Losing TennCare?

Transitional Medicaid

If your income increases, you may lose TennCare coverage. However, you could qualify for Transitional Medicaid, which provides 12 months of temporary coverage if you meet these requirements:

• You qualified for TennCare because your child (under 18) was eligible.
• You received TennCare benefits for at least 3 of the 6 months before losing your coverage.
• Your income was within the limit for the caretaker relative category before losing coverage.

This program ensures you don’t lose healthcare coverage right away during the transition period and will be determined automatically by TennCare.

Extended Medicaid

If your spousal support increases, you may lose TennCare coverage. However, you could qualify for Extended Medicaid, which also provides 12 months of temporary coverage if you meet these requirements:

• You received TennCare benefits for at least 3 of the 6 months before losing your coverage.
• You met the financial criteria in the caretaker relative category before losing TennCare.

This program ensures you don’t lose healthcare coverage right away during the extended period and will be determined automatically by TennCare.

Continuous Eligibility For Children

Children under 19 may keep TennCare coverage for 12 months, even if your income goes up. After 12 months, their coverage must be renewed. Certain TennCare groups are not eligible for continuous eligibility. This will be determined automatically by TennCare.

You must fit into a TennCare category to qualify for TennCare. If you no longer fit into a category, you may lose your TennCare coverage. You may be eligible in another TennCare category, but you need to complete the Questions for Review in the pretermination letter or the renewal packet that TennCare mailed to you or that is available in your electronic TennCare Connect account.

Below is a brief overview of some of the TennCare programs available in Tennessee. This information is for reference only.

For more details on TennCare categories visit the Tenncare Categories webpage.

• Children: Children ages 0-19 years old with low income.
• Pregnant Women: Pregnant women with low income. A pregnant woman is generally counted as a household of two (herself and her baby).
• Parents or Caretaker Relatives: Parents and caretaker relatives of a minor child(ren) under the age of 18 or children aged 18 and a full-time student. You must also meet income requirements.
• Deemed Newborns: 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.
• Medically Needy: Children up to age 21 or pregnant women with low income. The individuals must have income no more than the income limit set for this category or must have sufficient unreimbursed medical bills. These medical bills are to “spend down” to the income limits depending on the family size.
• Supplemental Security Income (SSI): Aged, blind, and/or disabled (ABD) individuals with low income who receive SSI payments in Tennessee.
• Former SSI Recipients: Certain aged, blind or disabled individuals who formerly received SSI payments and currently receive payments from the Social Security Administration.
• Institutionalized Individuals: Individuals who receive care in a medical institution such as a nursing facility (NF), hospital, or intermediate care facility (ICF) with intellectual disabilities (IID), or for individuals who get Home and Community Based Services (HCBS).
• Individuals with Breast or Cervical Cancer: Tennessee residents who are uninsured or whose insurance does not cover treatment for Breast or Cervical Cancer (BCC). To be eligible for TennCare in this category, individuals must be under age 65 and have been determined to need BCC treatment by the Department of Health (DOH).
• TennCare Standard: Children under age 19 whose TennCare 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.
• CoverKids – Children under age 19 whose income is below 250% of the FPL and who do not have other insurance.

Marketplace Coverage:

If you no longer qualify for TennCare, you may qualify for a low cost health plan through the Federal Marketplace.

• Visit Healthcare.gov for more information.
• The Federal Marketplace can connect you with local assistance to help you apply for a health plan.

Other Healthcare Coverage:

The Tennessee Department of Commerce and Insurance can help you find other health care options. For more information, go to Tennessee Department of Commerce and Insurance webpage.

• Call TennCare Connect for free at 855-259-0701 for general assistance, including help with applying for or renewing TennCare.
• Call the LTSS Help Desk for free at 1-877-224-0219 for questions about Long-Term Services and Supports.
• Beneficiary Support System - Helps individuals who are enrolled in the CHOICES, Employment and Community First (ECF) CHOICES, and the Katie Beckett program.
• Turning 19: Health Care Changes One Pager - A One Pager listing eligibility options for TennCare for a child turning 19.
• HealthCare Navigators - A non-profit program offering free health insurance enrollment and healthcare advice to all Tennesseans.
• Healthcare.gov - Find helpful information on a wide range of Medicaid topics.
• Tennessee Department of Commerce and Insurance - The Tennessee Department of Commerce and Insurance can help you find other health care options.