Tennessee Medicaid (TennCare): The Complete 2026 Guide

TennCare is Tennessee's Medicaid program, covering roughly 1.4 million Tennesseans in 2026. It is a Division of the state Department of Finance and Administration, not a freestanding agency, and it operates under a §1115 demonstration (TennCare III, approved January 8, 2021, running through December 31, 2030).1

Tennessee has not adopted ACA Medicaid expansion, so TennCare adult coverage is limited to traditional Medicaid categories and the long-term services and supports (LTSS) pathways that anchor this guide. Its central programs for older adults, adults with disabilities, and families with disabled children are CHOICES (nursing facility and home care), ECF CHOICES (intellectual and developmental disabilities), and Katie Beckett (children with severe disabilities).1

This is the navigation guide: it maps every TennCare older-adult and disability question to the dedicated deep-dive that answers it. The number to save right now is TennCare Connect at 1-855-259-0701 for eligibility and applications.

The 60-Second Version

• TennCare covers roughly 1.4 million Tennesseans in 2026 under §1115 demonstration authority (TennCare III, approved 1/8/2021, runs through 12/31/2030, an unusually long ten-year approval period).2
• Tennessee is a non-expansion state. TennCare adult coverage is limited to traditional Medicaid categories (parents and caretaker relatives, pregnant women, SSI/ABD adults, and the CHOICES/Katie Beckett LTSS pathways). There is no general working-age adult Medicaid coverage in TN.1
• Three MCOs serve nearly all TennCare members statewide: BlueCare Tennessee (1-888-747-8955), UnitedHealthcare Community Plan (1-800-690-1606), and Wellpoint Tennessee (1-833-731-2153, formerly known as Amerigroup). Members in CHOICES, ECF CHOICES, and Katie Beckett Part A are mandatorily enrolled in one of these three plans.3
• CHOICES is TN's umbrella LTSS program, three groups: Group 1 (nursing facility, entitlement, no waitlist), Group 2 (HCBS, 12,500-slot cap, waitlist when full), Group 3 (At Risk demonstration, 1,750 non-SSI slots). All three operate under §1115 (NOT §1915(c)) authority.4 The Group 2 Individual Cost Neutrality Cap is $294.87/day = $107,627.55/year per the TennCare memo effective January 1, 2026.5
• ECF CHOICES is TN's I/DD HCBS program, Groups 4–7 covering different I/DD populations and acuity levels. The application gateway runs through DDA. A Family Caregiver Stipend is available for the Group 4 (Essential Family Supports) population.3
• Katie Beckett has three components: Part A (full TennCare + up to $15,000/year HCBS, capped at 300 enrolled children, prioritized by acuity), Part B (up to $10,000/year flexible HCBS dollars, no Medicaid coverage, 4,700 slots statewide), Part C (bridge coverage for children losing Medicaid while awaiting a Part A slot).2
• TennCare Estate Recovery is among the most consumer-friendly in the South: probate-only recovery, no TEFRA liens during recipient's lifetime, a $10,000 cost-effectiveness threshold, and exemptions that bar recovery while the member is survived by a spouse, a child under 21, or a blind-or-disabled child (a timing bar under federal law, so the protection can lapse when the spouse dies or the child turns 21).6
• TennCare has rebalanced toward home care. In July 2025 TennCare LTSS launched a five-year, $50 million investment in its HCBS provider network to expand community-based capacity.7
• Money Follows the Person (MFP) is integrated with CHOICES: a person transitioning out of an institution under MFP moves into CHOICES (or another HCBS pathway) for ongoing home and community-based services. MFP is federally funded through September 30, 2027.7
• The Freedom for Family Caregiving Act (PC 182 of 2025), effective 7/1/2025, opened TennCare's agency-employed pathway to spouses, parents, and co-resident relatives across CHOICES, ECF CHOICES, Katie Beckett, the §1915(c) DD waivers, Private Duty Nursing, Home Health Nursing, and Home Health Aide services.8
• The single most important call for a new TN family seeking TennCare LTSS: 1-855-259-0701 (TennCare Connect, eligibility and application), then route to 1-866-836-6678 (the statewide Area Agencies on Aging and Disability line) for service planning.1

How This Guide Is Organized

The thirteen central TennCare questions in Tennessee map to dedicated guides:

The sections below preview each guide and link to the full article. Read this overview first, then dive into the specific guide that matches your question.

