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 adult coverage is limited to traditional Medicaid categories and the long-term services and supports (LTSS) pathways this guide is built around. The 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 page maps every TennCare older-adult and disability question to the guide that answers it. The number to save now is TennCare Connect, 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 for 2026, per a TennCare LTSS memo dated December 18, 2025.5
• ECF CHOICES is TN's I/DD HCBS program, five groups numbered 4 through 8, covering different I/DD populations and acuity levels, each with its own annual per-member expenditure cap. 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).3
• TennCare Estate Recovery is among the most consumer-friendly in the South: recovery only from the estate as Tennessee probate law defines it, 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 through 8 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), which pay Medicare premiums and, for QMB, all Medicare cost-sharing. 2026 income limits are $1,350 / $1,616 / $1,816 single ($1,824 / $2,184 / $2,455 couple) including the $20 disregard, with a $9,950 / $14,910 resource limit and auto-deemed Part D Extra Help. This is a separate route from full TennCare, so a Medicare beneficiary who does not qualify as Aged, Blind and Disabled may still qualify for help with Medicare's own costs.10,1

TN does not cover most working-age, non-disabled adults. Tennesseans without Medicaid eligibility buy subsidized coverage on 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. That cap counts only countable resources: TennCare's ABD manual excludes the home, so long as it is the principal residence of the applicant, spouse or dependent relatives and, for someone already in a long-term-care facility, intent to return is established. It also excludes one vehicle of any value used for transportation, and staff are told to assume a vehicle is used for transportation absent evidence otherwise, so do not read $2,000 as a limit on everything a family owns. 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.11,9

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.

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 and all three have passed NCQA accreditation. Networks, prior authorization rules, and ancillary benefits vary modestly, while pharmacy and dental are carved out statewide and are 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 develops the person-centered support plan, authorizes service hours, and approves provider agencies. A fourth plan, TennCare Select, is a state self-insured plan for specific groups (children under 21 eligible for SSI, children in state custody, children under 21 in an institutional category, and enrollees 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, the routine route is the annual change period, which runs in March for West Tennessee, May for Middle Tennessee, and July for East Tennessee, with only one change every 12 months. It is not the only route out: you must change MCOs if you move outside your plan's Grand Division and it is not authorized there, and if your MCO withdraws from TennCare you are assigned another and get 90 days to pick a different one. A change made during an annual change period sweeps in every household member enrolled in TennCare except children in TennCare Select, and an ECF CHOICES member may choose only from the MCOs participating in ECF CHOICES. The other 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, that the PCP has left the network and the member refused the alternatives offered, or that the member is a Medicare beneficiary who may use out-of-network providers anyway. For a CHOICES member there is a real LTSS path: if the member needs a long-term care service the current MCO does not offer, the Bureau first works with that MCO to arrange it, and only if it still cannot does that count as a hardship reason to switch. A denial of a switch request carries its own notice and appeal rights.15

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 semi-private and $120,450/year private (CareScout Cost of Care Survey 2025 state data tables, released March 2026). Read those as medians, not as a price: CareScout collects rates by metro area and says actual costs vary with the person's needs, provider availability, and the local market, so price the specific facility rather than budgeting the statewide number. TennCare's average Medicaid nursing-facility reimbursement effective January 1, 2026 is $294.87/day ($107,627.55/year), below both medians, which is why Medicaid coverage matters so much for a long stay.16

Patient Liability, the share of monthly income the resident pays the facility, is what remains after allowable deductions: a Personal Needs Allowance of $70/month (set by statute for income available on or after January 1, 2025, 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 rate for limited days to hold the room.

