TennCare Covered Services 2026, Complete Tennessee Medicaid Benefits Guide

If you just got approved for TennCare, or you're trying to figure out whether a procedure, prescription, or doctor visit will be covered, this is the answer.

Three things to know before you start. First, TennCare is one of the most managed-care-heavy Medicaid programs in the country. Almost every member is enrolled in one of three MCOs, BlueCare Tennessee, UnitedHealthcare Community Plan, or Wellpoint Tennessee, and it's the MCO that processes claims, runs prior authorizations, and assigns your care coordinator. Second, TennCare covers a lot more than most members realize, including comprehensive adult dental added in 2023 and a behavioral health benefit that's fully integrated into your medical plan. Third, the answer to "is this covered?" sometimes depends on which TennCare benefit package you're in, adult, child, LTSS, or CHOICES, so we'll walk through each one.

This guide covers exactly what TennCare pays for in 2026, what it doesn't, what the limits are, and how to appeal if a service is denied.

By Brevy Care Team · Last verified May 3, 2026

How TennCare Defines What You Get: Benefit Packages

Tennessee's Medicaid benefit isn't a single list. It's organized into "benefit packages" that depend on your enrollment category. The two regulatory documents that govern coverage are Tenn. Comp. R. & Regs. 1200-13-13-.04 (current revision effective 6/28/2025) and the TennCare Benefit Packages PDF (last updated 4/20/2026).

The four packages most relevant to senior members and their families:

If you're age 65 or older and dual-eligible (Medicare + TennCare), Medicare is generally your primary payer for medical services and Part D for drugs, TennCare wraps around with what Medicare doesn't cover, including most long-term services and supports.

Federally-Mandatory Services

These are the services every state Medicaid program must cover under 42 USC §1396d(a) and 42 CFR §440.210. TennCare covers all of them:

• Inpatient hospital services (excluding institutions for mental disease)
• Outpatient hospital services
• Physician services
• Nurse practitioner and nurse-midwife services
• Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services
• Laboratory and X-ray services
• Family planning services and supplies
• Nursing facility services for members 21 and older
• Home health services (with adult limits, see below)
• Non-emergency medical transportation (NEMT)
• EPSDT for members under 21
• Tobacco cessation for pregnant women

Most of these you'd expect from any health insurance. The two that catch families off guard are home health limits for adults and NEMT eligibility rules, covered later in this guide.

Tennessee's Optional Add-Ons

Beyond the federal floor, Tennessee elects to cover a wide range of services under its §1115 TennCare III demonstration, approved by CMS on January 8, 2021 and running through December 31, 2030. These services are described as "optional" in federal Medicaid jargon, but in Tennessee they are locked into the demonstration and treated as core benefits.

Prescription drugs

TennCare's pharmacy benefit is administered by OptumRx, which has been the statewide Pharmacy Benefit Manager since January 1, 2020. There is one statewide Preferred Drug List that applies identically across BlueCare, UnitedHealthcare Community Plan, and Wellpoint, meaning you cannot "shop plans" for drug coverage the way you can in Medicare Part D. The current PDL is the May 1, 2026 edition, with monthly updates following the Pharmacy Advisory Committee (statutorily authorized at Tenn. Code §§71-5-2401 to 71-5-2404).

Copays:

• Generic: $1.50 per prescription
• Brand-name: $3.00 per prescription
• One copay per 90-day fill on the 90-day supply list

Who's exempt from pharmacy copays: Members in nursing facilities, on HCBS waivers (CHOICES, ECF, Katie Beckett), in ICF/IID; pregnant members; hospice patients; American Indian / Alaska Native members receiving services through IHS or tribal providers; members under 21. Birth control, hospice medications, emergency medications, and pregnancy-related drugs are exempt regardless of who's filling them.

The big change in 2025: TennCare eliminated the long-contested 5-prescription-per-month cap for adults effective July 1, 2025. Adults can now fill as many medically necessary prescriptions as their prescribers order. The two-brand-per-month limit remains in effect, though drugs on the Auto-Exempt and Attestation List don't count against that limit.