1. Who Qualifies for TennCare?

The dedicated guide: TennCare Eligibility & Income Limits 2026

TennCare covers roughly 1.4 million Tennesseans across these eligibility categories:

• Children, children's Medicaid (CoverKids covers children up to higher income limits in a separate program)
• Pregnant women
• Parents and caretaker relatives
• SSI / Aged-Blind-Disabled (ABD) adults, automatic TennCare Medicaid for SSI recipients. Tennessee is a §1634 state, so anyone approved for SSI is enrolled with no separate state determination. The 2026 SSI Federal Benefit Rate is $994/month for an individual.9
• CHOICES Group 1, 2, 3, nursing facility / HCBS LTSS pathway with separate financial and clinical eligibility
• ECF CHOICES, Groups 4–7 covering I/DD populations
• Katie Beckett Parts A and C, children with severe disabilities under TCA §71-5-164
• Medicare Savings Programs (QMB / SLMB / QI), TennCare-administered programs covering Medicare premiums (and, for QMB, all Medicare cost-sharing) for low-income Medicare beneficiaries; 2026 income limits $1,350 / $1,616 / $1,816 single ($1,824 / $2,184 / $2,455 couple) plus a $20 disregard, $9,950 / $14,910 resource limit, auto-deemed Part D Extra Help10

TN does not cover most working-age, non-disabled adults; there is no ACA expansion population in TennCare. Tennesseans without Medicaid eligibility access subsidized private coverage through the ACA Marketplace at HealthCare.gov.1

LTSS financial eligibility (CHOICES Groups 1 and 2; Katie Beckett Part A; ECF CHOICES) uses an SSI-based income standard with a 300% Special Income Level cap of $2,982/month for a single applicant in 2026 (equal to 300% of the $994 SSI Federal Benefit Rate), plus a $2,000 individual and $3,000 couple asset cap. Tennessee is an income-cap state, so an applicant over the $2,982 limit cannot spend down and must establish a Qualified Income Trust (Miller Trust) to redirect the excess. Spousal impoverishment protections can shelter between $32,532 and $162,660 in countable resources for the community spouse and divert income up to a $4,066.50/month maximum maintenance allowance.11

Read the full guide: TennCare Eligibility & Income Limits 2026.

2. How Do I Apply for TennCare?

The dedicated guide: How to Apply for TennCare

Where you apply depends on which TennCare population you are applying under. The path below covers the most common LTSS route for an older adult or a person with a disability.

Read the full guide: How to Apply for TennCare.

3. Which MCO Should I Pick?

The dedicated guide: TennCare Managed Care Plans 2026

Three MCOs serve nearly all TennCare members statewide:

All three operate statewide. Network providers, prior authorization rules, and ancillary benefits (transportation, over-the-counter allowances, value-added benefits) vary modestly between MCOs, while pharmacy and dental are carved out statewide and are therefore not plan differentiators. CHOICES, ECF CHOICES, and Katie Beckett Part A members are mandatorily enrolled in one of these three plans, and the MCO's Care Coordinator (an RN or social worker) develops the person-centered support plan, authorizes service hours, and approves provider agencies. A fourth plan, TennCare Select, is a separate state self-insured plan that covers the same services for specific groups (children under 21 who are eligible for SSI, children in state custody, children under 21 in an institutional eligibility category, and enrollees living where MCO capacity is insufficient); it is not open to voluntary selection.14

Switching plans: a new member may change MCOs once within the first 90 calendar days from the date of the letter assigning the plan, provided another MCO in that member's Grand Division is currently permitted to take new enrollees. After that window, a change is allowed only during the annual change period, which runs in March for West Tennessee, May for Middle Tennessee, and July for East Tennessee, and only one change is permitted every 12 months. The exception is a Bureau-approved hardship reassignment, and hardship is narrow: TennCare's rule expressly says it is not a hardship that a member is unhappy with the plan or the PCP, or that the PCP has left the network and the member has refused the alternatives the MCO offered. For a CHOICES member there is a real LTSS path, though. If the member is assessed as needing a long-term care service the current MCO does not offer, the Bureau first works with that MCO to arrange it, and only if the MCO still cannot provide it does that count as a hardship reason to switch plans.15

Read the full guide: TennCare Managed Care Plans 2026.

