Tennessee Medicaid Programs for Seniors: A 2026 Guide

For a senior or family member trying to figure out where to start, TennCare, Tennessee's Medicaid program, can feel less like a single program and more like 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 a division of the Tennessee Department of Finance and Administration, not a freestanding cabinet department. The Director of TennCare, Stephen Smith, has held the role since March 2020 and serves jointly as Deputy Commissioner of F&A. TennCare's main office is at 310 Great Circle Road, Nashville.

For long-term services and supports, two other state agencies matter:

• The Department of Disability and Aging (DDA), launched July 1, 2024 from the merger of the Department of Intellectual and Developmental Disabilities (DIDD) and the Tennessee Commission on Aging and Disability (TCAD). Commissioner Brad Turner leads it. DDA is the application gateway for Katie Beckett, ECF CHOICES, and (through the AAAD network) older adults seeking CHOICES referrals.
• The 9 Area Agencies on Aging and Disability (AAADs), regional bodies that cover all 95 Tennessee counties and serve as the local intake point for adults 65+ exploring CHOICES, OPTIONS for Community Living, and other senior services. The statewide AAAD line is 1-866-836-6678.

TennCare itself operates under a federal Section 1115(a) demonstration, currently called TennCare III, that CMS approved on January 8, 2021 with an unprecedented 10-year approval running through December 31, 2030. This matters because it means Tennessee's program is structurally different from a "standard" Medicaid state plan: the state has more flexibility to cap enrollment in HCBS programs, charge premiums, and design pathways like Katie Beckett that other states cannot legally offer the same way.

Tennessee remained one of 10 states still NOT participating in ACA Medicaid expansion in 2026. That means TennCare adult coverage is limited to traditional Medicaid eligibility categories, there is no general "low-income adult" pathway the way there is in expansion states.

The Four TennCare Tracks for Seniors and Families

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.

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; spousal protection figures use the July 1, 2025–June 30, 2026 federal allowances.

Three structural points worth understanding:

• Tennessee is an "income-cap" state. If your monthly income exceeds the CHOICES limit ($2,982 in 2026), you cannot simply spend down excess income on medical bills the way you can in Michigan or other medically needy states. Instead, you redirect excess income through a Qualified Income Trust (QIT), Tennessee's version of what other states call a Miller Trust. The QIT must be funded each month, and the income that flows through it does not count against the $2,982 cap.
• There is no medically needy pathway for adults. TennCare's medically needy program is limited by rule to children under 21 and pregnant women. An adult who is over the SSI limit and does not need long-term care has no Standard TennCare path, they should look at Marketplace coverage, Medicare Savings Programs (if Medicare-eligible), or a Medicare Supplement plan instead.
• 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. The 2026 transfer-penalty divisor in Tennessee is $295.87/day, derived from TennCare's average daily nursing facility reimbursement rate per the ABD Eligibility Policy Manual (Policy 125.010, Jan 5, 2026), distinct from the CHOICES cost-neutrality cap of $294.87/day.

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):

• 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.
• Minimum Monthly Maintenance Needs Allowance (MMNA / MMMNA), 7/1/25–6/30/26: the at-home spouse can receive income from the CHOICES spouse to bring monthly income up to a minimum of $2,643.75 or as high as $4,066.50 if shelter expenses justify it.
• Home equity exclusion: up to $752,000 of equity in the primary residence is exempt as long as the applicant intends to return or a spouse, child under 21, or permanently disabled child still lives there.

For the full TN playbook, snapshot mechanics, the Income-First rule under 42 USC § 1396r-5(d)(6), TennCare's Single Fixed Annuity model, Hughes v. McCarthy 6th Circuit precedent, fair hearings under Tenn. Comp. R. & Regs. 1200-13-19, court-ordered support, 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.

Tennessee is a §1634 state, which means anyone receiving SSI is automatically enrolled in TennCare with no separate state determination. Two important federal protections also keep some adults on TennCare even after they technically lose SSI:

• Pickle Amendment, preserves TennCare for former SSI recipients who lost SSI solely because of Title II Social Security cost-of-living increases.
• §1619(b), preserves Medicaid for working SSI recipients whose earnings exceed the SSI break-even point, up to the federally calculated state threshold.

