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, so TennCare adult coverage runs through the traditional eligibility categories rather than an income-only expansion group. TennCare's own reference guide names them as Children; Families (parents and caretaker relatives); Women (pregnant women); Former Foster Care up to age 26; Aged, Blind & Disabled, which is where SSI, Institutional Medicaid, Katie Beckett, the SSI-related categories, breast-and-cervical-cancer coverage and ECF CHOICES all sit; and Medicare Cost Sharing (QMB, SLMB, QI 1, QDWI). That last category is the one older Tennesseans most often miss: it 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.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

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.

The three Medicare Savings rows cover Medicare premiums and cost-sharing only. Enrolling in any of them also automatically qualifies you for Part D Extra Help, the low-income drug subsidy, with no separate application. QDWI, the fourth Medicare Savings Program, does not confer it.7

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. The penalty is harsh in two ways TennCare's manual states outright: 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. It also does not start on the transfer date alone; it starts on the later of the date the person would otherwise be eligible for LTSS but for the transfer, or the first day of the month of the transfer.9

Six kinds of transfer are exempt, and a family that already made one is not penalised. TennCare's manual lists transfers to a spouse or for a spouse's sole benefit before institutional eligibility is established; transfers to the community spouse during the 12-month window after approval as part of the resource allowance; transfers to, or to a trust for the sole benefit of, a minor or adult child who is blind or disabled; transfers to a trust for the sole benefit of a disabled person under 65; transfers made exclusively for a purpose other than qualifying for TennCare, such as paying a legally enforceable debt; and transfers of the home where title went to the owner's spouse, a child under 21, an adult child who is blind or disabled, a sibling who has an equity interest in the home and lived there for at least a year before the institutionalization, or a child of any age who lived with the person for the two years immediately before nursing-home admission and provided the care that let them stay at home.9

There is also a hardship route past a penalty already imposed, and it runs on tight clocks. Hardship exists where the person has no available resources beyond the uncompensated value and the penalty would endanger their health or life or cost them food, clothing, shelter or other necessities, but not where a community spouse has available assets. A request must be filed within 90 days of the application date, or if later, no later than 40 days after the denial or termination notice. TennCare answers within 30 days, and a hardship denial can itself be appealed within 40 days.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):2

• Community Spouse Resource Maintenance Allowance (CSRMA): TennCare takes a resource "snapshot" at the first period of continuous confinement and protects the greater of three things: one-half of the couple's combined countable resources, bounded at $32,532 and $162,660; a court-ordered amount; or an amount an appeals officer sets for hardship. Read $162,660 as a cap on the one-half computation, not as a ceiling on what a community spouse may keep. The bounds that apply are those for the year of the snapshot date, not the year you apply, so a 2025 snapshot uses $31,584 and $157,920. Only what is left after the CSRMA comes out is measured against the applicant's own $2,000 limit, and the resources must actually be transferred within 12 months (a spouse-to-spouse transfer made per a completed assessment carries no transfer penalty).2
• Minimum Monthly Maintenance Needs Allowance (MMNA / MMMNA): the at-home spouse's Maintenance Needs Standard is the Standard Maintenance Amount plus any Excess Shelter Allowance, not the SMA alone. The SMA is $2,705.00 a month effective July 1, 2026, the standard housing allowance used to test whether an excess shelter amount is due is $811.50, and the standard utility allowance is $451. The federal maximum is $4,066.50 a month effective January 1, 2026. Two mechanics decide whether any of it reaches the at-home spouse: the allowance is deducted from the applicant's patient liability only if the money is actually transferred, and a community spouse who receives SSI, SNAP, Families First, a VA pension, QMB, or other needs-based help may accept or decline all, some, or none of the CSRMA where accepting would cost them those benefits. Declining is not free, though: whatever the community spouse turns down counts as the applicant's own resources and must be spent down first. The personal needs allowance the institutionalized spouse keeps is $70 a month.2
• 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.

The $2,000 resource limit is a limit on countable resources, and SSA's exclusion list is long: the home you live in and its land, household goods and personal effects, one vehicle of any value if you or your household use it for transportation, life insurance with a combined face value of $1,500 or less, burial spaces, burial funds of $1,500 or less each for you and your spouse, property used in your trade or business, and money set aside under a Plan to Achieve Self-Support. A Tennessee homeowner who owns a car is not over the $2,000 limit on account of the house or the car.8

