About Presumptive Eligibility
The Presumptive Eligibility (PE) program is a program created to provide immediate, temporary TennCare coverage based on medical conditions and eligibility criteria. The PE program’s goal is to reduce barriers to care and increase timely access to ensure better health outcomes. The Presumptive Eligibility Program has 2 components: Prenatal for pregnant individuals, and Breast and Cervical Cancer for those diagnosed with Breast and/or Cervical cancer.
Prenatal Presumptive Eligibility is aimed at pregnant individuals who need health insurance coverage for prenatal services, though TennCare obtained through the PE program still covers non-prenatal related health care. TennCare obtained through the PE program begins the date of enrollment and extends at least 1-year post-partum, regardless of how the pregnancy ends. Some TennCare coverages can extend past the 1-year post-partum period depending on eligibility. Dental coverage is now included with all pregnancy related TennCare coverage. There is no minimum or maximum age limit to apply for Prenatal PE coverage.
For those who are pregnant, but do not meet eligibility criteria for Prenatal PE, the county health department can assist with a CoverKids Pregnant Woman coverage. The eligibility criteria are less strict, but the coverage period is only the date of application through 60 days post-partum. The CoverKids Pregnant Woman coverage also does not provide immediate coverage. The coverage does not begin until full approval is obtained, though the begin date of coverage is the date of application.
Breast and Cervical Cancer Presumptive Eligibility covers individuals (regardless of gender) who have been diagnosed with breast and/or cervical cancer. Certain precancerous conditions may also be eligible for Breast and Cervical Cancer PE. Breast and Cervical Cancer TennCare coverage can only be obtained at the local health department through the PE program, though other TennCare coverages will cover Breast and/or Cervical cancer treatment. Breast and Cervical Cancer TennCare begins on the date of enrollment and extends until the patient is no longer considered in active treatment.