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, comprehensive benefits including exams, x-rays, cleanings, fillings, crowns, root canals, extractions, and dentures. Renaissance took over as Dental Benefits Manager effective November 1, 2025.
• Routine adult vision is not covered. Vision care is covered only when medically necessary or as part of an LTSS member's benefit package. Standard adults who need glasses pay out of pocket.

All Standard TennCare adults are enrolled in one of three MCOs (see below). There is no fee-for-service option.

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:

• 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 waitlist (historically about 12,500 slots; verify current cap against TennCare's most recent demonstration documents).
• 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 a 1,750 non-SSI slot target.

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.

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, residential setting, and acuity. Group 4, children and adults under 21 with I/DD living at home with family, is the most-applied-for category and includes a Family Caregiver Stipend of $500/month (children) or $1,000/month (adults) for families providing primary care.

Like CHOICES Group 2, ECF CHOICES operates with capped enrollment and a Referral List waitlist managed by DDA. Application runs through the DDA regional offices, not through TennCare directly.

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, Severely Disabled Minors

Katie Beckett is Tennessee's program for children under age 18 with severe medical or behavioral disabilities whose family income would otherwise disqualify them from Medicaid. Tennessee passed Katie Beckett through Public Chapter 494 of 2019 (TCA §71-5-164) and operationally launched it in late 2020.

The program has three Parts:

• Part A, full TennCare Medicaid (delivered through TennCare Select's Community component) plus up to $15,000/year in HCBS wraparound services. Capped at 300 children statewide, with 25 slots reserved for the most-medically-complex (Tier 1) cases. Acuity-prioritized waitlist.
• Part B, up to $10,000/year in flexible HCBS dollars but no TennCare Medicaid card. Cap was expanded to 4,700 slots. First-come, first-served waitlist. End-of-2024 enrollment hit 4,188 children.
• Part C, bridge coverage for children moving between Parts.

Critical eligibility note: Katie Beckett uses the child's own income and resources, not the family's, but premiums are owed if family income exceeds 150% of the Federal Poverty Level. Applicants must apply for Part B first; only after Part B determination can Part A be considered.

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).

• QMB (Qualified Medicare Beneficiary), income at or below 100% FPL plus a $20 disregard ($1,350/month individual / $1,824/month couple in 2026 per SSA POMS HI 00815.023). Pays Medicare Part A & Part B premiums (Part B = $202.90/month in 2026 per CMS) and all Medicare deductibles ($1,736 inpatient hospital and $283 Part B), coinsurance ($434/day Part A days 61-90; $217/day SNF days 21-100), and copayments. QMB enrollees are auto-deemed for the Part D Low-Income Subsidy ("Extra Help") under 42 USC § 1395w-114(a)(3)(B), which gives $0 premium on benchmark plans and $5.10 generic / $12.65 brand-name copays in 2026. Federal law at 42 USC § 1396a(n)(3)(B) also prohibits any Medicare provider from billing a QMB for any Medicare cost-sharing, the most comprehensive MSP.
• SLMB (Specified Low-Income Medicare Beneficiary), income between 100% and 120% FPL 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.
• QI (Qualifying Individual), income between 120% and 135% FPL plus the $20 disregard ($1,816/month individual / $2,455/month couple). Pays the Part B premium only and is funded by a capped federal allotment under 42 USC § 1396u-3 at 100% FMAP, so it's first-come, first-served. QI eligibility is statutorily mutually exclusive with full TennCare, CHOICES dual-eligibles cannot get QI but may qualify as full-benefit QMB-Plus or SLMB-Plus.

Resource limits for all three MSPs in 2026: $9,950 individual / $14,910 couple per the CMS CY 2026 LIS Resource Memo (Oct 31, 2025), these are the federally aligned LIS limits. The primary home and one vehicle are excluded with no equity cap (MSP is not LTSS). Application is through TennCare Connect at tenncareconnect.tn.gov or by phone at 1-855-259-0701, paper to P.O. Box 305240, Nashville, TN 37230-5240, or fax 1-855-315-0669. The Social Security Administration also accepts MSP applications via Form SSA-1020 with auto-referral to TennCare under 42 USC § 1320b-14. The 2023 CMS streamlining final rule (88 Fed. Reg. 65230, effective in stages June 3, 2024 through October 1, 2024) requires electronic verification through the Asset Verification System before paper documentation and accepts self-attestation for many financial elements.

