Categories

Brief Description: For children ages 0 to 19 years old with low income.

This is a mandatory program for states. States can set the income standards. Eligibility is determined by TennCare.

Age 0 up to 1 (195% FPL)

Ages 1 up to 6 (142% FPL)

Ages 6 up to 19 (133% FPL)

Brief Description: For pregnant women with low income. A pregnant woman is generally counted as a household of two (herself and her baby).

This is a mandatory program for states. States can set the income standards. Eligibility is determined by TennCare.

Pregnant Women (250% FPL)

Brief Description: For parents and caretaker relatives of a minor child(ren) under the age of 18 or children age 18 and a full-time student.

This is a mandatory program for states. States can set the income standards. Eligibility is determined by TennCare.

Parents or Caretaker Relatives (100% FPL)

Brief Description: For newborns who are born to women who had Medicaid when the baby was born and are eligible for one (1) year after birth. Eligibility is redetermined by TennCare.

Income Limit: There is no monthly or yearly income limit.

Resource Limit: There is no resource limit.

Brief Description: For children up to age 21 or pregnant women with low income. The individuals must have income no more than the income limit below or must have sufficient unreimbursed medical bills. These medical bills are to “spend down” to the income limits depending on the family size.

This Medicaid category is optional. The “spend down” income standards are set by the state. Eligibility is determined by TennCare.

**Add $100 per additional individual for the Resource Limit.

Brief Description: For aged, blind, and/or disabled (ABD) individuals with low income.

This is a mandatory program for states. Monthly cash assistance is provided by the Social Security Administration (SSA). Eligibility is determined by the SSA.

Brief Description: For individuals who need care in a medical institution such as a nursing facility (NF) or hospital, or need care in an intermediate care facility (ICF) with intellectual disabilities (IID), or for individuals who get Home and Community Based Services (HCBS).

This Medicaid category is optional. The need for placement in an NF, ICF/IID, or HCBS is determined by TennCare or the Department of Disability and Aging (DDA). Financial eligibility is determined by TennCare.

Institutionalized Individuals (300% of the SSI Federal Benefit Rate SSI-FBR)

Brief Description: For Tennessee residents who are uninsured or whose insurance does not cover treatment for Breast or Cervical Cancer (BCC). To be eligible for TennCare Medicaid, individuals must be under age 65 and have been determined the need for BCC treatment by the Department of Health (DOH).

This Medicaid category is optional. The Centers for Disease Control and Prevention (CDC) and the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) cover individuals who have been screened. The Department of Health and Tennessee Breast and Cervical Cancer Screening Program (TBCCSP) provides these screening services at DOH local offices throughout the state.

Monthly Income Limit: At or below 250% FPL.

Resource Limit: There is no resource limit.

If an individual has been identified as being uninsured and needing BCC treatment by the Department of Health, they are eligible for presumptive eligibility for Medicaid.

Presumptive eligibility extends through the end of the month following the month in which presumptive eligibility is established. During this time, the individual must complete an application for TennCare Medicaid to stay eligible for presumptive eligibility. The individual will be reviewed to determine eligibility for BCC or any Medicaid category.

The start date for presumptive eligibility is the date an application is approved by DOH.

For more information on how to apply, go to the How Do I Apply for TennCare? web page. Or call TennCare Connect for free at 855-259-0701.

Brief Description: For children under age 19 whose TennCare Medicaid is ending and do not have access to insurance through a job or a family member’s job, they meet the 211% of the FPL or are determined to be medically eligible. Eligibility is determined by TennCare.

Age 0 up to 19 (211% FPL)

**There is no resource limit.

Uninsured means an uninsured person is a child under age 19 losing Medicaid with no insurance or access to insurance, and their income is at or below 211% of the FPL.

Medically Eligible is a Medicaid category for children under age 19 who are losing Medicaid, have no insurance or access to insurance, have an income at or above 211% of the FPL, and have a qualifying medical condition that would have prevented them from getting health insurance prior to the Affordable Care Act (ACA). There is no resource limit.

TennCare Standard enrollees with income at or above 100% of the FPL pay co-pays for most TennCare services. For more information on co-pays, go to the Co-Payments web page.

Brief Description: For individuals who are entitled to Medicare Part A, have income at or below 100% of the FPL, and meet the resource limit.

This Medicaid category is mandatory. The state is required to pay Medicare premiums, deductibles, and co-pays. This is a cost-sharing assistance program for low-income Medicare beneficiaries, but it does not provide full Medicaid benefits. Eligibility is determined by TennCare.

For more information on how to apply for TennCare, go to the How Do I Apply for TennCare? web page. Or call TennCare Connect for free at 855-259-0701.

QMB Individuals (100% FPL)

Brief Description: For individuals who are entitled to and receive Medicare Part A, have income that is at least 100% of the FPL but less than 120% of the FPL, and meet the resource limit.

This Medicaid category is mandatory. The state is required to pay Medicare Part B premiums. This is a cost-sharing assistance program for low-income Medicare beneficiaries, but it does not provide full Medicaid benefits. Eligibility is determined by TennCare.

For more information on how to apply for TennCare, go to the How Do I Apply for TennCare? web page. Or call TennCare Connect for free at 855-259-0701.

SLMB Individuals (At least 100% FPL but less than 120% FPL)

Brief Description: For individuals who are entitled to Medicare Part A, have income at least 120% of the FPL but less than 135% of the FPL, and meet the resource limit. Individuals cannot be enrolled in TennCare Medicaid or TennCare Standard to qualify for QI-1.

This Medicaid category is mandatory. The state is required to pay Medicare Part B premiums as long as federal funds are available. This is a cost-sharing assistance program for low-income Medicare beneficiaries, but it does not provide full Medicaid benefits. Eligibility is determined by TennCare.

For more information on how to apply for TennCare, go to the How Do I Apply for TennCare? web page. Or call TennCare Connect for free at 855-259-0701.

QI-1 Individuals (At least 120% FPL but less than 135% FPL)

Brief Description: For individuals who are under age 65 and no longer entitled to Medicare Part A because they returned to work. Individuals must meet the income and resource limit and all non-financial eligibility requirements.

This Medicaid category is mandatory. The state is required to pay Medicare Part A premium. This is a cost-sharing assistance program for low-income Medicare beneficiaries, but it does not provide full Medicaid benefits. Eligibility is determined by TennCare.

For more information on how to apply for TennCare, go to the How Do I Apply for TennCare? web page. Or call TennCare Connect for free at 855-259-0701.

QDWI Individuals (At or below 200% FPL)