You can apply for TennCare, Tennessee's Medicaid program, in four ways: online through the TennCare Connect portal, by phone, on paper, or in person. The process is straightforward for someone applying for regular Medicaid coverage. It is much more involved if you are applying for CHOICES (long-term services and supports), ECF CHOICES (intellectual or developmental disabilities), or Katie Beckett (severely disabled minors), each of which adds a clinical evaluation, a longer document trail, and (often) a different intake agency.

This guide walks through every step for the 2026 program year: which channel to use, what documents to gather, how long you'll wait, what trips families up, and what to do if you get denied.

By Brevy Care Team · Last verified May 2, 2026

Before You Apply for TennCare: Know Which Program You Need

TennCare is not one program, it's at least four, and the right intake door depends on what you need. The application form is the same, but the supporting documents, the assessment process, and the case worker who picks up your file all differ.

Applying for Primary channel Also needs Lead agency
Standard TennCare (ABD adult) TennCare Connect Income/asset proof TennCare
CHOICES Groups 1, 2, 3 (LTSS) AAAD intake or hospital social worker PAE + 60-month financials + QIT (if over income) TennCare LTSS Unit + MCO Care Coordinator
ECF CHOICES (I/DD) DDA regional intake I/DD diagnosis documentation + Referral List signup DDA
Katie Beckett (children under 18) TennCare Connect (Part B first, then Part A) Medical records + DDA Level of Care assessment TennCare + DDA
Medicare Savings Programs TennCare Connect (or via SSA Form SSA-1020) Proof of Medicare enrollment + asset documentation (LIS limits: $9,950 individual / $14,910 couple in 2026) TennCare
Hospital Presumptive Eligibility (interim) Qualified hospital admissions Standard income screen by hospital TennCare (PE granted by hospital)

If you don't yet know which one applies to you, start with the TennCare programs hub for a side-by-side comparison.

Step 1: Gather Your Documents

The single most common reason TennCare applications stall is missing paperwork. Gather what you can before you start.

Identity and household:

  • Government-issued ID for the applicant (driver's license, TN state ID, passport)
  • Social Security numbers for everyone in the household applying
  • Proof of Tennessee residency (utility bill, lease, recent mail)
  • Birth certificates for children under 18 if they're applying

Income (60 days minimum, longer for LTSS):

  • Two most recent pay stubs for any working household members
  • Social Security or SSI award letter (current year)
  • Pension or annuity statements
  • Rental, dividend, or interest income statements
  • Tax returns for the last two years

Assets:

  • Bank statements for every account (checking, savings, CDs, money market)
  • Investment and retirement account statements (IRAs, 401(k)s, brokerage)
  • Vehicle titles and values
  • Life insurance policies (face value and cash surrender value)
  • Deeds and property assessments for any real estate
  • Burial plots and pre-need funeral contracts

CHOICES, ECF CHOICES, or Katie Beckett applicants, 60 months of history:

This is where TennCare LTSS applications get heavy. For long-term care pathways, the case worker reviews five years of financial history looking for uncompensated transfers that could trigger the federal look-back penalty (60-month window under 42 USC § 1396p(c) as amended by DRA-2005, with TN-specific operational guidance at TennCare ABD Manual § 125.010 and Tenn. Comp. R. & Regs. 1240-03-03-.03). You'll need:

  • 60 months of bank statements (every account)
  • 60 months of investment and retirement statements
  • Closing documents for any property sold in the last 5 years
  • Documentation for any large gifts or transfers (over $500 is a good threshold)
  • Records of any trusts, annuities, or pre-paid contracts
  • Loan documents for any money lent to family members

Medical (CHOICES, ECF CHOICES, Katie Beckett):

  • Current medications list
  • Primary care physician's contact information
  • Hospital discharge summaries from the last 2 years
  • Diagnosis documentation supporting the level-of-care claim (especially for ECF CHOICES I/DD applications and Katie Beckett medical-complexity documentation)
  • For CHOICES: the Pre-Admission Evaluation (PAE), usually completed by the AAAD, hospital, or nursing facility, not by the applicant directly

Step 2: Choose How to Apply for TennCare

There are four channels for the financial side of any TennCare application.