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 $20 general income exclusion (POMS SI 00810.420) and $65 + ½ earned-income disregard (POMS SI 00820.500), the QMB-Plus / SLMB-Plus / Other FBDE / QDWI dual-eligible category matrix, the Part B Special Enrollment Period under the Consolidated Appropriations Act of 2021 (87 Fed. Reg. 66454) for newly determined MSP enrollees who never enrolled in Part B, retroactive coverage rules under 42 CFR § 435.915 (3 months for SLMB/QI; none for QMB per 42 USC § 1396a(e)(8)), three worked household examples, 14 common application mistakes, and 12 misconceptions, see: Tennessee Medicare Savings Programs (QMB / SLMB / QI): The Complete 2026 Guide.

The Three TennCare MCOs

Every TennCare adult, whether in Standard Medicaid, CHOICES, ECF CHOICES, or Katie Beckett Part A, is enrolled in one of three MCOs as of 2026:

For LTSS members, the MCO assigns a Care Coordinator, usually an RN or social worker, who develops the person-centered support plan, authorizes service hours, and approves provider agencies. CHOICES and ECF CHOICES members may change MCOs during open enrollment (typically annually) or for cause at any time.

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:

• You cannot self-apply for CHOICES through TennCare Connect alone. A CHOICES application requires a clinical Pre-Admission Evaluation (PAE), that PAE is normally initiated by an AAAD intake worker, a hospital discharge planner, or a nursing facility. Start with the AAAD if you're at home; start with the hospital social worker if you're being discharged.
• DDA is the gateway for ECF CHOICES and Katie Beckett, not TennCare itself. Calling TennCare Member Services about an ECF or Katie Beckett application will get you redirected. Use the DDA regional numbers above.
• Apply for Part B before Part A on Katie Beckett. TennCare requires this sequence; trying to apply for Part A first delays the process.

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, was signed by Governor Lee in April 2025 and became fully effective July 1, 2025. PC 182 opened, for the first time, an agency-employed pathway allowing TennCare-contracted provider agencies to hire spouses and parents of minor children as paid Direct Support Workers across CHOICES, ECF CHOICES, and Katie Beckett.

This is separate from, and broader than, the existing Consumer Direction (CD) option, which still excludes spouses and certain household members. PC 182 didn't change CD rules; it created a parallel agency-employment route for the relationships that CD bars.

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. A decade ago, Tennessee spent roughly 3% of its long-term care dollars on HCBS and 97% on institutional care. As of 2026 that ratio is closer to 40% HCBS / 60% institutional, driven by CHOICES and the Money Follows the Person (MFP) program. TennCare also launched a $50 million HCBS provider capacity investment over 5 years (up to $10 million per year) supporting CHOICES, ECF CHOICES, the I/DD waivers, Katie Beckett, and OPTIONS for Community Living. The practical takeaway: more home-based capacity is being built, but provider shortages still drive the Group 2 waitlist.
• The 10-year demonstration extension. TennCare III's January 8, 2021 approval through December 31, 2030 gives Tennessee an unusually long planning horizon. CMS-pending amendments (Amendments 6 and 7) and a separate I/DD waiver integration amendment were under review as of early 2026; the policy environment is more stable than in most Medicaid states.

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 severe medical or behavioral disabilities? → Katie Beckett Explained
• Need help understanding terms like spend-down, NFLOC, or QIT? → Browse our glossary

If you don't yet know what you need, the AAAD line at 1-866-836-6678 is the best general starting point for adults 65+. For Katie Beckett or ECF CHOICES, start with the DDA regional intake number for your part of the state.

Learn More

• Tennessee Medicaid Programs Overview
• TennCare Eligibility & Income Limits
• How to Apply for TennCare
• TennCare CHOICES
• ECF CHOICES
• Tennessee Long-Term Care & Nursing Homes

Find personalized help with TennCare programs 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.