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Major Medicaid Eligibility Categories in Tennessee

This provides a short description of some of the Medicaid programs available in Tennessee. This information should be used as reference only.

For a quick look at the income limits, resources, and the groups of people who may be eligible for our programs, go to our Eligibility Reference Guide.

For more information on applying for TennCare, visit How you can apply or get help. Or, call TennCare Connect at 855-259-0701.

Brief Description: Low income children ages 0 to 19.

Annual (yearly) Income Limit

Age 0 up to 1 – 195% FPL
$24,882 (family size of 1)
$33,618 (family size of 2)
$42,354 (family size of 3)
$51,090 (family size of 4)

Ages 1 up to 6 – 142% FPL
$18,120 (family size of 1)
$24,481 (family size of 2)
$30,843 (family size of 3)
$37,204 (family size of 4)

Ages 6 up to 19 - 133% FPL
$16,971 (family size of 1)
$22,930 (family size of 2)
$28,888 (family size of 3)
$34,846 (Family size of 4) 

Comments: This is a mandatory program for states, although states can set the income standards. Eligibility is determined by TennCare.

Brief Description: Low income pregnant women.

Annual (Yearly) Income Limit

195% FPL
$33,618 (family size of 2)
$42,354 (family size of 3)
$51,090 (family size of 4)

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

Brief Description: Available to parents and other caretaker relatives of a minor child(ren) under age 18 OR children age 18 and a full-time student.

Monthly Income Limit

$1,018 (family size of 1)
$1,329 (family size of 2)
$1,611 (family size of 3)
$1,867 (family size of 4)

Comments: This is a mandatory program for states, although states can set the income standards. Eligibility is determined by TennCare.

Brief Description: Children born to Medicaid eligible women.

Monthly Income Limit: None

Resource Limit: None

Comments: Newborns who are born to Medicaid eligible women are automatically eligible for one (1) year after birth. Then eligibility must be redetermined by TennCare.

Brief Description: Low income persons who are also one of the following:

  • Children up to age 21
  • Pregnant

Monthly Income Limit: Individual must either have income no more than the figures provided below OR have sufficient unreimbursed medical bills to "spend down" to these income limits, depending upon family size:

$241 (family size of 1)
$258 (family size of 2)
$317 (family size of 3)
$325 (family size of 4)

Resource Limit
$2,000 (1)
$3,000 (2)

*add $100 per additional individual.

Comments: This is an optional Medicaid category. Eligibility is determined by TennCare.
The "spend down" income level is set by the state.

Brief Description: Low income aged, blind, and/or disabled individuals.

Monthly Income Limit
$783 (Family size of 1)
$1,175 (Family size of 2)

Resource Limit
$2,000 (1)
$3,000 (2)

Comments: This is a mandatory Medicaid eligibility category. Eligibility is determined by the Social Security Administration. Monthly cash assistance is provided by SSA.

Brief Description: Low income individuals who require care in a medical institution, like a nursing facility (NF) or hospital, or an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or who receive Home and Community-based Services (HCBS).

Monthly Income Limit
$2,349 (300% of the SSI benefit rate)

Resource Limit
$2,000

Comments: This is an optional Medicaid eligibility category. Need for placement in a NF, ICF/IID or HCBS is determined by the Bureau of TennCare or the Department of Intellectual and Developmental Disabilities. Financial eligibility is determined by TennCare.

Brief Description: The Breast and Cervical Cancer (BCC) category is an optional Medicaid category that covers individuals who have been screened through a Centers for Disease Control and Prevention ("CDC") approved National Breast and Cervical Cancer Early Detection Program ("NBCCEDP") and found to need treatment for breast and/or cervical cancer. In Tennessee, the state program is operated by the Tennessee Department of Health (DOH), through the county health departments, and called the "TN Breast and Cervical Screening Program."

Tennessee individuals who are uninsured or whose insurance does not cover treatment for breast or cervical cancer, who are under age 65, and who have been determined by the County Health Department to need treatment for breast or cervical cancer are eligible to enrollee in TennCare Medicaid.

Monthly Income Limit: The screening guidelines required by the CDC National Breast and Cervical Cancer Early Detection Program requires screened individuals to be at or below 250 percent of the federal poverty level.

Resource Limit: None

Comments

HOW TO APPLY - Presumptive eligibility is an established period of time (through the end of the month following the month in which eligibility is established) during which certain individuals identified by the DOH as being uninsured and needing treatment for breast or cervical cancer are eligible for Medicaid. During this period of time the presumptively eligible individual must complete an application for Medicaid in order to stay on the program. All applicants must complete a full application. For more information on applying for TennCare, visit How you can apply or get help. Or, call TennCare Connect at 855-259-0701.

