State Medicare Agencies Set to Redetermine Enrollees' Eligibility Post-COVID

Back in the normal days before COVID, state Medicaid programs (including TennCare and Kentucky Medicaid) reviewed eligibity for all Medicaid recipients on an annual basis through a process called Medicaid redetermination.This is also known as Medicaid renewal or recertification.

However, during the pandemic, states were required to pause the redetermination process and maintain coverage for all individuals enrolled in the Medicaid. This means that some recipients have not had their eligibility reviewed since 2020 or earlier.

Beginning April 1, 2023, many states, including Tennessee and Kentucky, reinstated their review procedure.

How It Will Work and Why It Matters

Reviews are being done based on annual renewal date, and states are attempting to auto-renew every recipient's coverage using existing and allowable data sources. In these situations, enrollees should receive notice that they have been approved or denied coverage and the reasoning behind the decision. 

For recipients whose coverage cannot be done automatically, renewal packets will be sent to them requesting additional information. Contact may be made via postal mail, email, or other ways that are on file with the Medicaid agency. Insurance carriers who administer Medicaid programs may also attempt to contact impacted members to help them with the recertification process.

Social Security checks increased by a greater percentage than the Federal Poverty line did. This means that people who were on the qualifying borderline will probably lose their Medicaid benefits.

More Information

A guide to elegibility for TennCare can be found here.