Standard TennCare covers the usual suite of acute care benefits: hospital, physician, prescription, behavioral health, transportation. What it does not cover is long-term care. Nursing facility services and CHOICES or ECF CHOICES home and community based services sit outside the standard adult benefit package, so personal care, adult day services, and home modifications require enrolling in one of those programs rather than being available through regular TennCare.10 Three 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 (TTY 711), 7 a.m. to 5 p.m. Central. There is no separate dental ID card: bring your TennCare health plan card to dental appointments. Renaissance assigns each member a dentist as a "dental home" and you can change at any time, but networks changed with the contract, so confirm your own dentist is in the Renaissance network before scheduling. Virtual dental care is included. For a member in ECF CHOICES or a 1915(c) I/DD waiver, dental covered under the Adult Dental Benefit does not count against the HCBS cost cap; only waiver-funded dental outside that benefit, such as behavior management and sedation, does.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.10
• Pharmacy loosened in 2025, but not entirely. TennCare eliminated the five-prescription-per-month adult limit effective July 1, 2025. The two-brand-name-per-month limit remains, though it is not absolute: drugs on TennCare's combined automatic-exemption and attestation list do not count toward monthly limits, and adults may exceed the brand limit in certain high-risk situations. Copays are $1.50 per generic and $3 per brand-name drug, and apply only to TennCare Medicaid adults who are not in a nursing home, an HCBS waiver, or an ICF/IID. Even then TennCare charges no pharmacy copay for birth control, for medicine in hospice care, for medicine in a medical emergency, or for medicine received while pregnant, though you have to tell the pharmacy you are pregnant or in hospice. Adult home health is capped at 8 hours a day and 27 hours a week of nursing care, or 30 hours a week for someone who qualifies for Level 2 nursing facility care.10

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. In its most recent quarterly report published to CMS, covering January through March 2025, TennCare gave a statewide Group 2 enrollment target of 11,000 against 8,759 members enrolled, with 300 statewide reserve-capacity slots held back.6
• 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, and SSI recipients who qualify for Group 3 do not count against that target. The annual HCBS expenditure cap here is far lower and the two governments publish different figures for it: TennCare's own policy uses $18,000, while CMS's approved terms set $19,764 per calendar year, both excluding minor home modifications. Ask your support coordinator which figure is being applied to your plan of care.6

Reaching a target is not the end of the road. CMS's approved terms carry three routes past a full Group 2: reserve slots the state may hold for people being discharged from a nursing facility, or from an acute care setting at imminent risk of nursing-facility placement; an MCO's discretion to offer the same home care as a cost-effective alternative outside the target; and an unconditional right for a Group 1 member who meets the Group 2 criteria to move into Group 2 at any time, target or no target. Ask about all three rather than accepting "the target is full" as the answer.1,6

Group 2 spending is bounded by an Individual Cost Neutrality Cap, and the cap is not one number. It is set at the average cost of the level of nursing-facility reimbursement the member would actually qualify for. For 2026 the general figure is $294.87 a day, $107,627.55 a year, but a member who would qualify for Enhanced Respiratory Care is priced against a higher ceiling: $173,010 a year at the tracheal-suctioning rate and $249,977.55 a year at the chronic-ventilator rate, with supporting documentation submitted alongside the evaluation. A ventilator-dependent applicant measured against $107,627.55 is being measured against the wrong ceiling. The cap limits what can be authorized, counting home health and private duty nursing alongside CHOICES services, and TennCare will not enroll someone in Group 2 without an MCO or AAAD determination that their needs can be met safely in the community within it. If the MCO later decides they cannot be, the member can be moved to nursing-facility care instead, and that decision is appealable through TennCare's Division of LTSS.6

Functional eligibility for CHOICES uses the Pre-Admission Evaluation (PAE), adjudicated by registered nurses in TennCare's Division of LTSS. Level of care has two components, medical necessity of care and need for inpatient care, and the acuity score speaks to the second: the applicant must need daily inpatient nursing care, be unable to perform that care themselves, and either score at least 9 on TennCare's 26-point NF level-of-care acuity scale or meet at-risk level of care and be found not to qualify for Group 3. The score is built from need for help with transfer, mobility, eating and toileting, plus deficits in communication, orientation, behavior and self-administering medication, and from skilled needs such as tube feeding, wound care, therapy and ventilator care. Every answer has to be backed by the medical evidence filed with the evaluation, and a TennCare nurse may approve a modified score rather than simply accepting or rejecting the one submitted.4

A score under 9 is not the end of the route. A denied evaluation, or one approved with an end date, carries appeal rights; the denial letter states the reason, the appeal rights, and a statewide list of legal aid offices, and the deadline is 30 days plus mailing time. Two protections sit alongside it. A nursing home may not discharge a current resident because TennCare initially denied the evaluation, until the appeal is resolved or the time to appeal has passed unused, and that protection expressly covers someone denied for nursing-facility level of care but approved as "at risk." And when an evaluation is denied, TennCare gives the facility 10 calendar days to submit more documentation, which if sufficient preserves the original effective date. The one thing you cannot appeal is a technical denial, which is a submission error the submitter simply corrects and resubmits.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 was implemented July 1, 2016 and is structured into five groups (4 through 8) based on age and the level of care a member needs; each group carries its own annual per-member expenditure cap.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 a base cap of $18,420 per person per calendar year (minor home modifications do not count against it). Group 5 (Essential Supports for Employment and Independent Living) is $38,820, which TennCare may exceed by up to $6,000 a year for emergency needs, and Group 6 (Comprehensive Supports) is tiered by level of need at $62,268, $95,620, or $129,048, with institutional-cost-based caps instead for a member assessed to have exceptional medical or behavioral needs. All three can be exceeded where necessary to give a member access to Supported Employment or Individual Employment Support. The state may adjust these figures over the life of the demonstration, so confirm the number applied to your plan with your support coordinator. One protection rides with them: a Group 4, 5, or 6 member cannot be disenrolled or have authorized services cut if the only reason the cap would be exceeded is a state-directed rate increase.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.4

