1. TennCare Redetermination Gordon Bonnyman, Staff Attorney Rachel Clifton, Training Coordinator/Client Advocate 10/21/2015

2. Agenda Description (5 min) Background (5 min) Process (10 min) Challenges (10 min) How to Help (20 min) Questions & Answers (10 min) 10/21/2015

3. What the law requires 10/21/2015

4. 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) 10/21/2015

5. 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. 10/21/2015 TennCare Rule 1200-13-13-.01

6. 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. 10/21/2015

7. 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

8. 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. 10/21/2015

9. Background

10. TennCare Redeterminations have been delayed for up to 3 years. 10/21/2015

11. Process

12. 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. 10/21/2015

13. Three Phases Phase 1: SNAP Match Phase 2: Confirmation Mailing Phase 3: Renewal Packet 10/21/2015

14. 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. 10/21/2015

15. 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. 10/21/2015

16. 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. 10/21/2015

17. Page 1 10/21/2015

18. Page 2 10/21/2015

19. Attachment TN A299a 10/21/2015

20. 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. 10/21/2015

21. Phase 3 MAJOR 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. 10/21/2015

22. Challenges in Completing Phase 2 10/21/2015

23. These Challenges Are: Enrollees may not receive the notice. Enrollees may not understand the notice. Enrollees may fail to take timely action. 10/21/2015

24. 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/ 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. 10/21/2015

25. Enrollees May Not Understand the Notice The notice is ambiguous. 10/21/2015

26. Intro Is Vague & Potentially Misleading 10/21/2015

27. Enrollees May Miss the Punchline 10/21/2015

28. Threat of Jail May Deter Enrollees from Taking Needed Action 10/21/2015

29. How to Help 10/21/2015

30. 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/.https://www.tnjustice.org/tenncare- redetermination/ 10/21/2015

31. 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 305240 Nashville, TN 37230-5240 Keep the delivery receipt. 10/21/2015

32. 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. 10/21/2015

33. Step Two: Understanding the Notice Encourage all enrollees to carefully read all notices to the end. Answer enrollees’ questions on household composition and income. 10/21/2015

34. How to Answer Questions – Family Size 10/21/2015

35. 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 10/21/2015

36. How to Answer Questions – Income (Pregnant Women, Children, Parent/Caretaker Relatives) 10/21/2015

37. 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

38. 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. 10/21/2015

39. Attachment TN A299a 10/21/2015

41. 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 rwatkins@tnjustice.org 10/21/2015

42. To Recap … 10/21/2015

43. 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) – Email to TN Health Connection. Keep the delivery receipt. 10/21/2015

44. 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. 10/21/2015 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.

45. Step 3 3.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. 10/21/2015

46. 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. 10/21/2015

47. 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/. https://www.tnjustice.org/tenncare- redetermination/ We will offer another webinar when we learn more about Phase 3. 10/21/2015

48. 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. www.facebook.com/tnjustice www.twitter.com/tnjusticecenter info@tnjustice.org www.tnjustice.org 10/21/2015