TennCare Connect at tenncareconnect.tn.gov is the fastest option for most families. Create an account, answer the application questions, upload scanned or photographed documents, and submit. You can save progress, return later, track your application status, renew coverage, and report changes through the same portal once you're enrolled.

TennCare Connect is the central portal for Standard TennCare, Katie Beckett (Part B then Part A), and Medicare Savings Programs. It can also be the financial intake for CHOICES, but a CHOICES application also requires a clinical PAE, see Step 3. For MSP applicants, the Social Security Administration also accepts MSP applications via Form SSA-1020 with auto-referral to TennCare under 42 USC § 1320b-14, useful if you're already filing for Part D Extra Help.

Option B: TennCare Connect (Phone)

Call 1-855-259-0701 (TN Relay 1-800-848-0298). A TennCare Connect representative can take your application by phone and help you through the questions. Useful if you don't have reliable internet, are uncomfortable with the online portal, or have questions about the form.

Option C: Paper Application

Download the TennCare application (English or Spanish) from tn.gov/tenncare and mail or fax it:

  • Mail: TennCare Connect, P.O. Box 305240, Nashville, TN 37230-5240
  • Fax: 1-855-315-0669

Paper takes longer because TennCare has to scan and key in your data, but it's still a valid channel, particularly if your application includes a lot of supplementary documentation that doesn't fit the online portal cleanly.

Option D: In-Person

Application assistance is available in person at:

  • Tennessee Department of Health county offices (find yours at tn.gov/health)
  • Area Agencies on Aging and Disability (AAADs), best starting point for older adults exploring CHOICES; statewide line 1-866-836-6678
  • Federally Qualified Health Centers (FQHCs) that participate in TennCare outreach
  • Hospital social workers at most Tennessee hospitals, particularly important if you are about to be discharged and need TennCare to cover post-acute care
  • Nursing facility admissions staff, most NFs help applicants file Group 1 CHOICES applications as part of their admission workflow

For ECF CHOICES, in-person intake goes through DDA's regional offices: West Tennessee 1-866-372-5709, Middle Tennessee 1-800-654-4839, East Tennessee 1-888-531-9876.

Step 3: The CHOICES Pre-Admission Evaluation (PAE)

If your application is for CHOICES Group 1, 2, or 3, you need a clinical PAE in addition to the financial application. The PAE is what proves you meet the Nursing Facility Level of Care standard, and without it, the financial side of the application can't be completed.

Who submits the PAE: AAADs, MCO Care Coordinators, hospitals, nursing facilities, PACE organizations (Tennessee's only PACE site is Ascension Living Alexian PACE in Hamilton County), and ICF/IID facilities can all submit. The clinical assessor must be an MD, DO, PA, NP/APN, RN, LPN, or LSW. Applicants do NOT submit their own PAE.

The Acuity Scale: TennCare scores the PAE on a 0–26 point scale (21 ADL points + 5 skilled-services points). A score of 9 or higher qualifies for nursing-facility level of care and full CHOICES Group 1 or 2 enrollment. A score of 5–8 can qualify for Group 3 ("At Risk") if a Safety Determination is made.

Where it goes: The PAE is submitted through the web-based TennCare Pre-Admission Evaluation System (TPAES) and reviewed by RNs in the Bureau of TennCare Long-Term Services and Supports Unit, not the MCO, not DDA. TennCare LTSS must receive an approvable PAE within 10 calendar days of the PAE Request Date or the physician certification date, whichever is earlier.

Timeline: Once both the PAE and the financial application are submitted, TennCare has up to 90 days under federal rules to issue an eligibility decision for CHOICES.

If you are at home and not in a hospital, the AAAD is the right starting point, they will dispatch an intake worker who can complete the PAE on your behalf. If you are in a hospital, the hospital social worker is the right starting point.