4. How Does TennCare Cover Nursing Facility Care?

The dedicated guide: Tennessee Medicaid Long-Term Care & Nursing Home

TennCare covers nursing facility care primarily through CHOICES Group 1, the entitlement pathway for adults age 65+ or adults 21+ with a physical disability who meet Nursing Facility Level of Care (NF LOC). Group 1 has no waitlist; anyone clinically and financially eligible is enrolled.

Pre-Admission Evaluation (PAE) uses the Acuity Scale to determine NF LOC. The PAE captures activities of daily living (ADLs), instrumental activities of daily living (IADLs), behavioral and cognitive status, skilled nursing needs, and skilled rehabilitation needs.3

Private-pay nursing-home care in Tennessee runs a statewide median of $113,150/year for a semi-private room and $120,450/year for a private room (CareScout Cost of Care Survey 2025 state data tables, released March 2026). TennCare's average Medicaid nursing-facility reimbursement effective January 1, 2026 is $294.87/day ($107,627.55/year), below those private-pay medians, which is why Medicaid coverage matters so much for a long stay.16

Patient Liability (the share of monthly income the resident contributes to nursing facility cost) is calculated by subtracting allowable deductions from the resident's income: a Personal Needs Allowance of $70/month (effective 1/1/2025 under Public Chapter 986 of 2024, TCA § 71-5-147), health insurance premiums, the spousal impoverishment maintenance allowance, and any dependent maintenance allowance.17

Bed-hold policies apply when a resident is hospitalized or takes therapeutic leave, TennCare pays a reduced bed-hold rate for limited days to preserve the resident's room.

Read the full guide: Tennessee Medicaid Long-Term Care & Nursing Home.

5. What HCBS Programs Are Available in Tennessee?

The dedicated guide: Tennessee HCBS Waivers

TennCare delivers HCBS through several authorities:

The CHOICES Group 2 Individual Cost Neutrality Cap is $294.87/day = $107,627.55/year for 2026, per the TennCare cost-neutrality memo effective January 1, 2026. This is a distinct figure from the $295.87/day transfer-penalty divisor used for the 5-year lookback (a one-cent-apart pair that is easy to confuse).5

Read the full guide: Tennessee HCBS Waivers. Also see the CHOICES-specific deep-dive: TennCare CHOICES: The 2026 Guide.

6. What Is CHOICES Specifically?

The dedicated guide: TennCare CHOICES: The 2026 Guide

CHOICES is TennCare's umbrella long-term services and supports program. It operates under TennCare's §1115 demonstration authority, not a §1915(c) waiver, and is delivered through the state's managed care organizations. Three groups:4

Group 3's annual HCBS expenditure cap is $18,000, excluding minor home modifications. The 12,500 figure for Group 2 is an enrollment target rather than an absolute wall: TennCare's rule lets reserve capacity and specified exceptions admit an applicant even once the target is reached, and a qualified applicant who cannot be enrolled goes onto the Group 2 waiting list.4

Consumer Direction (CD) is available across all three groups: the recipient or their representative becomes the employer of record for the worker, and spouses, conservators, and holders of power of attorney are excluded from being the paid CD worker.4

The agency-employed family caregiver pathway (after PC 182 of 2025) is an alternative to Consumer Direction, in which the family member becomes a W-2 employee of a TennCare-contracted home care agency.8

Read the full guide: TennCare CHOICES: The 2026 Guide.

7. What Is ECF CHOICES Specifically?

The dedicated guide: Employment and Community First (ECF) CHOICES

ECF CHOICES is TennCare's HCBS program for people with intellectual or developmental disabilities. It operates under the §1115 demonstration with four groups (4–7) representing different I/DD populations and acuity levels.3

Application gateway: through the Department of Disability and Aging (DDA) rather than TennCare Connect.19

A Family Caregiver Stipend is available for the Group 4 (Essential Family Supports) population: a flat monthly cash benefit to the primary family caregiver, up to $500/month when the member is a child under 18 and up to $1,000/month when the member is 18 or older, paid by the member's TennCare MCO.20

Read the full guide: Employment and Community First (ECF) CHOICES.

