistent with timeframes for disenrollment at redetermination, i.e., the last day of the month in which a final determination of ineligibility is made.

At the end of the twelve-month eligibility period, the family will be requested to confirm the eligibility information currently on file with CoverKids. The family completes the form and then signs and returns the form. Following return of the renewal form, eligibility will be reviewed, and if eligibility continues, the family will be sent a new enrollment card for another twelve- month period. They will also be sent information advising that if the family income is now lower, the application will be referred for Medicaid determination. Children whose applications have been sent to TennCare may remain in CoverKids for up to 60 days after the end of the 12-month CoverKids eligibility period if necessary while DHS reviews the TennCare application.

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