TennCare Presumptive Eligibility

Eligibility Criteria

Each type of Presumptive Eligibility has specific criteria. Individuals who do not meet these requirements cannot apply, because TennCare will not approve ongoing coverage.

Prenatal Presumptive Eligibility Criteria

To qualify, an individual must:

• Be a U.S. citizen, U.S. national, or have an eligible immigration status
• Be a Tennessee resident
• Be pregnant
• Have income below 250% of the Federal Poverty Level (FPL) based on household size
• Have a Social Security Number (if eligible for one)

Note:
Self-attestation of eligibility is accepted at county health departments for initial coverage. TennCare may request documentation to approve or deny ongoing coverage.

CoverKids Pregnant Woman Eligibility Criteria

To qualify, an individual must:

• Be a Tennessee resident
• Be pregnant
• Have income below 250% of the Federal Poverty Level (FPL) based on household size
• Have a Social Security Number (if eligible for one)
• Not have other insurance
  • Exception: insurance that does not cover prenatal care, or insurance obtained through the federal marketplace

Note:
Citizenship or immigration status is not required for CoverKids Pregnant Woman eligibility.

Self-attestation is accepted at the county health department. TennCare may request documentation for approval of ongoing coverage.

Breast and Cervical Cancer Presumptive Eligibility Criteria

To qualify, an individual must:

• Be a U.S. citizen, U.S. national, or have an eligible immigration status
• Be a Tennessee resident
• Be under age 65
• Have a diagnosis of breast cancer, cervical cancer, or certain precancerous conditions
• Be enrolled in or screened for the Tennessee Breast and Cervical Screening Program (TBCSP) at a county health department
• Have income below 250% of the Federal Poverty Level (FPL) based on household size
• Have a Social Security Number (if eligible for one)
• Not have other insurance
  • Exception: insurance that does not cover testing or treatment for cancer, or insurance purchased through the federal marketplace

Note:
Self-attestation is accepted at the county health department. TennCare may request documentation for ongoing coverage.

Proof of active cancer treatment is required to obtain full TennCare coverage under Breast and Cervical Cancer PE.

Where to Sign Up

Presumptive Eligibility (PE) services are available at every county health department in Tennessee. You may walk in or call your local health department to ask about enrolling in Presumptive Eligibility. To find the health department nearest you, visit: Find a Local Health Department. 

CoverKids Pregnant Woman Coverage

CoverKids Pregnant Woman coverage is also available at every county health department.

You may apply in one of the following ways:

• Visit or call your local county health department
• Complete an online application through TennCare Connect 
• Call 855-259-0701 to apply by phone

Please note:
CoverKids Pregnant Woman does not provide immediate coverage. Benefits begin only after TennCare reviews and approves the application, although the coverage start date is the date the application was submitted.

Breast and Cervical Cancer Presumptive Eligibility

Breast and Cervical Cancer Presumptive Eligibility can only be obtained at a county health department. Enrollment requires a screening through the Tennessee Breast and Cervical Cancer Screening Program (TBCSP).

Although other TennCare programs may cover treatment for breast or cervical cancer, only the Breast and Cervical Cancer Presumptive Eligibility program provides immediate TennCare coverage for individuals diagnosed with these cancers.

To locate your nearest county health department, visit: Find a Local Health Department. 

Resources

These resources provide information and support related to TennCare coverage, nutrition programs, cancer screening services, and local health department assistance.

TennCare

For information about TennCare coverage options, visit the TennCare website.

If you would like to create an account or manage your benefits online, visit TennCare Connect. TennCare Connect allows you to submit applications, check coverage status, and update your information.

WIC

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food assistance, nutrition education, breastfeeding support, and referrals to other health services for pregnant individuals, parents, and children under age five.

To learn more, visit the WIC Program Homepage.

Tennessee Breast and Cervical Screening Program (TBCSP)

The Tennessee Breast and Cervical Screening Program (TBCSP) provides eligible individuals with access to early breast and cervical cancer screening and diagnostic services.
Early detection improves treatment options and health outcomes.

To learn more and check eligibility, visit the TBCSP Program Homepage.

Local Health Department Resources

Local health departments maintain resource lists to support pregnant individuals and families in each county or region. When visiting your local health department, you may request information about available community programs and services.

To locate a health department near you, visit Find a Local Health Department.

For additional information about pregnancy, visit the CDC Pregnancy Resources page.

Data and Statistics

This section provides access to fact sheets that summarize key TennCare Presumptive Eligibility (PE) data, including enrollment trends, program utilization, and statewide impacts from recent reporting years.

• PE Fact Sheet – Calendar Year 2022
  
• PE Fact Sheet – Calendar Year 2021