Mandatory generic state. Per Tenn. Code §53-10-205, your pharmacist will fill the generic version unless your prescriber documents either an FDA-reported adverse reaction to the AB-rated generic or a contraindication to one of the generic's inactive ingredients. A therapeutic-failure pathway exists only for five high-risk classes: anticonvulsants, atypical antipsychotics, HIV antivirals, immunosuppressants, and oncology agents.

Mail order: OptumRx Mail Service Pharmacy at 1-800-356-3477 (24/7), up to a 90-day supply.

Adult vaccines. All ACIP-recommended adult vaccines are covered with no cost-sharing, flu, pneumococcal, COVID-19, RSV (60+ shared clinical decision-making, 75+ universal), shingles (Shingrix two-dose for 50+), and Tdap. This is a federal requirement under the Inflation Reduction Act amendments to 42 USC §1396d(a)(13), effective October 1, 2023.

What pharmacy does NOT cover: Erectile dysfunction drugs, fertility treatment, hair-growth agents, cosmetic drugs, weight-loss programs (with a carve-out for GLP-1 agonists prescribed for type 2 diabetes), most cough/cold OTC medications, and DESI / less-than-effective drugs. GLP-1s prescribed for obesity alone (such as Wegovy or Zepbound) are typically excluded, confirm the current PDL because this is a fast-moving exclusion category.

Adult dental

The 2023 expansion was the single biggest TennCare benefit change in years. Effective January 1, 2023, every adult member age 21 and over receives comprehensive dental, exams, X-rays, cleanings every six months, fillings, root canals, crowns, full and partial dentures, extractions, periodontal treatment, and nitrous oxide sedation. There are no copays on adult covered dental services.

Renaissance Dental is the statewide Dental Benefits Manager as of November 1, 2025, replacing DentaQuest. Member services: 866-864-2526. Find a dentist at tenncare.renaissancebenefits.com/find-a-dentist. The single statewide network applies regardless of which MCO you're in, dental is not an MCO plan differentiator.

For the full breakdown including pediatric orthodontia rules, the dentist participation reality, and how to appeal a denied dental service, see our dedicated guide: TennCare Dental Coverage in 2026.

Vision

This is one of the most-misunderstood categories of TennCare coverage.

For adults 21+ (Pkg B): Vision coverage is "limited to medical evaluation and management of abnormal conditions and disorders of the eye." Translation: TennCare covers eye care for diseases (glaucoma, diabetic retinopathy, cataracts, macular degeneration), but it does not cover routine eye exams, refractions, or eyeglasses. The one adult exception is the first pair of cataract glasses or contact lenses following cataract surgery.

MCO discretion. Some MCOs offer routine vision exams or eyeglasses as a "cost-effective alternative" under TennCare Policy BEN 08-001. These are not member entitlements, the MCO can change them, but they're often part of the value-added benefit package. Check your MCO's current member handbook.

For children under 21 (EPSDT): Comprehensive vision, refractions, eyeglasses, contact lenses, treatment for any condition discovered. The federal EPSDT mandate sets the floor.

Hearing

Hearing aids are not covered for adults. Tenn. Comp. R. & Regs. 1200-13-13-.04 and the TennCare Benefit Packages do not list hearing aids as a covered service for members 21 and older.

Cochlear implants are different. TennCare covers cochlear implants as medically necessary for adults 18+ with bilateral or single-sided sensorineural hearing loss meeting clinical criteria. The external components fall under DME; the internal components are covered as medical-surgical services.

For children under 21 (EPSDT): Hearing aids and audiology are fully covered as part of the federal EPSDT mandate.

Durable medical equipment, prosthetics, and orthotics

TennCare covers DME, prosthetics, and orthotics as medically necessary for adults under Rule 1200-13-13-.04. The MCO applies prior authorization for high-cost items, and TennCare covers the least-costly option that meets your medical need. Scooters and high-tech-active-lifestyle prosthetic devices are not in the State Plan but may be available through MCO cost-effective alternatives.

