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Do you have Medicare and TennCare?
If you have Medicare and TennCare, you recently received a letter explaining that there may be changes for you on the kinds of services TennCare will pay for. The letter explained that if you don't have QMB, there are some services TennCare will no longer pay for. A list of those services can be found here (Espaņol). If you have questions, call the Family Assistance Service Center at 1-866-311-4287.
Family Assistance Service Center 1-866-311-4287
Call this number for general information regarding TennCare, including:
- Applying for TennCare
- Disenrollment & Benefit Changes
- Reporting a change (such as a new address, or change in jobs)
- Establishing or changing an appointment with your DHS case worker
There are two (2) types of TennCare:
TennCare Medicaid is for Tennesseans who are eligible for a Medicaid program, such as Families First (AFDC). Children and adults can apply anytime for TennCare Medicaid. TennCare Medicaid has two (2) main groups: Categorically Needy and Medically Needy. You must meet all of the rules of one of these groups to qualify. Your income and resources will count, too. Resources are things like bank accounts, cars and land.
To find out if you qualify, go to your county DHS office for the application and eligibility determination process. These are some of the people who can qualify for TennCare Medicaid as Categorically Needy:
- 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 parent
- 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 in need of treatment for breast or cervical cancer
- People who get an SSI check (Supplemental Security Income)
- People who stopped getting SSI after November 13, 1987 while living in Tennessee-you don't have to be getting SSI now
- 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 $1,911 per month, or
- Gets other long term care services that TennCare pays for
These are the people who can qualify for TennCare Medicaid as Medically Needy:
- Children under age 21
- Women who are pregnant
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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 (Uninsured and Medically Eligible) 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.)
- 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.
TennCare Medicaid is the only way a new applicant can enroll in TennCare.
To apply, call your county Department of Human Services (DHS) office.
or to locate the nearest office. DHS staff can answer your questions and explain how to qualify. They can also tell you everything you need to bring to help them decide if you're eligible.
If you think you might be eligible or have questions, you can call the DHS Family Assistance Service Center for help (1-866-311-4287).
Major eligibility categories in Tennessee.
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