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TennCare Resource

There are two (2) types of TennCare:

TennCare Medicaid

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 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 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 $1,809 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

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 (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.

These are only examples. To find out if you can qualify for TennCare Medicaid, go to your county DHS office.

TennCare Medicaid is the only way a new applicant can enroll in TennCare.

To apply, call your county Department of Human Services (DHS) office.

DHS staff can answer your questions and explain how to qualify. They can also tell you everythingyou 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).