Behavioral health

TennCare's behavioral health benefit is fully integrated within the three MCOs. There is no separate Behavioral Health Organization (BHO), Prepaid Inpatient Health Plan (PIHP), or Regional Health Organization carving out mental health and substance use services. Your MCO handles your therapy, your psychiatric appointments, your medications, your inpatient psych admission, and your SUD treatment.

This is a meaningful structural difference from neighboring states. Michigan, for example, still carves out specialty BH/SUD services to ten regional PIHPs. In Tennessee, you call your MCO's behavioral health line, not a separate BH plan.

Adult covered services:

• Inpatient psychiatric services (prior authorization required)
• Outpatient mental health therapy, individual, group, family, no annual visit cap for medically necessary services
• Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP)
• 24/7 mobile crisis services accessed via 988 + press 0 or local crisis lines
• Crisis Stabilization Units (average 3-day stays)
• Peer support services (delivered by Certified Peer Recovery Specialists)
• Targeted case management for serious and persistent mental illness (SPMI)
• Psychosocial rehabilitation
• Inpatient detox / withdrawal management (both social and medical)
• Outpatient and residential SUD treatment in non-IMD facilities
• Methadone via federally certified Opioid Treatment Programs
• Buprenorphine through the TennCare BESMART network
• Naltrexone (oral and Vivitrol)
• Telehealth behavioral health, including audio-only allowance retained after the COVID-19 PHE

Tennessee Health Link (THL). For members with significant behavioral health needs, about 3x more likely to be hospitalized and 2x more likely to use the emergency department than the average TennCare member, TennCare assigns care coordination through Tennessee Health Link, statewide since December 1, 2016. THL providers are predominantly Community Mental Health Agencies (Centerstone, Frontier Health, Mental Health Cooperative, Volunteer Behavioral Health, Helen Ross McNabb Center, Cherokee Health Systems, and others).

Crisis services for everyone, TennCare or not. The 988 Lifeline, mobile crisis response, walk-in crisis centers, and crisis stabilization units are accessible to all Tennesseans regardless of insurance status, and do not require prior authorization for TennCare members. Tennessee answers approximately 89% of 988 calls in-state.

The Behavioral Health Safety Net (BHSN). If you're an adult with serious mental illness who isn't eligible for TennCare and doesn't have private insurance covering MH, the BHSN is a separate TDMHSAS-funded program providing outpatient mental health services in all 95 counties. Income limit is at or below 138% of the Federal Poverty Level.

Therapies (PT, OT, speech)

Physical therapy, occupational therapy, and speech-language therapy are all covered for adults with no enumerated annual visit cap. Medical necessity governs, and your MCO may apply prior authorization for ongoing courses of treatment.

Hospice

Hospice care is covered. Hospice members are exempt from pharmacy copays.

Home health

Adult home health benefits have specific limits worth knowing:

• Nursing services: 8 hours per day, 27 hours per week (30 hours per week if you have Level 2 nursing facility level of care)
• Home health aide plus nursing combined: 8 hours per day, 35 hours per week (40 hours per week if Level 2 NF LOC)

If you need more than these limits, the conversation moves to private-duty nursing (which for adults 21+ is restricted to ventilator and life-sustaining-technology cases) or to CHOICES home and community-based services, which add personal care, attendant care, adult day, and home modifications on top of the standard medical benefit.

Private-duty nursing (PDN)

For adults 21+, PDN is restricted to certain services needed to support ventilator equipment or other life-sustaining medical technology. PDN typically requires at least 8 hours of continuous skilled nursing need in a 24-hour period and is capped at 16 hours per day after age 21. For members under 21, EPSDT removes the ventilator-only restriction.

Podiatry and chiropractic

Both are covered as medically necessary for adults across all benefit packages, though the practical scope is narrow.

