Tennessee Medicaid Programs for Seniors: A Complete Guide (2026)

Tennessee Medicaid for seniors runs under one program with a different name and many doors. TennCare is what Tennessee calls its Medicaid program, and it can feel less like a single program than a maze of acronyms. CHOICES, ECF CHOICES, Katie Beckett, QMB, SLMB, MFP: each one has its own income test, its own waitlist (or lack of one), and its own front door.

This guide is the map. It walks through every TennCare program that matters for older adults and people with disabilities in 2026: what each one pays for, who qualifies, how the financial rules work, and which door to knock on first.

Who Runs TennCare

TennCare is the Division of TennCare inside the Tennessee Department of Finance and Administration, not a freestanding cabinet department. Stephen Smith is the Director of TennCare and Deputy Commissioner of the Division of TennCare.5

For long-term services and supports, two other state agencies matter. Here is who owns which piece of the senior-care front door:5

TennCare itself operates under a federal Section 1115(a) demonstration, currently called TennCare III, that CMS approved on January 8, 2021 with an unusual 10-year approval running through December 31, 2030. That structure is why Tennessee's program differs from a standard Medicaid state plan: the state can cap enrollment in home- and community-based programs, charge premiums, and run capped, premium-bearing versions of pathways like Katie Beckett.1

Tennessee has not expanded coverage to low-income adults under the ACA. That means TennCare adult coverage runs through the traditional eligibility categories (parents and caretaker relatives, pregnant women, and the Aged, Blind & Disabled category, including the CHOICES and Katie Beckett long-term-care pathways), there is no general "low-income adult" pathway the way there is in expansion states.5

Tennessee Medicaid for Seniors: The Four TennCare Tracks

Most older Tennesseans (and most family caregivers researching options) will be looking at one of four tracks. The table below summarizes; the rest of this guide walks through each in detail.1,4,7

Tennessee Medicaid for Seniors: The 2026 Financial Eligibility Numbers

Every TennCare program has its own income and asset test, but most senior-focused pathways line up against one of three frameworks. All figures are for 2026 unless noted. The spousal resource figures are the federal minimum and maximum effective January 1, 2026; the community spouse's income floor is the allowance effective July 1, 2026 through June 30, 2027.

Three structural points worth understanding:

• Tennessee is an "income-cap" state for long-term-care Medicaid. If your gross monthly income exceeds the CHOICES limit ($2,982 in 2026), TennCare gives you the opportunity to redirect the excess through a Qualified Income Trust (QIT), Tennessee's version of what other states call a Miller Trust, and then tests your income eligibility again. The QIT must be funded each month. Income placed in a valid QIT is treated as unavailable, but the income you leave outside the trust must itself be at or below the $2,982 cap.2,3
• The ABD categories run on SSI rules. TennCare's Aged, Blind and Disabled manual builds its categories of eligibility around SSI: SSI recipients, plus Pickle Passalong, Disabled Adult Children, and Widow/Widower categories for people who lost or never received an SSI check. If you are over the SSI income standard and do not need long-term services and supports, ask TennCare Connect which category fits before assuming none does, and check the Medicare Savings Programs (if you have Medicare) and Marketplace coverage in the meantime.8
• The five-year look-back applies to LTSS pathways only. Applications for CHOICES or any nursing-facility Medicaid trigger a federal 60-month look-back on asset transfers under 42 U.S.C. § 1396p(c). Standard ABD Medicaid is not subject to the look-back. For applications dated on or after January 1, 2026 the Tennessee transfer-penalty divisor is $295.87/day ($8,846.10/month), the average daily cost of nursing facility care per the ABD Eligibility Policy Manual (Policy 125.010, manual dated January 5, 2026). Do not confuse it with the CHOICES cost-neutrality cap of $294.87/day, which is the average cost of Medicaid nursing-facility reimbursement and caps HCBS plan-of-care spending for Group 2 members.9

Spousal Protections

If one spouse needs CHOICES (for either nursing facility or HCBS placement) and the other stays in the community, federal spousal impoverishment rules apply (codified at 42 USC § 1396r-5; TennCare ABD Manual § 125.015):10

