TennCare Medicaid

The Medicaid program in Tennessee providing health insurance coverage to low-income residents is called TennCare. This program covers 1.2 million Tennesseans in need of health insurance, providing a source of free medical care. TennCare is one of the oldest Medicaid managed care programs in the country, and is the sole state to enroll every public health program member in managed care. Operating under a demonstration waiver from the Centers for Medicaid and Medicare Services, TennCare strives to serve as an example that by using managed care exclusively, the state will generate enough savings to offer coverage to a greater number of people.

TennCare offers coverage to various groups of residents, including pregnant women, children and young adults up to age 21, adults with children, women who have had breast or cervical cancer, and SSI beneficiaries. Each group is eligible for preventive services, hospital and emergency care, physician visits, and prescription coverage. Certain health services are personalized to different groups and individual needs, such as maternity care for women and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for children. Long term care services are also available for those in need of such support. For those who are disabled and require medical supplies and equipment, TennCare accommodates such needs.

 

TennCare Eligibility

To qualify for the TennCare Medicaid program, you must be a resident of Tennessee, a legal immigrant or U.S. citizen, and earn a specific income according to your eligibility group. Adults who qualify for the program must either be single parents or caretaker relatives and have a child living at home, or a couple with a child at home one of whom has lost a job or work hours, or has a mental health condition expected to last 30 days. All qualifying applicants must be currently uninsured, and not be receiving benefits through their job, COBRA, or a temporary health plan. Eligibility is determined by your total household income and size in relation to the most recent poverty guideline.

 

Current Federal Poverty Level

 

Pregnant Women & Infants 185%

Family of 2: $2,333 monthly, $27,991 yearly

Family of 3: $2,943 monthly, $35,317 yearly

Family of 4: $3,554 monthly, $42,643 yearly

Family of 5: $4,164 monthly, $49,969 yearly

 

Children Ages 1-5 133%

Family of 1: $1,238 monthly, $14,856 yearly

Family of 2: $1,639 monthly, $19,699 yearly

Family of 3: $2,068 monthly, $24,817 yearly

Family of 4: $2,497 monthly, $29,965 yearly

 

Children Ages 6-21  100%

Family of 1: $938 monthly, $11,170 yearly

Family of 2: $1,260 monthly, $15,130 yearly

Family of 3: $1,590 monthly, $19,090 yearly

Family of 4: $1,920 monthly, $23,050 yearly

 

Parent (unemployed) 38%

Family of 1: $354 monthly, $4,245 yearly

Family of 2: $479 monthly, $5,749 yearly

Family of 3: $605 monthly, $7,254 yearly

Family of 4: $729 monthly, $8,759 yearly

Family of 5: $855 monthly, $1,026 yearly

 

Parent (employed) 69%

Family of 1: $642 monthly, $7,707 yearly

Family of 2: $870 monthly, $10,440 yearly

Family of 3: $1,098 monthly, $13,172 yearly

Family of 4: $1,325 monthly, $15,905 yearly

Family of 5: $1,553 monthly, $18,637 yearly

 

Single Aged, Blind, or Disabled 75%

$698 monthly, $8,377 yearly

*$2,000 Asset Limit

 

Couple Aged, Blind, or Disabled 83%

$1,046 monthly, $12,558 yearly

*$3,000 Asset Limit

 

Qualified Medicare Beneficiaries (QMB) 100%

Medicaid covers your premiums, coinsurance, and deductibles.

Single: $938 monthly, $11,170 yearly

Couple: $1,260 monthly, $15,130 yearly

 

Specified Low-Income Medicare Beneficiaries (SLMB) 120%

Medicaid covers your premiums only.

Single: $1,117 monthly, $13,404 yearly

Couple: $1,513 monthly, $18,156 yearly

 

Covered Benefits

As there are twelve different benefit packages for various TennCare recipients, not all services are consistent from one group to another. Depending on whether or not you are also enrolled in Medicare or Standard Spend Down, or receive long term care, TennCare Medicaid benefits adjust based on what your other coverage includes. Below are some of the services covered by each of the TennCare Medicaid benefit packages.

 

  • Chiropractic
  • Community health clinics
  • Dental care (for those under 21)
  • Durable Medical Equipment
  • Emergency transport and ambulance
  • Home health care
  • Hospice care
  • Inpatient hospital care
  • Lab and X-ray
  • Medical supplies
  • Mental health care
  • Occupational therapy
  • Outpatient hospital care
  • Pharmacy
  • Preventive care
  • Private duty nursing
  • Reconstructive breast surgery
  • Renal dialysis
  • Speech therapy
  • Vision care

 

Managed Care

Based on which part of the state you live in, there are different health plans offering TennCare services. These include UnitedHealthcare Community Plan, TennCare Select, BlueCare, and Amerigroup. Your managed care organization must be chosen once you are approved for TennCare, and you can select a primary care physician through your health plan to coordinate your care. For any questions regarding your benefits, plan, or health care needs, you must contact your health plan.

West Tennessee MCOs

 

Middle Tennessee MCOs

 

East Tennessee MCOs

 

How to Apply

In order to apply for TennCare, you may fill out a form online, print the form and complete it, pick up an application at your local Department of Human Services office, or call your local DHS to have one sent to you. When you have filled out your paper application, send it to the closest DHS office.

Apply online

Locate a DHS office by county

 

Resources

TennCare

Apply online for TennCare

Family Assistance Service Center: 866-311-4287

TTY or TDD: 877-779-3103

 

 

Sources:

 

1. TennCare. http://www.tn.gov/tenncare/.