tenncare redetermination gordon bonnyman, staff attorney rachel clifton, training coordinator/client...
TRANSCRIPT
TennCare Redetermination
Gordon Bonnyman, Staff AttorneyRachel Clifton, Training Coordinator/Client Advocate
10/21/2015
Agenda• Description (5 min)• Background (5 min)• Process (10 min)• Challenges (10 min) • How to Help (20 min)• Questions & Answers (10 min)
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What the law requires
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Periodic Redetermination of Medicaid Eligibility
By federal law, all Medicaid (TennCare) enrollees must have their eligibility redetermined every 12 months.
42 CFR 435.916(a) and (b)
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According to the TennCare Rules:REDETERMINATION shall mean the process by which [DHS] evaluates the ongoing eligibility status of TennCare Medicaid and TennCare Standard enrollees. This is a periodic process that is conducted at specified intervals or when an enrollee’s circumstances change. The process is conducted in accordance with TennCare’s, or its designee’s, policies and procedures.
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TennCare Rule 1200-13-13-.01
The State is Required to…• Extend coverage for all enrollees whose current
eligibility can be determined by review of records already available to the state. (“Ex parte review”)
• Send to enrollees notices that are pre-populated with any information already available to the state.
• Afford enrollees an opportunity to provide any missing information or documentation.
• Provide assistance – in person & by phone.
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And…• Assess enrollees’ eligibility in all open
categories of TennCare.• If ineligible for TennCare, determine eligibility
for other insurance affordability programs (CoverKids, PTCs, CSRs).
• Electronically transfer files to the Marketplace for those determined eligible for other insurance affordability programs.
• Notify enrollees of the state’s determination.10/21/2015
The Enrollee is Required to…• Keep TennCare informed of any changes in
contact information.• Report changes in income &/or household
composition.• Respond to redetermination notices within 30
days.• Provide supporting documentation, as
requested by the state.
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Background
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TennCare Redeterminations have been delayed for up to 3 years.
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Process
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Changes in the Process• This year’s redetermination process will look
different than in previous years.• DHS is no longer involved.• Enrollees do not have a case worker they can
contact.• A separate form must be sent back for every
household member.
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Three Phases
• Phase 1: SNAP Match• Phase 2: Confirmation Mailing• Phase 3: Renewal Packet
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Phase 1• In May & September the state redetermined
eligibility for approximately 720,000 individuals.• TennCare used SNAP (Supplemental Nutrition
Assistance Program a.k.a food stamps) data gathered by DHS to redetermine eligibility.
• No one lost eligibility as part of Phase 1.• Enrollees for whom there was a SNAP match
should have received a notice that their TennCare will continue.
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Phase 2• Starting in October, TennCare sent notices to
an additional group of 100,000 enrollees.– Letters will go to 200k more in November & December.
• The notice asks individuals to sign & return the forms if their circumstances have not changed since their last eligibility review.
• Based on self-attestation.• No immediate loss of eligibility in Phase 2.
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Phase 2• Enrollees can complete the form & fax or mail
it to TennCare to complete the redetermination process.
• Every enrollee in a family will receive his/her own form to fill out & send back in.
• It is especially important that all notices are returned to the address &/or fax number noted on the notice.
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Page 1
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Page 2
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Attachment TN A299a
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Phase 3• Phase 3 will start on December 1. • This step will require enrollees to respond to
extensive requests for information.• It will affect individuals due for
redetermination, whose eligibility was not redetermined in Phase 1 or 2.
• Failure to document eligibility or respond to notices will result in termination of TennCare.
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Phase 3MAJOR TAKEAWAY: Phase 3 will be extremely challenging. It has enormous risk of loss of coverage.
For the sake of both the state and enrollees, it is important to make sure everyone who can qualify for redetermination in Phase 2 be identified and have their coverage renewed.
