Eligibility Criteria

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Each of the Presumptive Eligibility coverages has certain criteria that must be met before they are eligible and can apply.  If someone does not meet the eligibility criteria for the coverage, they cannot apply because they will not be approved by TennCare for ongoing coverage.

Prenatal Presumptive Eligibility criteria is listed below:

  • Be a U.S. citizen, U.S. national, or eligible immigration status
  • Be a Tennessee resident
  • Be pregnant
  • Have under 250% of the Federal Poverty Level income based on household size
  • Have a social security number (if eligible for a social security number)

Note: Self-Attestation of these criteria is accepted by the county health department to apply.  TennCare may request additional documentation of these criteria to approve or deny ongoing TennCare coverage

 

CoverKids Pregnant Woman eligibility criteria is as follows:

  • Be a Tennessee resident
  • Be pregnant
  • Have under 250% Federal Poverty Level income based on household size
  • Have a social security number (if eligible for a social security number)
  • Must not have other insurance plans (unless the insurance does not cover prenatal care, or the insurance was obtained through the federal marketplace)

Note: Citizenship or immigration status is not relevant to CoverKids Pregnant Woman eligibility

Note: Self-Attestation of these criteria is accepted by the county health department to apply.  TennCare may request additional documentation of these criteria to approve or deny ongoing TennCare coverage

 

Breast and Cervical Cancer Presumptive Eligibility criteria is listed below:

  • Be a U.S. citizen, U.S. national, or eligible immigration status
  • Be a Tennessee Resident
  • Be under the age of 65
  • Have breast cancer, cervical cancer, or certain precancerous conditions
  • Be enrolled or screened for Tennessee Breast and Cervical Cancer Screening Program at the county health department
  • Have under 250% Federal Poverty Level income based on household size
  • Have a social security number (if eligible for a social security number)
  • Must not have other insurance plans (unless the insurance does not cover testing/treatment of cancer care, or the insurance was obtained through the federal marketplace)

Note: Self-Attestation of these criteria is accepted by the county health department to apply.  TennCare may request additional documentation of these criteria to approve or deny ongoing TennCare coverage.  Breast and Cervical Cancer PE always requires proof of cancer treatment to obtain full coverage.