Step 4: ECF CHOICES and Katie Beckett: Different Doors

For ECF CHOICES, you do not start at TennCare Connect. You start at DDA.

Three on-ramps:

  • Online self-referral at perlss.tenncare.tn.gov/externalreferral
  • Existing TennCare members: call your MCO and ask for ECF CHOICES referral
  • Non-members: call the DDA regional office for your part of the state

Once DDA accepts the referral, you go onto the Referral List (capped enrollment, with priority categories that determine when an opening is offered). DDA also handles the I/DD diagnostic confirmation and the Person-Centered Support Plan.

For Katie Beckett, the application starts at TennCare Connect, but families need to apply for Part B first. Only after Part B determination can Part A be considered. The financial side runs parallel to the medical/Level of Care side, which DDA handles.

DDA regional intake numbers, same as ECF CHOICES:

  • West Tennessee: 1-866-372-5709
  • Middle Tennessee: 1-800-654-4839
  • East Tennessee: 1-888-531-9876

Step 5: What to Expect After You Submit

Federal rules govern TennCare's processing timelines:

  • 45 days for non-disability applications (standard adult Medicaid, MSPs)
  • 90 days for applications requiring a disability determination, and for CHOICES

You should receive at least one acknowledgment notice within the first 30 days confirming TennCare received your application. If TennCare needs additional documentation, you'll get a request, usually with a 10-day response window. Respond to every TennCare letter promptly. Missing a response window is one of the most common reasons applications get denied.

Retroactive coverage: If you are determined eligible, TennCare can backdate your coverage up to 3 months prior to your application date as long as you were eligible during that window. This is important for hospital bills incurred before you applied, request retroactive coverage on the application form.

Step 6: Hospital Presumptive Eligibility (For Acute Care)

If you are admitted to a Tennessee hospital and need immediate Medicaid coverage, ask the hospital social worker about Hospital Presumptive Eligibility (HPE).

HPE has been active in TennCare since July 1, 2016. Qualified hospitals can grant temporary TennCare coverage to non-LTSS adults, children, parents and caretaker relatives, pregnant women, breast and cervical cancer treatment program enrollees, and former foster youth, pending a full TennCare application. HPE coverage is time-limited and ends if you don't file the full application by the deadline.

Important limitation: HPE does NOT cover CHOICES, ECF CHOICES, Katie Beckett, or any pathway that requires a Pre-Admission Evaluation. If you are being discharged to a nursing facility or to home with care needs, HPE will cover your inpatient hospital stay but not the post-acute services. The CHOICES application has to be filed separately.

A second presumptive pathway, Presumptive Eligibility for Pregnant Women, runs through local health departments at or below 195% FPL.

Step 7: Annual Renewal

Once you're enrolled, TennCare reviews your eligibility annually.

The renewal process:

  1. Around month 9 of your coverage year, TennCare attempts an ex parte renewal, a behind-the-scenes review using data TennCare already has from SSA, the Department of Labor, and other state systems. If everything still matches, you'll get a notice that your coverage has been renewed automatically.
  2. If TennCare needs more information, you'll get a request with a 40-day response window plus a 20-day supplement window.
  3. If you don't respond, coverage ends about 12 months from your last approval.
  4. If your coverage was terminated for procedural reasons (you missed a deadline), you have a 90-day Reconsideration Period to file the missing information and have your coverage reinstated retroactively.

CHOICES members must complete BOTH the annual financial redetermination AND a PAE re-certification each year. Children enrolled in CHIP/CoverKids have 12-month continuous eligibility, so renewal is less frequent.