8. What About My Child with Severe Disabilities?

The dedicated guide: Tennessee Katie Beckett: Parts A, B, C

Tennessee Katie Beckett is the pathway to Medicaid for children under 18 with significant disabilities or complex medical needs whose family income or assets would otherwise disqualify them. It operates under §1115 demonstration authority and TCA §71-5-164, not a §1915(c) waiver.2

Three components in 2026:

Part A's 300 slots are filled in numerical order by each child's level-of-care prioritization score, and a child who is medically eligible with no slot open stays on the Part A waiting list.3 Part B grew to 4,700 slots after budget-authority transfers in August 2023 and October 2024, and TennCare requires a family to apply for and be found eligible for Part B before the child is considered for Part A.21

Under Consumer Direction, a family member shall not be reimbursed for a service they would otherwise have provided without pay, spouses cannot be Consumer-Directed Workers, and persons residing with the child cannot deliver Supportive Home Care or hourly respite.3

The Freedom for Family Caregiving Act (PC 182 of 2025) opened a new pathway: a Katie Beckett family can now have a parent or other resident relative hired by a TennCare home health, private duty nursing, or home health aide provider agency to deliver authorized, medically necessary skilled care or hours above the parental floor.8

Read the full guide: Tennessee Katie Beckett: Parts A, B, C.

9. What Does TennCare Cover Overall?

The dedicated guide: TennCare Covered Services

TennCare covers the federal Medicaid benefit floor plus state-elected optional benefits:22

• Hospital inpatient and outpatient
• Physician and clinic services
• Prescription drugs through TennCare's single statewide pharmacy benefits manager and one program-wide Preferred Drug List
• Behavioral health and SUD services
• Maternity and newborn care
• Family planning
• Federally-qualified health center (FQHC) and rural health clinic (RHC) services
• Home health, private duty nursing, hospice (adult private duty nursing is limited to what is needed to support a ventilator or other life-sustaining medical technology, and home health is hour-capped)
• Long-term care via CHOICES, ECF CHOICES, Katie Beckett
• Non-emergency medical transportation (NEMT) through MCO subcontractors
• Vision services (for adults, limited to medical evaluation and management of eye conditions, plus the first pair of glasses or contacts after cataract surgery)
• Dental, comprehensive adult dental for members 21+ since January 1, 2023; comprehensive children's dental through CoverKids and EPSDT23

Note that CHOICES and ECF CHOICES benefits (nursing facility care and home and community based services) sit outside the standard adult benefit package, so personal care, adult day services, and home modifications require CHOICES or ECF CHOICES enrollment.22

Pharmacy is carved out of the health plans. TennCare runs prescription drugs through one statewide pharmacy benefits manager, OptumRx (TennCare's PBM since January 1, 2020), which publishes a single program-wide Preferred Drug List, so drug coverage does not vary by which MCO a member is enrolled in. Copays are $1.50 per generic and $3.00 per brand-name drug and apply only to adults on TennCare Medicaid who are not in a nursing home, an HCBS waiver, or an ICF-MR. The old five-prescriptions-per-month adult limit was eliminated effective July 1, 2025; the two-brand-name-per-month limit remains.24

Behavioral health and substance use care runs through the member's own MCO, the same plan that covers physical health, and members find behavioral health and substance use providers through that plan's provider directory. Buprenorphine treatment for opioid use disorder runs through the BESMART provider network. Crisis help is statewide and around the clock: call or text 988 and press 0 to reach a licensed counselor.25

Read the full guide: TennCare Covered Services.

10. Does TennCare Cover Dental Care?

The dedicated guide: TennCare Dental Coverage

Children: Comprehensive dental services as medically necessary until age 21, plus orthodontia only for a child diagnosed with a handicapping malocclusion, which TennCare rule 1200-13-14 defines as a malocclusion causing one of three documented conditions (a nutritional deficiency that does not respond to medical treatment, a speech pathology that does not respond to speech therapy, or laceration of soft tissue from a deep impinging overbite). Braces sought only to improve a child's smile are treated as cosmetic and are not paid for.23

One dental plan for everyone: Renaissance became TennCare's single statewide dental benefits manager on November 1, 2025, replacing DentaQuest. Because one manager runs dental for every member, dental is not a reason to pick one MCO over another. Members keep the same TennCare health plan ID card they already have, there is no separate dental card, and everyone uses the same statewide Renaissance network. Renaissance member services is 866-864-2526 (TTY 711), 7 a.m. to 5 p.m. Central. Confirm your dentist is in the Renaissance network before scheduling, because TennCare warns members may see changes in which dentists are in network.26

Adults (21+): Comprehensive adult dental, effective January 1, 2023. Covered categories include exams and diagnostic X-rays, preventive cleanings, fluoride treatment, fillings, endodontics (root canals), scaling and root planing, crowns, partial and complete dentures, extractions, and palliative treatment, at no cost to the member for all medically necessary covered benefits.23

Read the full guide: TennCare Dental Coverage.

