TennCare Eligibility Redetermination Has Resumed
If a loved one lives in a nursing home and is a TennCare CHOICES member, be aware that eligibility redetermination (also known as reverification or renewal) for TennCare members has resumed and will continue over the next several months.
Continuity of eligibility for CHOICES members is particularly important since gaps in coverage can result not only in the loss of services for members and payment for providers, but also in the potential loss of “grandfathered” status for eligibility in certain categories. For example, persons enrolled in CHOICES Groups 1 or 2 prior to July 1, 2012 who do not meet the nursing facility level of care criteria which became effective on July 1, 2012 can remain eligible for CHOICES 1 or 2 and for Medicaid in their current eligibility category so long as they continue to meet the level of care standards in effect at the time of their enrollment, and remain continuously enrolled in TennCare and in their CHOICES Group. A gap in coverage will result in the need to meet new standards, and if not met, could result in the person no longer qualifying for LTSS or for TennCare.