• Community Spouse Resource Allowance (CSRA): the at-home spouse keeps half of countable assets, up to a maximum of $162,660 in 2026. The minimum protected amount is $32,532.10
• Minimum Monthly Maintenance Needs Allowance (MMNA / MMMNA): the at-home spouse can receive income from the CHOICES spouse to bring monthly income up to a floor of $2,705.00 (the Standard Maintenance Amount effective July 1, 2026 through June 30, 2027) or as high as $4,066.50 (the maximum effective January 1, 2026) if shelter expenses justify it.10
• Home equity limit: the home is excluded when it is the principal place of residence of the applicant, their spouse, or dependent relatives, or where intent to return is established. But an institutional individual is ineligible for LTSS payments once home equity exceeds $752,000.2

For the full TN playbook, snapshot mechanics, the Income-First rule, TennCare's Single Fixed Annuity model, fair hearings, and four worked examples, see Tennessee Spousal Impoverishment Rules: 2026 CSRA, MMMNA, and the Community Spouse Toolkit.

Program-by-Program: How Each Track Works

1. Standard TennCare for Aged, Blind, and Disabled Adults

Standard TennCare is the "regular Medicaid" track for older adults and adults with disabilities who need acute care, doctor visits, hospital stays, prescriptions, behavioral health, but who do not require long-term services and supports.8

Tennessee is a §1634 state, which means Social Security, not TennCare, makes the Medicaid eligibility determination for SSI recipients. A Tennessee resident found eligible for SSI is automatically enrolled in TennCare Medicaid with no independent state evaluation of income and resources, and also gets automatic buy-in for Medicare Parts A and B. When SSI payments end, TennCare reviews the enrollee for eligibility in every other category before terminating coverage, and the ABD Manual carries several SSI-related categories for people not currently receiving an SSI check:

• Pickle Passalong (policy 115.020), for people who would still be SSI-eligible if Social Security cost-of-living increases were disregarded.
• Disabled Adult Children (115.010), for people who lost SSI because of entitlement to, or an increase in, a Disabled Adult Child Social Security benefit.
• Widow/Widower Categories (115.030), for certain widows and widowers who would be SSI-eligible if their Social Security widow/widower benefit were disregarded.

Standard TennCare covers the usual suite of acute care benefits: hospital, physician, prescription, behavioral health, transportation. Two coverage notes worth flagging:

• Adult dental coverage launched January 1, 2023 for members 21 and older: exams and x-rays, cleanings, fillings, endodontics (root canals), crowns, extractions, and partial or complete dentures, at no cost to the member when medically necessary. Renaissance became the Dental Benefits Manager on November 1, 2025, and it is the single statewide DBM, so dental does not vary by MCO. Members reach Renaissance at 866-864-2526.11,12
• Adult vision is narrow, not absent. For an adult 21 or older, TennCare covers medical evaluation and management of abnormal conditions and disorders of the eye, plus the first pair of cataract glasses or contact lenses following cataract surgery. Routine eye exams and everyday glasses sit outside that benefit.13

Standard TennCare benefits are delivered through the member's MCO (see below), so which plan you are in determines your provider network.

2. TennCare CHOICES, Long-Term Services and Supports

CHOICES is TennCare's program for adults age 65+ and adults 21+ with a physical disability who need long-term services and supports. It is structured into three groups:6

• Group 1, Nursing Facility care. Entitlement, no waitlist. Anyone who is clinically and financially eligible is enrolled.
• Group 2, HCBS in lieu of nursing facility. Same level of care threshold, but services delivered at home or in the community. Capped enrollment with a waiting list. The rule sets the Group 2 Enrollment Target, the maximum number of people who can be enrolled at any given time, at 12,500 (effective July 1, 2012). Once it is reached, qualified applicants go on the Group 2 waiting list, though Reserve Capacity and the rule's specified exceptions can still permit enrollment at target. Group 2 spending is also bounded by an Individual Cost Neutrality Cap of $294.87/day ($107,627.55/year) for 2026: if a member's care can reasonably be expected to exceed it, they do not qualify to enroll in or stay in Group 2.6,14
• Group 3, "At Risk of Nursing Facility Placement." A demonstration population for adults who do not yet meet nursing-facility level of care but would absent intervention. Reopened October 1, 2022 with an enrollment target of 1,750 for non-SSI recipients. Group 3 carries a much lower annual HCBS expenditure cap of $18,000, excluding minor home modifications.6,14

Functional eligibility for CHOICES uses the Pre-Admission Evaluation (PAE), a 0-to-26-point acuity scale where a score of 9 or higher generally qualifies for nursing-facility level of care.4

For the full walk-through of how CHOICES groups work, the application process, services covered, and what to do if you're stuck on the Group 2 waitlist, see our dedicated guide: TennCare CHOICES Explained.

