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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.
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
Family of 1: $1,238 monthly, $14,856 yearly
Children Ages 6-21 100%
Family of 1: $938 monthly, $11,170 yearly
Family of 2: $1,260 monthly, $15,130 yearly
Medicaid covers your premiums only.
Single: $1,117 monthly, $13,404 yearly
Couple: $1,513 monthly, $18,156 yearly
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.
- 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
- Preventive care
- Private duty nursing
- Reconstructive breast surgery
- Renal dialysis
- Speech therapy
- Vision 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