11. What's the Difference Between Medicare and TennCare?

The dedicated guide: Medicare vs. TennCare

Medicare and TennCare are different programs with different eligibility, financing, coverage, and billing structures:

• Medicare is federal, age-based (65+) or disability-based (24-month waiting period), and runs through CMS. Parts A, B, C (Medicare Advantage), D (Rx).
• TennCare is state-administered Medicaid under §1115 demonstration authority, income-and-need-based, and runs through the TN Division of TennCare under F&A.
• Dual-eligibles are Tennesseans who have both Medicare and TennCare. Medicare pays first; TennCare covers Medicare cost-sharing (for QMB-level dual-eligibles) and benefits Medicare doesn't cover, especially LTSS.
• Medicare Savings Programs (QMB / SLMB / QI), TennCare-administered programs that pay Medicare premiums (Part B = $202.90/month in 2026) and, for QMB, all Medicare deductibles, coinsurance, and copays for low-income Medicare beneficiaries; QMB enrollees auto-deemed for Part D Extra Help; QMB billing prohibition under 42 USC § 1396a(n)(3)(B).10

Tennessee does offer integrated dual-eligible coverage through Medicaid-aligned Dual Eligible Special Needs Plans (D-SNPs). BlueCare Plus, BlueCross BlueShield of Tennessee’s D-SNP, holds both a Medicare contract and a contract with the Division of TennCare, so a single plan coordinates Medicare, TennCare, prescription drugs, and long-term care. TennCare lists three 2026 BlueCare Plus plans (BlueCare Plus, BlueCare Plus Choice, and BlueCare Plus Select) alongside UnitedHealthcare's Dual Complete plans and Wellpoint's Full Dual Advantage plans as the D-SNP options for dual-eligible members. Dual-eligibles who prefer can still keep Original Medicare alongside their TennCare coverage.27

Alignment is tightening, and there is a deadline. By January 1, 2027, a full-benefit dual eligible who wants to be in a D-SNP must get Medicare and Medicaid benefits from the same health plan. TennCare opened a special enrollment period running June 1, 2026 through October 31, 2026 so members can line the two up, and a D-SNP that still does not match the member's TennCare plan on December 31, 2026 results in disenrollment from the D-SNP back into Original Medicare.14

Read the full guide: Medicare vs. TennCare.

12. Will TennCare Take Mom's House?

The dedicated guides: TennCare Estate Recovery, and the consolidator that braids estate recovery, the home equity limit, the 5-year lookback, and what works in TN: How to Protect Your Home from Medicaid in Tennessee (2026).

TennCare estate recovery is among the most consumer-friendly in the South. Five framing facts:6

1. Probate-only recovery. TennCare recovers from the probate estate. Tenn. Code Ann. §71-5-116(d)(1) and the State Plan define the recoverable estate by reference to Tennessee probate law (T.C.A. Titles 30, 31, and 32) rather than by a flat federal rule, so what falls inside it is set by state law and by Tennessee courts. Tenancy by the entirety between spouses, joint tenancy with an express right of survivorship, and property in a properly funded living trust pass outside probate and are not reached.6
2. No TEFRA liens during the recipient's lifetime. Tennessee's State Plan answers the TEFRA-lien question with "Not applicable. Tennessee does not apply TEFRA liens," so no TEFRA lien attaches to the home while the recipient is alive. Read that as a disclaimer of TEFRA liens specifically rather than of every kind of lien: 42 U.S.C. §1396p(a)(1)(A) still permits a pre-death lien imposed by a court judgment on account of benefits incorrectly paid.
3. Only LTSS recipients age 55+ are subject to recovery. A deceased member is subject only if they received CHOICES Group 1, 2, or 3 long-term services at age 55 or older; non-LTSS Medicaid recipients are not subject to estate recovery in TN.
4. $10,000 cost-effectiveness threshold. All claims of $10,000 or below are deemed not cost-effective and released. Recovery is also waived when the cost of recovery plus higher-priority claims would exceed the recoverable estate.6
5. Survivor exemptions and undue hardship waivers. TennCare cannot recover while the member is survived by a spouse (any age), a child under 21, or a child of any age who is blind or disabled. Federal law frames this as a timing bar rather than permanent forgiveness: recovery may be made only after the surviving spouse has died, and only at a time when there is no surviving child under 21 and no surviving blind or disabled child. So the protection can lapse when the spouse dies or the child turns 21. An undue-hardship waiver is available where the recoverable property is the survivors' sole income-producing asset, such as a family farm or business.