3. ECF CHOICES, Employment and Community First for I/DD

ECF CHOICES is TennCare's program for children and adults with intellectual or developmental disabilities (I/DD). It serves a different population than CHOICES, younger, with cognitive rather than physical care needs, and it operates with an employment-first philosophy, prioritizing competitive integrated employment, community living, and independent skill-building over institutional care.

ECF CHOICES is structured into five groups (4 through 8) based on age and the level of care a member needs.4,1 Group 4 (Essential Family Supports) covers people with I/DD who live at home with family, both children under 21 and adults 21 or older who elect that group, with an expenditure cap of $18,000 per person per calendar year (minor home modifications do not count against it).4

Group 4 also carries a Family Caregiver Stipend paid by the member's MCO to the primary family caregiver: up to $500/month when the member is a child under age 18, and up to $1,000/month when the member is age 18 or older. The actual amount is set based on the individual's needs, it is a flat sum rather than an hourly wage, and it may not duplicate paid Consumer Direction hours or paid agency services for the same time period. A member cannot enroll in Group 4 for the stipend alone: other ECF CHOICES supports must be received first, and employment and community-integration goals must be addressed before the stipend is considered.15

Like CHOICES Group 2, ECF CHOICES has limited annual funding, so not everyone who applies and qualifies can enroll right away. A qualified applicant who cannot be enrolled immediately goes on a referral list, and enrollment then follows priority groups and the availability of slot openings; an applicant may also enroll against an available reserve-capacity slot.1

There are three ways to apply, and all of them are self-referrals. Anyone can complete the online self-referral form at perlss.tenncare.tn.gov/externalreferral. If the applicant already has TennCare, they can call their assigned managed care health plan and ask for help with a self-referral. If the applicant does not have TennCare, they can call the DDA regional office and ask for help with both the self-referral and Medicaid enrollment.16

For the full ECF CHOICES walk-through, group-by-group eligibility, the Referral List process, the Family Caregiver Stipend, and the employment-first service array, see our guide: ECF CHOICES Explained.

4. Katie Beckett, Children Under 18 with Complex Needs

Katie Beckett is Tennessee's program for children under age 18 with disabilities or complex medical needs who are not Medicaid eligible because of their parents' income or assets. Tennessee enacted it through Public Chapter 494 of 2019 (HB 498 / SB 476, effective May 24, 2019; codified at Tenn. Code Ann. §71-5-164), and applications opened in late November 2020.1

The program has three Parts:

• Part A, full TennCare Medicaid (home health, private duty nursing, durable medical equipment, therapies) plus up to $15,000/year in HCBS wraparound services such as respite, supportive home care, and home and vehicle modifications. Capped at 300 children statewide, with 25 slots reserved for the most-medically-complex (Tier 1) cases. Children are enrolled from an acuity-prioritized waiting list, in order of their level-of-care score.4
• Part B, the "Medicaid Diversion" group for children at risk of institutional care: up to $10,000/year in flexible services, but the child is not enrolled in Medicaid. Dollars can go toward insurance premium assistance, a health-care reimbursement account for IRS-qualified expenses, respite and supportive home care, or community-based provider services. The cap has been expanded to 4,700 slots, up from 2,700; end-of-2024 enrollment stood at 4,188 children.7
• Part C, the Continued Eligibility group for children moving between Parts.1

Critical eligibility note: Part A grants full Medicaid eligibility by waiving the deeming of the parents' income and assets to the child, so the child's own income and resources are what count. Part A families with income above 150% of the Federal Poverty Level owe a premium, calculated on a sliding scale by monthly income and household size. Applicants must apply for and be found eligible for Part B before Part A can be considered.4

For the full walk-through of Parts A, B, and C; the eligibility criteria; the application sequence; and the family caregiver paid-pathway under Public Chapter 182 of 2025, see our guide: Katie Beckett Explained.

