TennCare Overview
TennCare is the state of Tennessee’s Medicaid program that provides health care for approximately 1.5 million Tennesseans and operates with an annual budget of approximately $14 billion. TennCare members are primarily low-income pregnant women, children and individuals who are elderly or have a disability. TennCare covers approximately 23 percent of the state’s population, 50 percent of the state’s births, and 53 percent of the state’s children.
TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, 1994. The TennCare program operates under a Section 1115 waiver from the Centers for Medicare and Medicaid Services (CMS) in the United States Department of Health and Human Services. Unlike traditional fee-for-service Medicaid, TennCare is an integrated, full-risk, managed care program.
TennCare services are offered through managed care entities. Medical, behavioral and Long-Term Services and Supports are covered by “at-risk” Managed Care Organizations (MCOs).
The care provided by TennCare’s MCOs is assessed annually by the National Committee for Quality Assurance (NCQA) as part of the state’s accreditation process. On average, TennCare is above the national average on 50% of reported Medicaid HEDIS measures.
In addition to the MCOs, there is a Pharmacy Benefits Administrator for coverage of prescription drugs and a Dental Benefits Manager for coverage of dental services.
As a leader in managed care Long-Term Services and Supports (LTSS), the state successfully implemented TennCare CHOICES in 2010 bringing LTSS into the managed care model. These services are provided in Nursing Facilities (NFs) and Intermediate Care Facilities for persons with intellectual disabilities (ICF/IID), as well as by Home and Community Based Service providers. In 2016, the Employment and Community First CHOICES program launched providing supports for people with intellectual and developmental disabilities targeted to employment and independent community living. Katie Beckett, a program for children with disabilities or complex medical needs who are not Medicaid eligible, launched in 2020.