Statutory authority: 42 USC §1396p(b) (federal floor) and Tenn. Code Ann. §71-5-116 (state implementation).6

Read the full guide: TennCare Estate Recovery. For federal context, the OBRA-93 mandate, hardship-waiver standards, and the cross-state planning toolkit, see Medicaid Estate Recovery Explained.

13. What Other TN Medicaid Programs Exist?

The dedicated guide: Tennessee Medicaid Programs Hub

The programs hub catalogs every TN Medicaid-related program in a single Programs at a Glance table:

1. CHOICES Groups 1, 2, 3, adults 65+ / 21+ disabled
2. ECF CHOICES Groups 4–7, I/DD population
3. Katie Beckett Parts A, B, C, severely disabled minors
4. §1915(c) DD Waivers, Self-Determination, Statewide, CAC
5. TennCare Standard / ABD, SSI-related adults
6. Medicare Savings Programs, QMB / SLMB / QI; 2026 limits $1,350 / $1,616 / $1,816 single ($1,824 / $2,184 / $2,455 couple); $9,950 / $14,910 resource limit; auto-deemed Part D Extra Help; federal QMB billing prohibition10
7. Money Follows the Person (MFP), institution-to-community transitions
8. OPTIONS for Community Living, TN state-funded HCBS through AAADs (NOT TennCare-funded)
9. PACE, integrated Medicare + Medicaid for adults 55+ meeting NF LOC; only one TN site (Ascension Living Alexian PACE in Hamilton County)18
10. CoverKids, separate CHIP program for higher-income children
11. State Veterans Homes (TN-funded), separate from TennCare nursing facility
12. TN Pharmacy Assistance Programs, limited assistance for non-TennCare seniors

Read the full guide: Tennessee Medicaid Programs Hub.

What Makes Tennessee Medicaid Different From Other State Programs

A few structural features distinguish TennCare from peer-state Medicaid programs:

• It's a Division of F&A, not a standalone department. TennCare sits inside the Tennessee Department of Finance and Administration, and Stephen Smith serves as Deputy Commissioner of the Division of TennCare and Director of TennCare. That structure shapes how Medicaid policy is budgeted and developed in the state's executive branch.1
• Tennessee has not adopted ACA Medicaid expansion. Adult coverage is limited to traditional categories (parents and caretaker relatives, pregnant women, SSI/ABD adults, and the CHOICES and Katie Beckett LTSS pathways), with no general working-age adult coverage; others use the ACA Marketplace at HealthCare.gov.1
• TennCare III is an unusually long §1115 demonstration. Approved effective January 8, 2021 and running through December 31, 2030, it uses an aggregate-cap financing model, a longer approval than the five-year cycle typical of peer states.2
• Estate recovery is notably family-protective. Probate-only recovery, no TEFRA liens during the recipient's lifetime, a $10,000 cost-effectiveness threshold, and survivor exemptions for a spouse, minor child, or disabled child together mean no TEFRA lien attaches to the home during life and recovery does not reach property that passes outside the probate estate. The survivor exemptions defer recovery rather than cancel it.6
• The DDA reorganization and PC 182 restructured LTSS. The Department of Disability and Aging launched July 1, 2024, merging the former DIDD with the Tennessee Commission on Aging and Disability under Commissioner Brad Turner, and it is now the intake gateway for ECF CHOICES, Katie Beckett, and the AAAD network. The Freedom for Family Caregiving Act (PC 182 of 2025) then opened TennCare's agency-employed pathway to spouses, parents, and co-resident relatives. Families navigating the system today should not rely on pre-2024 guidance.1

Deeper Tennessee Planning Guides

Several TennCare topics have their own dedicated deep-dive:

• Tennessee 5-Year Lookback and Penalty Divisor: Tennessee applies a 60-month lookback to asset transfers, and for applications dated on or after January 1, 2026 the transfer-penalty divisor is $295.87/day ($8,846.10/month) per TennCare ABD Manual 125.010. Note this is a distinct figure from the $294.87/day CHOICES cost-neutrality cap.5
• Tennessee Spousal Impoverishment Rules: a 2026 CSRA of $32,532 (minimum) to $162,660 (maximum) and a maximum maintenance allowance of $4,066.50/month, with the snapshot and income-diversion mechanics.28
• Tennessee PACE Program: the Program of All-Inclusive Care for the Elderly, available at TN's single site (Alexian PACE, Chattanooga), for adults 55+ meeting Nursing Facility Level of Care.18
• Tennessee Medicare Savings Programs: QMB, SLMB, and QI cover Medicare premiums (and, for QMB, all Medicare cost-sharing) for low-income Medicare beneficiaries; 2026 income limits are $1,350 / $1,616 / $1,816 for a single applicant.10
• How to Protect Your Home from Medicaid in Tennessee: the 2026 home equity limit ($752,000, the federal floor Tennessee elects), the 5-year lookback, probate-only estate recovery, and what works in TN (tenancy by the entirety, properly funded trusts) versus what does not (Tennessee does not recognize lady bird deeds, and TOD deeds for real estate were not enacted after HB 1793/SB 2029 was withdrawn on February 25, 2026).6

If TennCare Denies or Cuts Your Coverage

A denial is not the end of the road, and the deadline to challenge it is usually shorter than people expect.

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.29 A state must allow you a reasonable time to ask for that hearing, and federal rule caps that time at 90 days from the date the notice of action was mailed.30 The 90 days is the federal outer limit, not a floor you are guaranteed: many states set a shorter window, and a shorter state deadline is fully enforceable, so go by the date printed on your own notice of action.

There is a second, earlier deadline that matters more if you are already enrolled. If you request the hearing before the date the action takes effect, your benefits generally continue while the appeal is decided.31 Miss that earlier date and you may still appeal, but coverage can stop in the meantime.

So when an adverse notice arrives: find the effective date, request the hearing before it, and ask in writing that your benefits continue. See Tennessee Medicaid Appeals and Fair Hearings for how to file, what the hearing itself involves, and what happens after a decision.

Keeping TennCare Coverage Once You Have It

Coverage is not permanent once approved. Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

TennCare must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.32 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Tennessee may offer the same windows but is not required to, so ask TennCare what applies to you.32

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).32

Keep your mailing address current, open anything from TennCare, and return the form by the deadline printed on it. See Tennessee Medicaid Recertification and Renewal for the full cycle.

The Bottom Line: Five Things Every TN TennCare Family Should Know

1. TennCare is structurally distinct from most state Medicaid programs. It's a division of F&A rather than a freestanding department; it operates under an unusually long §1115 demonstration; and Tennessee has not adopted ACA Medicaid expansion. Don't rely on generic state-Medicaid guidance; TN-specific rules apply.1
2. Save 1-855-259-0701 (TennCare Connect) and 1-866-836-6678 (the statewide Area Agency on Aging and Disability line). TennCare Connect handles eligibility and applications; the AAADs provide local intake and service planning for older adults, and DDA handles ECF CHOICES and Katie Beckett intake. Most TN families will use both numbers during their first month navigating the system.1
3. CHOICES is your LTSS umbrella. Group 1 is nursing facility care (entitlement, no waitlist). Group 2 is HCBS (12,500-slot cap, waitlist when full). Group 3 is the At Risk demonstration. Each has different application paths, eligibility, and benefits, so identify which group your loved one fits before navigating.4
4. Estate recovery is often not the threat families fear. TN does not use TEFRA liens during the recipient's lifetime; recovery is probate-only; only LTSS recipients age 55+ are subject; and a $10,000 cost-effectiveness threshold releases most small estates. With tenancy by the entirety for married couples or a properly funded irrevocable trust, many TN families can limit or avoid recovery. Tennessee does not recognize lady bird deeds and has not enacted TOD deeds for real estate, so out-of-state templates may have no legal effect. See How to Protect Your Home from Medicaid in Tennessee.6
5. The Freedom for Family Caregiving Act (PC 182, 2025) changed the paid-caregiver landscape. If you previously could not be paid through TennCare Consumer Direction because of spousal or co-residence rules, you may now qualify through the agency-employed pathway. Talk to your MCO Care Coordinator or a TennCare-contracted home care agency about being hired as a W-2 employee.8

This pillar is the navigation map. The dedicated guides above are the deep dives; start with the one that matches your question.

Tennessee Medicaid FAQ

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Find personalized help with Tennessee Medicaid (TennCare) at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.