5. Medicare Savings Programs

For Tennesseans who have Medicare and limited income, TennCare administers three Medicare Savings Programs (MSPs) that help pay Medicare premiums and cost-sharing under federal authority at 42 USC § 1396a(a)(10)(E) and § 1396d(p). These are not full TennCare Medicaid, they're targeted Medicare premium-and-deductible assistance funded through Medicaid using SSI-related ABD income methodology (not MAGI).17

• QMB (Qualified Medicare Beneficiary), income at or below 100% of the Federal Poverty Level plus a $20 disregard ($1,350/month individual / $1,824/month couple in 2026). Pays Medicare Part A and Part B premiums (Part B = $202.90/month in 2026) and the Medicare Part A and Part B deductibles, coinsurance, and copayments. That is the boundary of the protection, and it is worth reading precisely: what QMB covers is Medicare Part A and Part B cost sharing. Federal law prohibits all Original Medicare and Medicare Advantage providers and suppliers, not only those that accept Medicaid, from billing a QMB for Part A and Part B cost sharing, which makes it the most comprehensive MSP. Filing a Medicare Part D Low-Income Subsidy ("Extra Help") application with Social Security also initiates an MSP application.17
• SLMB (Specified Low-Income Medicare Beneficiary), income between 100% and 120% of the Federal Poverty Level plus the $20 disregard ($1,616/month individual / $2,184/month couple). Pays the Medicare Part B premium only, a savings of $2,434.80/year in 2026.17
• QI (Qualifying Individual), income between 120% and 135% of the Federal Poverty Level plus the $20 disregard ($1,816/month individual / $2,455/month couple). Pays the Part B premium only, funded by a capped annual federal allotment to the state, so states approve applications first-come, first-served with priority to people who got QI benefits the previous year, and you must apply every year to stay in it. TennCare requires that a QI applicant not be enrolled in TennCare Medicaid or TennCare Standard, so CHOICES dual-eligibles cannot get QI but may qualify as full-benefit QMB Plus or SLMB-Plus.17

Resource limits for all three MSPs in 2026 are $9,950 individual / $14,910 couple, the federal standards Tennessee's own manuals state. Social Security notes that states can effectively raise the federal limits by disregarding certain income and resources, so ask TennCare how your specific resources are counted. Apply through TennCare Connect at tenncareconnect.tn.gov or 1-855-259-0701; the Social Security Administration also accepts MSP applications via Form SSA-1020 and refers them to TennCare automatically.17

A senior who qualifies for both full TennCare (through CHOICES, for example) and an MSP becomes a "full-benefit dual eligible", sometimes called "QMB Plus" or "SLMB Plus", and gets both the MSP cost-sharing protection and the full TennCare benefit package. This is the most generous coverage combination in the system.

For the full deep-dive on all three MSPs, including the dual-eligible category matrix, the Part B Special Enrollment Period, retroactive coverage rules, worked household examples, and common application mistakes, see: Tennessee Medicare Savings Programs (QMB / SLMB / QI): The Complete 2026 Guide.

The Three TennCare MCOs

Every TennCare adult, whether in Standard Medicaid, CHOICES, or ECF CHOICES, is enrolled in one of three MCOs as of 2026, with TennCare Select covering certain special populations:4,5

For LTSS members, the MCO assigns a Care Coordinator or Support Coordinator, and TennCare directs members with a service question to contact that coordinator first. If a CHOICES Group 2 or 3 or ECF CHOICES member moves between MCOs, TennCare policy CON 19-001 requires the receiving MCO to continue HCBS for at least 30 days, and it may not reduce those services until it has conducted a comprehensive needs assessment, developed a plan of care or person-centered support plan, and authorized and initiated services under that new plan.4

If you encounter a 2024-or-earlier source that mentions "Amerigroup Tennessee," it's the same plan that's now called Wellpoint.

