Emilie Meyer
TennCare is Tennessee's Medicaid program, offering health insurance to over 1.4 million low-income children, pregnant women, parents of minor children, and elderly or disabled people. The program is jointly funded by the state and federal governments and is administered by the Division of TennCare. TennCare operates under an 1115 waiver, allowing Tennessee to deviate from certain federal Medicaid rules and expand coverage to optional populations, including those who are uninsurable. Applications for TennCare can be made at any time through the self-service portal, TennCare Connect, over the phone, or by submitting a paper application.
| Characteristics | Values |
|---|---|
| What is TennCare? | Tennessee's Medicaid program |
| Who does it cater to? | Low-income pregnant women, parents or caretakers of a minor child, children, and individuals who are elderly or have a disability |
| How to apply? | Through the self-service portal called TennCare Connect, over the phone by calling TennCare Connect at 855-259-0701, in person at the local DHS office, or by submitting a completed paper application |
| Who to contact if you do not have TennCare? | Local Area Agency on Aging and Disability (AAAD) at 1-866-836-6678 |
| What if you do not qualify for Medicaid? | AAAD can suggest other programs that may help |
| What if you have a disability? | AAAD will come to your house to help you apply for TennCare |
| What does TennCare cover? | Services that are medically necessary |
| What is the eligibility criterion? | Income and resource limits |
| What is the Katie Beckett Program? | Helps children with disabilities or complex medical needs who would not usually qualify for TennCare |
| What is the "1115 waiver"? | Lets Tennessee deviate from some federal Medicaid rules |
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What You'll Learn
TennCare is Tennessee's Medicaid program
There are three ways to apply for TennCare Medicaid and Medicare Savings Programs (MSP): using the self-service portal TennCare Connect, applying online, or over the phone. Applicants can also apply for the Katie Beckett Program, which assists children with disabilities or complex medical needs who would not usually qualify for TennCare. Additionally, the CoverKids program helps children under 18 and pregnant women, while the Medicare Savings Program helps with Medicare costs.
If you need help with the application process, there are several options. You can call TennCare Connect for free at 855-259-0701 to receive assistance over the phone. Alternatively, you can visit any DHS office in Tennessee's 95 counties, where trained staff can help you apply. To locate the nearest DHS office, call 866-311-4287. Private groups can also provide assistance, and their contact information can be obtained by calling 866-475-7879. If you have a disability, someone can come to your house to help you with the application process.
If you do not have TennCare, your local Area Agency on Aging and Disability (AAAD) may be able to provide information about other programs that can help. They can be reached at 1-866-836-6678. Even if you do not qualify for Medicaid, they may be able to direct you to alternative programs. For help with Medicare costs, you can also call 1-877-801-0044.
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$22.9 $37.05
TennCare offers health insurance to low-income children, pregnant women, parents of minor children, elderly and disabled people
TennCare is Tennessee's Medicaid program, offering health insurance to over 1.4 million low-income residents. This includes children, pregnant women, parents or caregivers of minor children, the elderly, and people with disabilities.
To qualify for TennCare, applicants must meet certain income and resource limits. TennCare is designed to provide healthcare to those who might not otherwise be able to afford it. This includes low-income families, pregnant women, and children, as well as individuals who are blind, elderly, or disabled.
The program also covers individuals receiving Supplemental Security Income (SSI) and offers the Katie Beckett Program, which assists children with disabilities or complex medical needs who would not typically qualify for TennCare due to their parents' income or assets. This program helps pay for medical care that private insurance does not cover.
There are three ways to apply for TennCare: through the self-service portal TennCare Connect, by phone, or through the TennCare Medicaid webpage. Applicants can apply anytime and receive assistance with their application if needed. Even if an applicant does not qualify for Medicaid, they may be informed of other programs that can help them.
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Eligibility criteria for TennCare
TennCare is the state of Tennessee's Medicaid program. It provides healthcare to low-income pregnant women, parents or caretakers of minor children, children, and individuals who are elderly or have a disability.
There are no monthly or yearly income limits for newborns born to women with Medicaid eligibility. This eligibility lasts for one year after birth. For children up to age 21 and pregnant women with low incomes, there are income limits, which vary depending on family size. For those above age 21, the income limit is set at 250% FPL.
If you are uninsured and require treatment for breast or cervical cancer (BCC), you may be eligible for TennCare. Eligibility is determined by the Social Security Administration (SSA) and the Department of Health (DOH).
There are three ways to apply for TennCare: online, over the phone, or with a paper application. You can also apply for the Medicare Savings Program, which may help with Medicare premiums and cost-sharing. If you have a disability, someone can come to your house to help you apply for TennCare.
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Applying for TennCare
TennCare is the state of Tennessee's Medicaid program. It provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children, and individuals who are elderly or have a disability. To get Medicaid, one must meet the income and resource limits.
There are four ways to apply for TennCare:
- Online: You can apply for TennCare using the self-service portal called TennCare Connect. First, you must create a TennCare Connect account. Then, you can apply online.
- Phone: Call TennCare Connect at 855-259-0701 for help over the phone.
- In-person: Visit any DHS office in any of Tennessee's 95 counties. A trained staff member will help you apply. Call 866-311-4287 to find a DHS office near you.
- By mail: Mail your application to: TennCare Connect P.O. Box 305240 Nashville, TN 37230-5240.
If you have a disability, someone can come to your house to help you apply for TennCare. You can also get help from private groups. To find someone near you, call 866-475-7879.
When applying for coverage, be ready to answer questions about the people in your home who are applying, the people who live with you, your income, and the things you pay for and own. Providing as much information as possible will help speed up the process and get you a decision faster.
You can apply for TennCare anytime.
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TennCare operates under an 1115 waiver
TennCare is the name for Medicaid in Tennessee. It is the state budget's largest department, with the federal government paying 2/3 of the cost. TennCare operates under an "1115 waiver", which allows the state to deviate from some federal Medicaid rules. This waiver means that all TennCare beneficiaries are enrolled in plans administered by private health insurance companies, known as managed care organizations (MCOs). MCOs receive a capitated (or lump-sum) payment for each enrollee and are responsible for managing the costs of enrollees within those payments. Tennessee is one of only two states to enrol every Medicaid enrollee in an MCO.
When TennCare launched in January 1994, Tennessee used expected savings from this approach to expand Medicaid coverage to optional populations. These populations included "uninsurable" individuals and uninsured individuals not otherwise eligible for employer or government insurance. Within a few years, however, MCOs were losing money on TennCare enrollees. By the early 2000s, rising pharmaceutical and medical care costs had created budget shortfalls of hundreds of millions of dollars. Federal funding under the waiver was capped, which contributed to the state's shortfalls.
In response, policymakers sought to modify eligibility, limit certain benefits, and disenroll some beneficiaries. However, legal challenges halted and reversed some of these efforts. In 2005, Tennessee received federal approval to modify its waiver to eliminate eligibility for some adults and limit benefits for others while preserving benefits for children. By the end of 2006, an estimated 170,000 people had been disenrolled from TennCare. Today, TennCare still uses MCOs to administer benefits and primarily serves populations required by federal Medicaid law. These populations include low-income children, low-income pregnant women, low-income mothers, and low-income aged, blind, or disabled individuals.
Medicaid waivers are time-limited, and the state must renew its waiver approximately every five years. At this point, the federal government can tweak existing requirements or add new ones. In late December 2016, the TennCare waiver was renewed through June 2021.
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