Common Denial Reasons (and How to Avoid Them)

Most TennCare denials trace back to a handful of common issues:

  • Excess countable assets, for ABD adults, the limit is $2,000 individual / $3,000 couple; for CHOICES it's the same. Make sure you understand which assets count vs which are exempt (the home up to $752,000, one vehicle, household goods, prepaid burial plans).
  • Income over the limit without a Qualified Income Trust, for CHOICES applicants whose income exceeds $2,982/month in 2026, a properly drafted and monthly-funded QIT is mandatory. Most applicants in this situation work with an elder-law attorney to set one up.
  • Missing or expired PAE, the CHOICES PAE must reach TennCare LTSS within 10 days of the request date.
  • Un-rebutted asset transfers, any uncompensated gift or below-market transfer in the last 60 months can trigger a penalty period unless you can document a non-Medicaid-planning reason for the transfer (e.g., it was a customary gift, you got fair market value back). The 2026 transfer-penalty divisor is $295.87/day per the TennCare ABD Eligibility Policy Manual § 125.010 (effective January 5, 2026). Critically, post-DRA-2005 (42 USC § 1396p(c)) the penalty period does NOT start on the transfer date, it begins on the LATER of the transfer date or the date you are otherwise eligible AND in a nursing facility AND would be receiving Medicaid but for the penalty. See TN's complete 5-Year Lookback and Penalty Divisor guide for the full exempt-transfer list (caregiver child, sibling, sole-benefit trust, spousal), DRA-2005 SPIA requirements, promissory note three-prong test, life estate 1-year residency rule, undue hardship waiver mechanics (40-day filing deadline), and worked penalty calculations.
  • Missing citizenship or identity verification, make sure to provide documentation (birth certificate, passport, naturalization papers) along with the application.

What to Do If You Get Denied

You have the right to appeal any TennCare denial. Tennessee uses a two-track appeal system:

Eligibility appeals, for denials, terminations, or LTSS application delays exceeding 90 days. File with TennCare Connect:

  • Phone: 1-855-259-0701
  • Online: tenncareconnect.tn.gov
  • Mail: Eligibility Appeals, P.O. Box 23650, Nashville, TN 37202-3650
  • Fax: 1-844-563-1728

The hearing must be held within 90 days for CHOICES (LTSS) applications, or 45 days for non-LTSS. File within 40 days of the denial notice.

Medical/service appeals, for any Adverse Benefit Determination on a TennCare service (denial, reduction, or termination of services). File with TennCare Member Medical Appeals:

Filing deadline is 60 days from the date you find out about the problem. Standard decision timeline is 90 days; expedited is about 1 week if waiting could endanger your life or health.

Continuation of Benefits (COB): If your existing services are being reduced or terminated, you can request that they continue during the appeal, this requires both a timely appeal AND a timely COB request.

Free legal help:

  • Tennessee Justice Center: tnjustice.org
  • TennCare Advocacy Program: 1-800-758-1638
  • Regional Legal Aid offices: West TN, Middle TN, East TN, and Memphis Area Legal Services
  • TN Free Legal Answers: tn.freelegalanswers.org
  • Help4TN: 211 or help4tn.org

The Grier Consent Decree (Grier v. Goetz, M.D. Tenn. 2005, modified) provides Tennessee-specific procedural protections that go beyond federal Medicaid appeal rights, for example, allowing CHOICES members to proceed directly to a State Fair Hearing concurrent with the MCO appeal level. The free legal-help resources above can advise on Grier protections specific to your case.

Frequently Asked Questions

For Standard TennCare, the federal rule is 45 days. For CHOICES or any application requiring a disability determination, 90 days. In practice, complete applications with all documents attached are decided faster; incomplete ones take longer because of back-and-forth requests for missing information.

You must be a U.S. citizen or qualified non-citizen (legal permanent resident, refugee, asylee, etc.) to qualify for full TennCare coverage. Some non-citizens have a 5-year bar on Medicaid eligibility. Pregnant women and emergency-only Medicaid have somewhat different rules. The TennCare application asks about immigration status; provide accurate information and TennCare will determine the appropriate category.