Transportation: Getting to Your Appointments

TennCare's non-emergency medical transportation (NEMT) benefit covers rides to any covered TennCare service for members who have no other reasonable means of transportation. The benefit is grounded in 42 CFR §431.53, the federal "assurance of transportation" regulation.

Important: Tennessee uses a broker-per-MCO model, not a single statewide vendor. Two transportation brokers serve four lines of business:

Modivcare and MTM are not current TennCare brokers, that's a frequent point of confusion because Modivcare was the broker in earlier years.

What trips qualify: Doctor visits, specialist visits, dialysis, hospital discharge, PT/OT/speech therapy, lab and imaging, covered dental and vision care, behavioral health appointments, and SUD treatment visits. Adult day care under CHOICES is covered only when the nearest covered program is more than 30 miles from your home.

What doesn't qualify: Personal errands, social visits, family events, non-medical destinations, and trips for services TennCare doesn't cover. Note: Because TennCare does not cover methadone for opioid use disorder pharmacotherapy, transportation to a methadone clinic for OUD treatment is not a covered NEMT trip. (Transportation to other forms of OUD treatment, buprenorphine, residential SUD, outpatient counseling, remains covered.)

Modes of transport:

• Mileage Reimbursement Program (MRP): $0.725 per mile in 2026, paid via pay card after the trip log is processed. The member or designated driver must have a valid license and current auto insurance. Trips must still be pre-scheduled with the broker, and only one household member is reimbursed when multiple attend the same facility on the same day (effective 4/1/2025).
• Ambulatory sedan/van for members who can transfer independently
• Wheelchair-accessible van
• Stretcher van for prone transport
• Non-emergent ambulance for medical-necessity stretcher transport (not for true emergencies, call 911)
• Public transit bus pass where available
• Taxi or rideshare in some regions

Scheduling. The contractual minimum is 2 business days' advance notice, though some consumer materials still say 72 hours. Same-day urgent transport is available when the broker can verify urgency with the medical provider. For hospital discharge, the broker must arrive within 3 hours (urban) or 4 hours (non-urban) of notification. Be ready within 5 minutes of scheduled pickup or the driver leaves.

Cost to members: zero. NEMT is provided at no cost.

CHOICES, ECF CHOICES, and Katie Beckett: What Long-Term Care Adds

If you're enrolled in TennCare's long-term services and supports programs, you receive the standard medical benefit plus a wraparound of home and community-based services. The wraparound is not a replacement for regular TennCare, it's additive.

CHOICES Group 2 and 3 (HCBS for adults 65+ and adults with physical disabilities):

• Personal Care Visits, 2,580 hours per year (max 2 visits per day at 4 hours each)
• Attendant Care, 1,080 hours per year (1,400 if homemaker is bundled)
• Adult Day Services, 2,080 hours per year
• Home modifications, $6,000 per project, $10,000 per year, $20,000 lifetime
• Personal Emergency Response Systems
• Pest control, in-home respite, minor home modifications, and other services per the CHOICES catalog

ECF CHOICES (employment and community first for I/DD): The Family Caregiver Stipend benefit ($500/month for kids in Group 4, $1,000/month for adults), employment services, community living supports, and dental wraparound budgets on top of standard adult dental.

Katie Beckett (children under 18 with significant disabilities): Part A provides full Medicaid plus up to $15,000 of HCBS; Part B provides $10,000 of flexible HCBS without full Medicaid; Part C provides bridge coverage during enrollment.

These long-term care services are detailed in our dedicated guides:

• TennCare CHOICES
• ECF CHOICES
• Katie Beckett

Important coverage line: Personal care, adult day services, and home modifications are not part of the standard adult benefit. They are available only through CHOICES, ECF CHOICES, Katie Beckett, or one of the legacy 1915(c) HCBS waivers.

