TennCare Presumptive Eligibility
Prenatal Presumptive Eligibility
Prenatal presumptive eligibility (PE) is a TennCare Medicaid category of coverage for pregnant women. The presumptive
eligibility option encourages early entry into prenatal care for improved health outcomes for both the mother and the baby. A pregnant woman who qualifies for presumptive eligibility can begin receiving covered services on the day that she is approved for PE. Our intent is to offer her prenatal care at the earliest possible time during her pregnancy. Presumptive eligibility gives the woman TennCare coverage through the end of the month following the month of approval to allow time to apply for regular Medicaid. If no Medicaid application is filed during the Presumptive span of eligibility, then coverage will end. Both the PE application and the full Medicaid application are completed at local health departments.
Breast & Cervical Cancer Presumptive Eligibility (BCS)
BCS presumptive eligibility is a TennCare Medicaid category of coverage for men and women with a primary diagnosis of breast or cervical cancer. The presumptive eligibility option encourages early entry into treatment for improved health outcomes for the patient. An individual who qualifies for BCS presumptive eligibility can begin receiving covered services on the day they are approved for PE. BCS presumptive eligibility gives the individual TennCare coverage through the end of the month following the month of approval. BCS PE applications can only be completed at local health departments. Upon completion of the PE application, a full Medicaid application will also be completed.