Presumptive eligibility lasts until the end of the month following the month in which it was established, or until a determination is made on a full Medicaid application. During the presumptive eligibility period, the individual must apply through TennCare Connect to complete enrollment in Medicaid. The individual will be reviewed to determine eligibility for any other Medicaid category. TennCare will determine if the individual is eligible for coverage in the BCC Medicaid category to during the time the individual needs treatment for cervical or breast cancer. A redetermination of eligibility will occur at least every 12 months with TennCare and will be based on the need for continuing treatment for breast or cervical cancer, as determined by the individual’s treating physician.

The effective date of presumptive eligibility is the date an application is approved at the Department of Health.

Brief Description: This category is only available to children under age 19 whose TennCare Medicaid eligibility is ending, who do not have access to insurance through a job or a family member's job, and whose family incomes are below 211% poverty. Eligibility is determined by TennCare.

Yearly Income Limit

Below 211% poverty
$26,924 (family size of 1)
$36,377 (family size of 2)
$45,830 (family size of 3)
$55,282 (family size of 4)

Resource Limit
None

Comments: "Uninsured" means without access to insurance through one's job or a family member's job.  Coinsurance (co-pays) for some services is required for a TennCare Standard Uninsured child if the family income is at or above 100% poverty. For more information on co-pays

Medically Eligible*

Brief Description: This category is only available to children under age 19 whose TennCare Medicaid eligibility is ending and whose family income is at or above 211% poverty. To be medically eligible, the child must have health conditions that make the child "uninsurable." Before the Affordable Care Act (ACA), the family would have been unable to purchase health care insurance for the child in the private market because of the child's qualifying medical conditions. Eligibility is determined by TennCare.

Monthly Income Limit: Coinsurance (co-pays) for some services is required for a TennCare Standard Medically Eligible child if the family income is at or above 211% poverty.  For more information on co-pays

Resource Limit
None

Medicare Cost Sharing Programs

Brief Description: Low income persons eligible for Medicare Part A.

Monthly Income Limit
At or below 100% poverty
$1,064 (family size of 1)
$1,437 (family size of 2)

Resource Limit
$7,860 (1)
$11,800 (2) 

Comments: This is a mandatory program. State is required to pay Medicare premiums, deductibles, and coinsurance for these individuals. This is cost sharing assistance for low income Medicare beneficiaries, but does not provide full Medicaid benefits. Eligibility for this program is determined by TennCare. For more information on applying for TennCare, visit How you can apply or get help. Or, call TennCare Connect at 855-259-0701.

Brief Description: Low income Medicare beneficiaries.

Yearly Income Limit
At least 100% but less than 120% poverty

$12,760 - $15,312 (family size of 1)
$17,240 - $20,688 (family size of 2)

Monthly Income Limit
$1,064 -$1,276 (family of 1)
$1,437 -$1,724 (family of 2)

Resource Limit
$7,860 (1)
$11,800 (2) 

Comments: This is a mandatory program. State is required to pay Medicare Part B premiums for these individuals. This is cost sharing assistance for low income Medicare beneficiaries, but does not provide full Medicaid benefits. Eligibility for this program is determined by TennCare. For more information on applying for TennCare, visit How you can apply or get help. Or, call TennCare Connect at 855-259-0701.

Brief Description: Cost sharing assistance for low income Medicare beneficiaries. Individual can’t be eligible for another category of Medicaid at the same time.

Yearly Income Limit
At least 120% but less than 135% poverty
$15,312 - $17,226 (family size of 1)

$20,688 - $23,274 (family size of 2)

Monthly Income Limit
$1,276 -$1,436 (family size of 1)
$1,724 -$1,940 (family size of 2)

Resource Limit
$ 7,860 (1)
$11,800 (2)

Comments: This is a mandatory program. State is required to pay Medicare Part B premiums for these individuals as long as federal funds are available. This is cost sharing assistance for low income Medicare beneficiaries, but does not provide full Medicaid benefits Eligibility for this program is determined by TennCare. For more information on applying for TennCare, visit How you can apply or get help. Or, call TennCare Connect at 855-259-0701.

Brief Description: Low income disabled working individuals under age 65 who are entitled to Medicare Part A.

Yearly Income Limit
At or below 200% poverty

$25,520 (family size of 1)
$34,480 (family size of 2) 

Monthly Income Limit
$2,127 (family size of 1)
$2,874 (family size of 2)

Resource Limit
$4,000 (1)
$6,000 (2)

Comments: This is a mandatory program. State is required to pay Medicare Part A premiums for these individuals. This is cost sharing assistance for low income Medicare beneficiaries, but does not provide full Medicaid benefits. Eligibility for this program is determined by TennCare. For more information on applying for TennCare, visit How you can apply or get help. Or, call TennCare Connect at 855-259-0701.