EPSDT: How Coverage Differs for Members Under 21

Federal Medicaid law's Early and Periodic Screening, Diagnostic, and Treatment mandate (42 USC §1396d(r)) requires every state to cover any medically necessary service for enrolled children, even if it's not covered for adults. EPSDT raises the floor substantially:

If your child's pediatrician says a service is medically necessary, EPSDT is your legal backstop, services that adults cannot get may still be covered for your child.

What's NOT Covered for Adults

Set realistic expectations up front. The following are explicitly not covered under the standard adult benefit:

If you want any of these, expect to pay out of pocket, or, in the case of cosmetic services, through private insurance or self-funded financing.

Copays: Pharmacy and Otherwise

Pharmacy copays ($1.50 generic / $3.00 brand) apply to most adult TennCare members not in LTSS. Exemptions covered earlier.

Non-pharmacy copays depend on income. For TennCare Medicaid Aged, Blind, and Disabled adults at or below 133% of the Federal Poverty Level, which is the 65+ population most ABD members fall into, non-pharmacy copays are zero for all covered services.

For higher-income TennCare Standard members:

• 134–199% FPL: $5 PCP / specialist / inpatient; $8.20 ER non-emergency (waived if admitted)
• ≥200% FPL: $15 PCP, $20 specialist, $100 inpatient, $50 ER non-emergency

There are no copays on dental services for any adult.

Need help understanding what TennCare will cover for your family?

Brevy can walk you through your benefits, help you read denial letters, and connect you with TennCare-participating providers in your area. We can also help you file an appeal if a covered service has been denied.

Talk to a Brevy advisor

Prior Authorization: When Your MCO Decides First

Most routine services are covered without your having to think about prior authorization. The categories that typically need PA from your MCO include:

• Inpatient psychiatric admissions
• Residential SUD treatment
• Intensive Outpatient Programs and Partial Hospitalization
• Specialty drugs and non-preferred drugs (the PDL has a clinical pathway)
• Advanced imaging (MRI, CT, PET)
• High-cost durable medical equipment
• Non-emergency surgical admissions
• Out-of-network non-emergency services
• Crowns, dentures, periodontal surgery, deep sedation, select endodontic procedures (handled by Renaissance for dental)

Decision windows. The federal floor under 42 CFR §438.210(d) is 14 days for standard prior authorization decisions and 72 hours for expedited (urgent). Tennessee added the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements to the 1/1/2026 MCO contract amendment, which formalizes a Patient Access API and prior authorization timing decisions.

The pharmacy backstop. Tenn. Code §71-5-197 requires a 24-hour PA response and authorizes pharmacists to dispense at least a 72-hour emergency supply of any covered drug while PA is pending, so you should never go without a critical medication while PA is being processed.

EPSDT and emergencies. Under Rule 1200-13-13-.04, an MCO cannot deny a service for lack of prior authorization if the member is under 21 (EPSDT) or if the service is a true emergency.

How to Appeal a Denied Service

This is the section TennCare members get wrong most often. Tennessee uses a single-step state-level appeal process. Unlike most managed-care states, you do not have to file an MCO grievance first and exhaust it before appealing to the state.

Process:

1. You receive a Notice of Adverse Benefit Determination from your MCO, a denial, reduction, or termination of a service.
2. You have 60 days from the date on the notice to file a TennCare medical appeal.
3. File directly with TennCare Member Medical Appeals (TMMA), formerly called the TennCare Solutions Unit, using any of these channels:
   • Phone: 1-800-878-3192 (they take appeals over the phone)
   • Mail: PO Box 593, Nashville, TN 37202-0593
   • Email: TMMA.Contact.Center@tn.gov
   • Fax: 1-888-345-5575
4. Standard decision: within 90 days of filing.
5. Expedited decision: about one week if waiting could endanger your life or physical/mental health.
6. Continuation of benefits: If you appeal within 10 days of the action notice and request continuation, your existing services continue during the appeal under federal §438.420.
7. Fair hearing: If TennCare denies your appeal, you can request a fair hearing before an administrative law judge.