How to Apply

Tennessee uses a single application portal, TennCare Connect, for almost every Medicaid pathway. Where you apply depends on what you need:

A few common-trap notes:

• A CHOICES application is not just a TennCare Connect form. Medical eligibility for CHOICES Groups 1 and 2 is decided by a clinical Pre-Admission Evaluation (PAE), the Bureau's assessment of nursing-facility level of care.4 The AAADs are the local intake point for older adults and adults with physical disabilities, so start with your AAAD if you're at home, or with the hospital social worker if a discharge is in progress.5
• ECF CHOICES has three doors, and one of them is online. Anyone can file the self-referral at perlss.tenncare.tn.gov/externalreferral. If the applicant already has TennCare, their assigned health plan can help with the self-referral; if they do not, the DDA regional office can help with both the referral and Medicaid enrollment.16
• Katie Beckett splits between two agencies. The application starts as a self-referral online at TennCare Connect, then runs on two tracks that begin together: DDA handles medical eligibility (making the Part B level-of-care call and referring Part A cases to Ascend), TennCare handles financial eligibility. The financial side cannot finish until the medical determination is done.4
• Apply for Part B before Part A on Katie Beckett. TennCare requires this sequence; trying to apply for Part A first delays the process.4

A Word on Paid Family Caregiving

Tennessee made a significant policy change in 2025 that affects every TennCare LTSS program. Public Chapter 182 of 2025, the Freedom for Family Caregiving Act (SB 1178 / HB 712), was signed by Governor Bill Lee on April 30, 2025 and took effect July 1, 2025. It prohibits TennCare and DDA from blocking a provider agency from hiring a relative as a paid Direct Support Worker based solely on the family relationship, a shared residence, the recipient's age, parental or spousal status, or which TennCare program the recipient is in. The route it opens is the agency-employed one: a TennCare-contracted home care agency may hire the family member as a W-2 employee to deliver the recipient's authorized care hours.18

Read the two limits before you plan around it. Court-appointed conservators and legal guardians remain excluded unless a court order explicitly permits employment, and agencies are not required to hire any specific family member, so access still depends on finding a willing agency. PC 182 also did not change TennCare's Consumer Direction (CD) rules: CD still bars spouses, conservators, and powers of attorney from being the paid worker. What PC 182 created is a parallel agency-employment route for relationships CD bars, not an entitlement to be hired.18

For the full landscape of paid family caregiver pathways in Tennessee, including Consumer Direction, the agency-employed PC 182 route, ECF CHOICES Family Caregiver Stipends, VA programs, and personal services contracts, see our guide: How to Get Paid as a Family Caregiver in Tennessee.

What TennCare Has Been Doing Differently

Two trends are worth knowing about because they affect what's available to families today:

• HCBS rebalancing. Tennessee has been shifting long-term care toward home and community based services, and CHOICES and the Money Follows the Person (MFP) program are the main vehicles: a person who transitions under MFP does so into CHOICES, ECF CHOICES, or other waiver HCBS, so MFP funds the move while CHOICES provides the ongoing services. In July 2025 TennCare's Long-Term Services and Supports division launched an initiative to invest $50 million in its HCBS provider network over five years to expand community-based capacity. The practical takeaway: more home-based capacity is being built, but provider shortages still drive the Group 2 waiting list.19
• The 10-year demonstration extension. TennCare III's January 8, 2021 approval through December 31, 2030 gives Tennessee an unusually long planning horizon. CMS said the longer approval period lets the state test its financing approach and reduces the administrative burden of renewing the demonstration more frequently, so the policy environment is more stable than in most Medicaid states.1

Where to Go Next

The right next step depends on where you are in the journey. A few starting points:

• Trying to figure out if you can get paid to care for a family member? → How to Get Paid as a Family Caregiver in Tennessee
• Need long-term care for a parent or yourself (age 65+)? → TennCare CHOICES Explained
• Caring for a child or adult with intellectual/developmental disabilities? → ECF CHOICES Explained
• Have a child under 18 with a disability or complex medical needs? → Katie Beckett Explained
• Need help understanding terms like spend-down, NFLOC, or QIT? → Browse our glossary

Learn More

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.