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 a TennCare LTSS memo dated December 18, 2025. 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 is an enrollment target, not an absolute wall, and a family told the program is closed has rules to cite. The approved TennCare III terms set out three exceptions in the same paragraph: the state may reserve slots for people being discharged from a nursing facility, or from an acute-care setting at imminent risk of nursing-facility placement; an MCO may at its own discretion offer HCBS as a cost-effective alternative to a member who meets the Group 2 criteria but cannot be enrolled, and serve them outside the target until a slot opens; and a CHOICES Group 1 enrollee who meets the Group 2 requirements can move into Group 2 at any time, target reached or not. Only when none of those applies does a qualified applicant go onto the Group 2 waiting list, and both a capacity denial and a reserve-capacity denial carry notice and the right to request a fair hearing.4,2

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.3

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

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 five groups, numbered 4 through 8, representing different I/DD populations and acuity levels. Each group carries its own annual per-member expenditure cap, and the state may adjust the Group 4, 5 and 6 caps over the life of the demonstration, so confirm the figure applied to your own plan of care with your support coordinator.3

Application gateway: through the Department of Disability and Aging (DDA) rather than TennCare Connect.4

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.3

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.3

Three components in 2026:

Part A is capped at 300 enrolled children and has a waiting list; under the TennCare III Special Terms and Conditions that list must be run statewide with a standardized assessment tool and objective criteria applied consistently in every region. In 2024 the slots reserved for Tier 1 (most-complex) children were cut from 50 to 25 to let more Tier 2 children enroll.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. Part B dollars do not roll over: unspent funds cannot be carried into the next plan year.3

Two deadlines can cost a family the program. If financial eligibility is approved and a premium applies, which the TennCare III terms condition on family income above 150% of the FPL, it must be paid within 60 days or Part A enrollment is denied and the child is enrolled in Part B if a slot was available at referral. And if Part A level of care is denied, there are 30 days from the date of the notice to appeal.3

Under Consumer Direction a member may hire people close to them, family members included, but not a spouse. On the agency-employed side, PC 182 puts limits on the agency rather than the family: an agency may not impose extra hiring restrictions solely because of a family relation, where the caregiver or the member lives, the member's age, a parental or spousal relationship, or which waiver program the member is in.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

9. What Does TennCare Cover Overall?

The dedicated guide: TennCare Covered Services

TennCare covers the federal Medicaid benefit floor plus state-elected optional benefits:19

• 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; adult home health nursing is capped at 8 hours a day and 27 hours a week, or 30 hours a week for someone who qualifies for Level 2 Nursing Facility care)
• 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 EPSDT20

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.19

Pharmacy is carved out of the health plans. TennCare runs drugs through one statewide PBM, OptumRx, on a single program-wide Preferred Drug List, so drug coverage does not vary by MCO. Copays are $1.50 generic and $3.00 brand-name, and apply only to TennCare Medicaid adults not in a nursing home, an HCBS waiver, or an ICF-MR. The five-prescriptions-per-month adult limit ended July 1, 2025; the two-brand-name limit remains, though drugs on TennCare's Auto-Exempt and Attestation List do not count toward it.21,19

Behavioral health and substance use care runs through the member's own MCO, the same plan that covers physical health, so use that plan's provider directory. Buprenorphine treatment for opioid use disorder runs through the BESMART network. Crisis help is statewide and around the clock: call or text 988 and press 0 for a licensed counselor.22

10. Does TennCare Cover Dental Care?

The dedicated guide: TennCare Dental Coverage

Children: comprehensive dental as medically necessary until age 21, plus orthodontia only for a handicapping malocclusion, which TennCare rule 1200-13-14 defines as one causing a nutritional deficiency unresponsive to medical treatment, a speech pathology unresponsive to speech therapy, or laceration of soft tissue from a deep impinging overbite. Braces sought only to improve a smile are cosmetic and not paid for.20

One dental plan for everyone: Renaissance became TennCare's single statewide dental benefits manager on November 1, 2025, replacing DentaQuest, so dental is not a reason to pick one MCO over another. There is no separate dental card. Renaissance member services is 866-864-2526 (TTY 711), 7 a.m. to 5 p.m. Central. Confirm your dentist is in network before scheduling, because TennCare warns members may see changes.23

