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Eligibility

There are two (2) kinds of TennCare:

To be eligible for TennCare as a new applicant, you must qualify for TennCare Medicaid

DHS staff can answer your questions and explain how to qualify. They can also tell you what information they'll need from you to help them decide if you're eligible.

If you think you might be eligible or have questions, call the Family Assistance Service Center at 1-866-311-4287.

TennCare Medicaid

TennCare Medicaid is for Tennesseans who are eligible for a Medicaid program. You can apply anytime for TennCare Medicaid.

There are several different groups of people that may qualify. And, each group has different income limits. Some of the groups also have limits on how much you own-your "resources." These are things like bank accounts, cars, and land. The number of people who live in your household count too.

Some of the groups TennCare Medicaid covers are:

  • Children under age 21
  • Women who are pregnant
  • Single parents or caretakers of a minor child (The child must live with you and be a close relative.)
  • Two-parent families with a minor child living at home when one of the parents:
    • Has lost their job or had their work hours cut, or
    • Has a health or mental health problem expected to last 30 days (DHS will need proof from your doctor)
  • Women who need of treatment for breast or cervical cancer
  • People who get an SSI check (Supplemental Security Income)
  • People who have gotten both an SSI check and a Social Security check in the same month at least once since April, 1977 AND who still get a Social Security check
  • A person who:
    • Lives in a nursing home and has income below $2,022 per month, or
    • Gets other long term care services that TennCare pays for

You can be screened on line to help you decide if you want to apply for Medicaid. To apply, call your county Department of Human Services (DHS) office or go to the application. To find out the address and phone number of your local DHS office.

TennCare Standard

TennCare Standard is only available for children under age 19 who are already enrolled in TennCare Medicaid and:

  • Who lack access to group health insurance through their parents' employer, or
  • Their time of eligibility is ending and they don't qualify anymore for TennCare Medicaid.

DHS will determine if they qualify for TennCare Standard. There are two ways they can qualify and be able to keep their healthcare benefits:

Uninsured

To qualify as uninsured:

  • The child's eligibility through TennCare Medicaid is ending,
  • The child must be under the age of 19,
  • Lacks access to group health insurance through their own job or a parent's job, and
  • The family income is below 200 percent of poverty.

If the family's income is above 200 percent of poverty, the child may qualify for TennCare Standard as Medically Eligible.

Medically Eligible

To qualify as "medically eligible";

  • The child must be under the age of 19,
  • Have a health condition which makes the child "uninsurable", (or unable to access private health insurance because of their health condition.) and
  • Lacks access to group health insurance through their job or a parent's job

Once screened for this category through DHS, TennCare will mail a Medical Eligibility packet to the child's caregiver to complete. The packet asks for specific information about the child's health and from the information, a determination of eligibility is made.

Standard Spend Down

TennCare Standard Spend Down is only available to adults who have Standard Spend Down now. It's called "Spend Down" because to qualify, you use medical bills to "spend down" (or lower) your income. To re-qualify, you must have Standard Spend Down now and be able to meet resource and all other technical requirements. AND you must be:

  • Aged (65 or older), or
  • Blind (We use Social Security rules.), or
  • Disabled (We use Social Security rules.), or
  • The caretaker of a minor child (The child must live with you and be closely related to you.).
    • In a two-parent family with a minor child, one of the parents must:
      • have lost a job or had work hours cut,
      • or have health or mental health problems expected to last 30 days. (DHS will need proof from your doctor.)