You can still file an MCO grievance, and you should if your concern is about quality of care, customer service, or a billing dispute that doesn't involve a covered-service denial. But for a covered-service denial, the binding pathway runs directly to TennCare.

Get help filing. Free help with TennCare appeals is available from the Tennessee Justice Center, Legal Aid Society of Middle Tennessee and the Cumberlands, West Tennessee Legal Services, and Legal Aid of East Tennessee. TennCare Connect at 855-259-0701 can help you with the appeal form itself.

Dental is the exception. Because dental is administered through Renaissance Dental as the statewide DBM, dental denials follow a two-step process: a Renaissance grievance first (call 866-864-2526), then a TennCare medical appeal if Renaissance still denies. The 60-day TennCare deadline applies once Renaissance has issued its decision.

How TennCare Coordinates with Medicare for Dual Eligibles

If you have both Medicare and TennCare (a "dual-eligible"), Medicare is your primary payer for medical services and Medicare Part D for prescription drugs. TennCare wraps around:

• Part D-excluded drugs: TennCare covers categories statutorily excluded from Part D under 42 USC §1395w-102(e)(2), including benzodiazepines and barbiturates (with PA), prescription vitamins (other than prenatal and fluoride), and certain weight-loss agents in carve-outs.
• Part B coinsurance / deductibles: TennCare covers these for full duals through standard Medicaid crossover claims (Tenn. Comp. R. & Regs. 1200-13-17).
• Part D copays: Full duals receive Extra Help / Low-Income Subsidy (LIS), which eliminates Part D premiums (up to benchmark), the deductible, and reduces drug copays. As of 2026, full-LIS duals pay $0 for covered Part D drugs (Inflation Reduction Act, codified at 42 USC §1395w-114). TennCare does not pay Medicare Part D copays for the LIS-eligible dual population, LIS already zeroes them out.
• Long-term services and supports: Medicare doesn't cover most LTSS. TennCare's CHOICES, ECF CHOICES, and standard nursing facility benefits are the LTSS pathway for duals.

Bottom Line

If you just got approved for TennCare, the short version of what to expect is this:

• The federal floor is solid, hospital, physician, lab, family planning, nursing facility, home health, and EPSDT for kids.
• Tennessee adds a comprehensive adult dental benefit (since 2023), a unified statewide pharmacy formulary through OptumRx, fully-integrated behavioral health within your MCO, and free non-emergency transportation through your MCO's broker.
• The biggest gaps in adult coverage are routine vision, eyeglasses, hearing aids, adult orthodontia, fixed bridges, dental implants, and adult-only services like personal care or adult day care, those last two are reserved for CHOICES and ECF CHOICES.
• For dual-eligibles 65+, Medicare runs primary; TennCare wraps around with what Medicare doesn't cover, including most long-term services and supports.
• If a service you believe should be covered is denied, call 1-800-878-3192 within 60 days and file a TennCare medical appeal. You don't need to exhaust MCO grievance first.

The hardest part of using TennCare in 2026 isn't the benefit. It's navigating a managed-care system where the answer to "what's covered?" depends on which package you're in, which MCO you're enrolled in, and whether the question is medical, dental, pharmacy, or behavioral health. When in doubt, call the member services line on your TennCare ID card, and don't take a verbal "not covered" from a provider's front desk as the final answer.

What does TennCare cover in 2026?

TennCare covers all federally-mandatory Medicaid services (hospital, physician, lab, family planning, nursing facility, home health, EPSDT for kids, NEMT) plus Tennessee's optional add-ons under its §1115 demonstration: prescription drugs, comprehensive adult dental (since January 1, 2023), behavioral health (integrated into MCOs), durable medical equipment, hospice, PT/OT/speech therapy, podiatry, chiropractic, and more. Coverage details vary by benefit package (adult, EPSDT, LTSS, CHOICES).

Are TennCare prescription drug copays still $1.50 and $3?