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Challenges in Completing Phase 2
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These Challenges Are:
• Enrollees may not receive the notice.• Enrollees may not understand the notice.• Enrollees may fail to take timely action.
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Enrollees May Not Receive the Notice
• At least one third are likely to have moved since their eligibility was last determined. http://blogs.census.gov/2012/12/10/america-a-nation-on-the-move/
• Even if they reported a change in address, they can’t be sure the new address made its way into the system.
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Enrollees May Not Understand the Notice
The notice is ambiguous.
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Intro Is Vague & Potentially Misleading
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Enrollees May Miss the Punchline
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Threat of Jail May Deter Enrollees from Taking Needed Action
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How to Help
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Step One: Getting the Notice• Encourage all enrollees to update their contact
information with TennCare.• Make sure to list all the household members.• Include – email address– phone number– text message contacts.
• Distribute the Legal Aid Society flier on our website: https://www.tnjustice.org/tenncare-redetermination/.
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Updating Contact Info• Fax new contact information to Tennessee Health
Connection at 1-855-315-0669. Keep the fax receipt.
OR
• Mail by certified mail, return receipt requested to: Tennessee Health Connection
P.O. Box 305240Nashville, TN 37230-5240
Keep the delivery receipt.10/21/2015
Updating Contact Info
• Even if enrollees don’t receive a Phase 2 notice, they will want to get a Phase 3 notice.
• Enrollees may need to show they provided updated contact information on appeal if they lose coverage in Phase 3.
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Step Two: Understanding the Notice
• Encourage all enrollees to carefully read all notices to the end.
• Answer enrollees’ questions on household composition and income.
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How to Answer Questions – Family Size
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Family Changes Can Affect Eligibility
Changes to family size include:– Birth or adoption of child– Marriage, divorce, or legal separation– Death of family member– Family member no longer lives with you
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How to Answer Questions – Income
(Pregnant Women, Children, Parent/Caretaker Relatives)
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What Income Counts?• Alimony/child support– Alimony counts.– Child support does not count.
• Exclude government benefits based on need.– (SNAP (food stamps), Families First, SSI, housing &
energy assistance, veterans’ benefits) • Exclude gifts, inheritances, and Worker’s Comp.• In most cases, children’s Social Security
benefits do not count.10/21/2015
Even If Circumstances Changed, Sign & Send In the Form IF:
Countable income is below the amount specified for the family’s size in TennCare Form TN A299a that accompanies the redetermination notice.
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Attachment TN A299a
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Outreach Opportunity
Have a large number of TennCare patients or serve a large number of TennCare enrollees?
Consider telling them about redetermination.
We can help you with the message content!
If interested, please send an email to:
Rob Watkins at [email protected]
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To Recap …
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Step 1
1. Make sure TennCare has your clients’ current contact information. Fax or mail (delivery receipt requested) the change of: – Address– phone number(s)– Emailto TN Health Connection. Keep the delivery receipt.
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Step 2
2. If your client does get a notice, read the notice all the way through with each individual client. Don’t assume “a dime a dozen.” Make sure you know what TennCare is asking the person to do. Then help the client comply.
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Note: The address & fax number for Phase 2 forms is different than the address & fax number for TN Health Connection. Make sure you send Phase 2 forms to the address on TN 299VR.
Step 33. If the enrollee:
(A) has not had a change in family size or income, OR(B) has had a change, but his income is less than the amount listed in the notice for his family size,
sign the form for each member of the family and send it in NOW. Save fax or mail receipt.
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Step 4
4. Consider reaching out during Phase 2 to the TennCare enrollees you serve. An ounce of prevention is worth a pound of cure.
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Stay tuned…
For more info in future months on what to do to help people through Phase 3.• We will post information as we get it:
https://www.tnjustice.org/tenncare-redetermination/.
• We will offer another webinar when we learn more about Phase 3.10/21/2015
Thank you for joining us today!“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
-Martin Luther King, Jr.
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