Adults (21+): Comprehensive adult dental, effective January 1, 2023, at no cost to the member for all medically necessary covered benefits. Covered categories include exams and X-rays, cleanings, fluoride, fillings, root canals, scaling and root planing, crowns, dentures, extractions, and palliative treatment.20

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) pay Medicare premiums (Part B is $202.90/month in 2026) and, for QMB, all deductibles, coinsurance and copays; QMB enrollees are auto-deemed for Part D Extra Help and providers may not balance-bill them, 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 TennCare contract, so one plan coordinates Medicare, TennCare, drugs, and long-term care. BlueCare Plus is not the only D-SNP in Tennessee. TennCare's 2026 D-SNP resource table lists thirteen plans from six carriers: three BlueCare Plus plans (BlueCare Plus, Choice, and Select), UnitedHealthcare's three Dual Complete plans, Wellpoint's three Full Dual Advantage plans, two Humana Gold Plus SNP-DE plans, HealthSpring's TotalCare Plus, and Wellcare Dual Access. That table is where a dual-eligible should compare them. A dual-eligible who prefers can still keep Original Medicare alongside TennCare.24

Alignment is tightening, and there is a deadline. By January 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. 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, with a Part D drug plan then to be selected. There are two ways to make them match, not one: change the TennCare plan, for which TennCare opened a special enrollment period running June 1, 2026 through October 31, 2026, or change the D-SNP, for which a dual eligible has a monthly special enrollment period to move into a fully integrated dual special needs plan and can also switch during Medicare's annual enrollment period, October 15 to December 7.14

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. Recovery runs through the probate estate. Tenn. Code Ann. §71-5-116(d)(1) and the State Plan define the recoverable estate as everything owned at the moment before death, as limited or expanded by Tennessee probate law (T.C.A. Titles 30, 31, and 32) and by Tennessee courts. That is not a flat probate-only rule handed down by the State Plan itself, so whether a particular asset is reachable is a question of Tennessee law and worth asking a Tennessee attorney rather than assuming.6
2. No TEFRA liens during the recipient's lifetime. Tennessee's State Plan answers the question with "Not applicable. Tennessee does not apply TEFRA liens." Read that as a disclaimer of TEFRA liens specifically, not of every lien: 42 U.S.C. §1396p(a)(1)(A) still permits a pre-death lien imposed by court judgment on account of benefits incorrectly paid.
3. Only LTSS recipients age 55+ are subject. A deceased member is reachable only if they received CHOICES Group 1, 2, or 3 long-term services at 55 or older; non-LTSS Medicaid recipients are not.
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. Undue hardship comes in three forms, not one. The first is that the property is the survivors' sole income-producing asset, such as a family farm or business, with no value limit, and TennCare says it acts as a waiver. The other two are caregiver grounds: a sibling who lawfully lived in the home for the year before admission, provided care that kept the member out of an institution, and has lived there continuously since; and a son or daughter who meets the same three tests over two years. Those two only defer recovery while the caregiver stays. TennCare states the hardship "no longer applies when the caretaker moves out of the property, sells the property, or passes away," so claim it while still living there.

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 4–8, 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