Probably not directly through Standard TennCare, Tennessee does not have a medically needy program for adults. Your options: (a) if you're 65+ or have a disability that qualifies you for Medicare, look at Medicare Savings Programs (QMB/SLMB/QI) which have higher income thresholds (up to ~$1,816/month individual / $2,455/month couple for QI in 2026) and pay your $202.90/month Part B premium plus, for QMB, all Medicare cost-sharing; (b) if you need long-term care, CHOICES uses a higher income limit ($2,982/month) and allows a Qualified Income Trust for over-income applicants; (c) for general health coverage, look at the federal Marketplace (healthcare.gov) where you may qualify for premium subsidies.

A Qualified Income Trust (QIT), sometimes called a Miller Trust, is a special trust authorized under federal law (42 USC § 1396p(d)(4)(B)) that lets you redirect excess income so it doesn't count against the CHOICES income limit. You set up the trust at a bank, designate a trustee (usually a family member), and each month deposit your over-the-limit income into the trust. The trust then pays only allowable expenses according to a federally mandated seven-tier waterfall (Personal Needs Allowance → premiums → spousal MMNA → family allowance → court-ordered support → trust fees → patient liability). Most CHOICES applicants over the income limit work with an elder-law attorney to set one up because the trust document must be drafted to TennCare's specifications. Tennessee elder-law attorney fees typically run $1,500-$3,500 flat fee for QIT setup. See our TN QIT/Miller Trust deep guide for the full mechanics, banks that accept QITs in Tennessee, and three worked examples, and our TN spousal impoverishment guide for how the MMNA tier interacts with the Excess Shelter Allowance, Income-First rule, and Tennessee's Single Fixed Annuity model.

Yes. You can be an Authorized Representative for someone applying for TennCare. The applicant signs the Authorized Representative form (HCFA-1701-AR or equivalent), which TennCare provides. As the Authorized Representative, you can complete the application, communicate with TennCare on the applicant's behalf, and receive notices. This is common for adult children helping aging parents apply for CHOICES.

Ask the hospital social worker about Hospital Presumptive Eligibility (HPE). Qualified Tennessee hospitals can grant interim TennCare coverage on the spot for non-LTSS care, while the full application is processed. HPE doesn't cover CHOICES (long-term services), but it does cover the inpatient hospital stay and immediate post-discharge acute care, buying time to file the full TennCare application.

Two practical paths: (a) Money Follows the Person (MFP): if your need is severe enough that nursing facility care would qualify, you can enter a nursing facility under Group 1 (which is an entitlement, no waitlist) and then transition to HCBS through MFP after 60 days. This is often the fastest path for people who need significant home help; (b) OPTIONS for Community Living: state-funded (non-Medicaid) home and community-based program through your AAAD that can provide modest in-home support while you wait. Call your AAAD at 1-866-836-6678 for a referral.

Yes, in most cases. TennCare offers a 90-day Reconsideration Period after termination for procedural reasons (missed deadline, missing documentation). File the missing information within 90 days and your coverage can be reinstated retroactively. You can also file a full eligibility appeal within 40 days of the termination notice.

Where to Go Next

Application is the start of the journey, not the end. Once you're approved:

  • Approved for Standard TennCare? You'll be assigned to one of three MCOs (BlueCare, UnitedHealthcare Community Plan, or Wellpoint). Pick a primary care physician within your MCO's network.
  • Approved for CHOICES? Your MCO will assign a Care Coordinator who develops your person-centered support plan. See the TennCare CHOICES guide for what to expect.
  • Approved for ECF CHOICES? DDA will assign a Support Coordinator. See the ECF CHOICES guide.
  • Approved for Katie Beckett? DDA assigns a Support Coordinator for Part A; Part B is administered through TASC as the HRA vendor. See the Katie Beckett guide.
  • Want to be paid as a family caregiver? See the How to Get Paid as a Family Caregiver in Tennessee guide.

For the full landscape of TennCare programs, the Tennessee Medicaid Programs hub is the navigation root.

Find personalized help applying for TennCare at brevy.com.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.