Medicaid Eligibility Requirements for Tennessee

Qualified Tennessee residents can receive health care coverage through TennCare, the state's Medicaid program, administered by the Department of Human Services (DHS). According to TennCare, the program provides health benefits for more than one million low-income residents, including senior citizens, pregnant women, children, the blind and disabled Tennesseans. Residents must meet income limits and residency prerequisites to qualify for TennCare programs. Coverage and requirements can depend on the type of plan the applicant qualifies for.

Categories

• TennCare places enrollees in one of nine different types of categories. Categories separate participants by groups such as women, children, adults, senior citizens, disabled residents and those who are blind. Each category has specific eligibility requirements.

TennCare Medicaid

• TennCare Medicaid provides health care coverage for residents who meet eligibility requirements for Medicaid. TennCare Medicaid programs can cover pregnant women, children under the age of 21, single parents with minor children, women with cervical or breast cancer and people receiving Supplemental Security Income (SSI) from the Social Security Administration. Families with two parents can also qualify when one parent is unemployed or one parent has a heath problem that a doctor expects to continue for at least 30 days. Requirements can depend on the category in which the applicant belongs. DHS bases eligibility for TennCare Medicaid on family size, resources and income.

TennCare Standard

• TennCare Standard only covers children under the age of 19 who already participate in the TennCare Medicaid program. Kids can qualify as uninsured or medically eligible. Uninsured children can qualify when medical care coverage is not available through a group plan and when kids no longer meet eligibility requirements for TennCare Medicaid. Children who have a medical condition considered uninsurable and do not have access to a group medical plan can meet the medically eligible requirements for TennCare Standard.

Income and Resource Limits

• Each category of TennCare coverage has specific income limits, which can vary. For example, TennCare participants who qualify because they receive SSI benefits cannot have an income above $674 per month for a household of one or $1,011 per month for a household of two people (as of November 2010). SSI participants cannot have resources over $2,000 for a single household or $3,000 for a household of two. TennCare Standard coverage for uninsured children caps household income at $1,838 for a family of four, but does not have resource limits. Newborn babies born to Medicaid eligible mothers do not face household income or resource limits.

Residency

• Only Tennessee residents can qualify for TennCare coverage. In the event a Tennessee resident receives care in a long-term care facility out of state, TennCare can continue coverage if the resident plans to return to the state and considers Tennessee as their primary state of residence.

Eligibility Determination

• DHS takes applications and determines the eligibility of all TennCare applicants, with the exception of people receiving SSI benefits. The Social Security Administration takes applications and determines eligibility for SSI recipients.