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, run by Deputy Commissioner and Director Stephen Smith. That shapes how Medicaid policy gets budgeted in the state's executive branch.1
• TennCare III is an unusually long §1115 demonstration, approved January 8, 2021 and running through December 31, 2030 on an aggregate-cap financing model, well past the five-year cycle typical of peer states.2
• The DDA reorganization and PC 182 restructured LTSS. The Department of Disability and Aging launched July 1, 2024, merging DIDD with the Commission on Aging and Disability under Commissioner Brad Turner, and is now the intake gateway for ECF CHOICES, Katie Beckett, and the nine regional AAADs. PC 182 of 2025 then opened the agency-employed pathway to spouses, parents, and co-resident relatives. Do 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. The manual is blunt about the penalty: there is no limit on the maximum months of ineligibility, and once a penalty period begins it runs uninterrupted even if the person stops receiving institutional-level care. Six categories of transfer are exempt from it, among them a transfer to a spouse and a transfer to a blind or disabled child.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. The bounds that apply are the ones for the year of the snapshot date, not the year you apply, so a 2025 snapshot is still measured against the 2025 pair.25
• Tennessee PACE Program: at TN's single site (Alexian PACE, Chattanooga), for adults 55+ meeting Nursing Facility Level of Care.18
• Tennessee Medicare Savings Programs: 2026 income limits of $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 rather than the $1,130,000 ceiling), the 60-month lookback and the $295.87/day divisor, the homestead exclusion and how it survives renting the house out, and the life-estate math. The equity limit is not a wall: it does not disqualify an applicant while a spouse, a child under 21, or a blind or disabled child lawfully resides in the home. On transfer-on-death deeds, HB 1793, the Tennessee Uniform Real Property Transfer on Death Act, is recorded on the General Assembly's bill tracker as "Sponsor(s) Withdrawn. 02/25/2026," so it did not pass that session.6

If TennCare Denies or Cuts Your Coverage

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

Federal law gives Medicaid applicants and beneficiaries the right to a fair hearing before the state agency, whether the dispute is about eligibility or a specific service being reduced or ended, and it reaches further than most families realize: a nursing facility resident who believes the facility has wrongly decided they must be transferred or discharged holds that same right. It is not unconditional. The agency need not grant a hearing when the sole issue is a federal or state law requiring an automatic change that hits some or all beneficiaries.26 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.27 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.28 Miss that earlier date and you may still appeal; coverage can stop in the meantime, but a request made no more than 10 days after the date of action lets the agency reinstate your services under a separate federal rule, 42 CFR 431.231.28

One more trap, and it costs the appeal. A denial, reduction, or termination of services is an Adverse Benefit Determination, and TennCare says it is not what the complaint and grievance process is for: file the appeal, not a grievance. An LTSS member who wants help outside their own plan has routes that do not run back through it, including TennCare's Beneficiary Support System at Disability Rights Tennessee, (888) 723-8193, and the Long-Term Care or Community Living Supports Ombudsman at (866) 836-6678.3

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 involves, and what happens after a decision.

Keeping TennCare Coverage Once You Have It

Coverage is not permanent. Eligibility is re-checked on a 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 what it already holds, and may request documents only if it cannot.29 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form. That duty, and the 90-day reconsideration 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 need not, so ask what applies to you.29

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).29

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. A division of F&A rather than a freestanding department, under an unusually long §1115 demonstration, in a state that never adopted ACA expansion. Generic state-Medicaid guidance will mislead you here.1
2. Save 1-855-259-0701 (TennCare Connect) and 1-866-836-6678 (the statewide AAAD line). TennCare Connect handles eligibility and applications; the AAADs handle local intake and service planning for older adults; DDA handles ECF CHOICES and Katie Beckett intake. Most families use both numbers in their first month.1
3. CHOICES is your LTSS umbrella. Group 1 is nursing facility care (entitlement, no waitlist), Group 2 is HCBS (12,500-slot target, waitlist when full), Group 3 is the At Risk demonstration. Identify the group before you navigate.4
4. Estate recovery is often not the threat families fear. TN does not use TEFRA liens during the recipient's lifetime; recovery runs through the probate estate as Tennessee law defines it; only LTSS recipients age 55+ are subject; and a $10,000 cost-effectiveness threshold releases most small estates.6 HB 1793, the bill that would have created a Tennessee transfer-on-death deed for real estate, was withdrawn on February 25, 2026, so check with a Tennessee attorney before relying on an out-of-state TOD template. 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 spousal or co-residence rules once blocked you from being paid through Consumer Direction, the agency-employed pathway may now work. Ask your MCO Care Coordinator or a TennCare-contracted home care agency about being hired as a W-2 employee.8

Start with the dedicated guide 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.