Yes. Generics are $1.50 and brand-name drugs are $3.00 in 2026. Members in long-term care, pregnant women, hospice patients, members under 21, and American Indian / Alaska Native members through IHS are exempt. Birth control, hospice medications, emergencies, and pregnancy-related drugs are also exempt regardless of who's filling them.

Did TennCare really eliminate the 5-prescription-per-month cap?

Yes, effective July 1, 2025, the long-contested 5-Rx adult monthly cap was eliminated. Adults can now fill as many medically necessary prescriptions as their prescribers order. The two-brand-per-month limit remains, though drugs on the Auto-Exempt and Attestation List don't count against it.

Does TennCare cover hearing aids?

Not for adults. Hearing aids are not listed as a covered service under Tenn. Comp. R. & Regs. 1200-13-13-.04 for members 21 and older. Cochlear implants are separately covered as medically necessary for adults 18+ with qualifying sensorineural hearing loss. For children under 21, EPSDT requires comprehensive hearing aid coverage.

Does TennCare cover eyeglasses?

For adults: only the first pair of cataract glasses or contact lenses following cataract surgery. Routine eye exams, refractions, and eyeglasses are not covered. Some MCOs offer routine vision as a "cost-effective alternative", check your MCO handbook. For children under 21, EPSDT covers comprehensive vision including refractions and eyeglasses.

Does TennCare cover adult dental in 2026?

Yes, comprehensive coverage since January 1, 2023. Cleanings, fillings, root canals, crowns, dentures, extractions, and periodontal treatment are all covered with no copays. Renaissance Dental is the statewide DBM as of November 1, 2025 (member services 866-864-2526). Adult orthodontia, cosmetic dentistry, and dental implants are not covered.

Is mental health covered by TennCare?

Yes, fully integrated within your MCO benefit. Outpatient therapy has no annual visit cap. Inpatient psychiatric, IOP, PHP, residential SUD, peer support, mobile crisis, and medication-assisted treatment are all covered. There is no separate behavioral health plan to navigate. Tennessee answers approximately 89% of 988 calls in-state.

Does TennCare cover transportation to my doctor?

Yes, at no cost. NEMT is provided through your MCO's transportation broker: Verida (BlueCare and TennCare Select) or Tennessee Carriers (UnitedHealthcare and Wellpoint). Schedule at least 2 business days ahead. Self-driver mileage reimbursement is $0.725 per mile in 2026.

Does TennCare cover therapy?

Outpatient mental health therapy has no annual visit cap and is covered by your MCO. Self-referral is allowed for in-network providers. Physical, occupational, and speech therapy are covered as medically necessary, with prior authorization sometimes required for ongoing courses of treatment.

Does TennCare cover personal care or home health aides?

Not under the standard adult benefit. Personal care, attendant care, and adult day services are available only through CHOICES Group 2 / 3 (for adults 65+ or with physical disabilities), ECF CHOICES (for I/DD), or one of the 1915(c) waivers. The standard adult home health benefit is limited to 8 hours per day / 27 hours per week of nursing.

How do I appeal a denied TennCare service?

Call 1-800-878-3192 within 60 days of the denial letter. Tennessee uses a single-step state-level appeal, you do not have to file an MCO grievance first. Standard decisions within 90 days; expedited decisions within about a week if waiting could endanger your health. If denied at TennCare level, you can request a fair hearing before an administrative law judge. Free help with appeals is available from Tennessee Justice Center, Legal Aid Society of Middle Tennessee and the Cumberlands, West Tennessee Legal Services, and Legal Aid of East Tennessee.

What if I have both Medicare and TennCare?

Medicare is primary for medical services and Part D for drugs. TennCare wraps around with Part D-excluded drugs (benzos, certain vitamins), Medicare Part B coinsurance and deductibles, and long-term services and supports through CHOICES. Full duals get $0 Part D copays through Extra Help / LIS, TennCare does not pay Part D copays for this population.