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

If you are on the referral list, read the reserve capacity groups before you settle in to wait. They are wider than the summaries usually given, and they are the routes a waiting family is most likely to qualify under. TennCare publishes an Aging Caregiver group, for a custodial parent or caregiver at least 75 for a person with an intellectual disability or at least 80 for a person with a developmental disability. It publishes an Emergent Circumstances group that covers not only a recently deceased primary caregiver with no one else available, but also a primary caregiver who is permanently incapacitated with no one else available, the recent loss of the person's living arrangement, clear evidence of serious abuse, neglect or exploitation with no alternative placement, discharge from an acute care setting at imminent risk of nursing-facility placement or after a PASRR finding that a nursing facility is inappropriate, aging out of state custody, discharge from an inpatient psychiatric hospital, release from incarceration, and immediate ongoing risk of serious harm after other interventions have failed. There is a transition group for people leaving a nursing facility or an ICF/IID, and a Multiple Complex Health Conditions group for a working-age person whose chronic or acquired conditions prevent them from working and who urgently needs support to stay where they live. Other eligibility rules still apply, so fitting a description is not the same as an enrollment, but it is worth raising with DDA rather than waiting silently.6

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.6

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, with sub-limits inside that total including $5,000 a year for assistive technology, adaptive equipment and supplies and $500 a year for family caregiver education and training. Capped at 300 children statewide, with 25 slots reserved for the most-medically-complex (Tier 1) cases, reduced from 50 in 2024 to let more Tier 2 children enroll. Part A has a waiting list, which CMS requires the state to manage statewide using a standardized assessment tool, on objective criteria applied consistently in every part of the state.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, and they do not roll over: unspent money does not carry into the next plan year. The cap has been expanded to 4,700 slots, up from 2,700; end-of-2024 enrollment stood at 4,188 children. A Part B slot is not guaranteed either, and a child with no slot open goes on the Part B waiting list.4
• Part C, the Continued Eligibility group, which lets a child keep Medicaid when they would qualify for Part A but no Part A slot is open. Part C slots are used only when Part A has no openings, and a child in Part C who is later offered a Part A slot must move to Part A.4

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

The premium is not the family's real cost, and the payment rules bite harder than most families expect. TennCare reduces the Part A premium by the eligible child's own share of employer-sponsored or private health insurance, and where that share is larger than the premium there is no premium requirement to enroll at all. But the first two months are due before a child can be enrolled, and if they go unpaid for 60 days the slot is released to another child and the family has to reapply. After enrollment, a payment more than 30 days late suspends Part A benefits and one more than 60 days late disenrolls the child unless payment arrives in full, though a child disenrolled that way moves to Part B if a slot was available at referral. Families can appeal a premium they believe was calculated wrong, and can appeal a denial or a Part A level-of-care denial within 30 days of the notice.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).7

• 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. What that is worth in 2026 is concrete: the Part A inpatient deductible is $1,736, Part A coinsurance is $434 a day for hospital days 61 through 90 and $217 a day for skilled-nursing days 21 through 100, and the Part B annual deductible is $283. A QMB also gets Extra Help and pays no more than $12.65 in 2026 for each drug their Medicare drug plan covers. One edge to know: Medicare notes a QMB may still receive a bill for a small Medicaid copayment where one applies. Filing a Medicare Part D Low-Income Subsidy ("Extra Help") application with Social Security also initiates an MSP application.7
• 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, and you must have both Part A and Part B to qualify.7 SLMB enrollment also automatically qualifies you for Part D Extra Help, so the drug subsidy comes on top of that figure.7
• 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.7 Like QMB and SLMB, QI enrollment automatically qualifies you for Part D Extra Help.7

Resource limits for all three MSPs in 2026 are $9,950 individual / $14,910 couple, the federal standards Tennessee's own manuals state. Treat those as a floor to apply against rather than a ceiling to screen yourself out on: Medicare says a person may still qualify in their state even where income or resources run above the federal figures, because some states do not count certain types or amounts, and tells applicants to apply even when they think they will not qualify. Apply through TennCare Connect at tenncareconnect.tn.gov or 1-855-259-0701, by mail to TennCare Connect, P.O. Box 305240, Nashville, TN 37230-5240, or by fax to 1-855-315-0669; the Social Security Administration also accepts MSP applications via Form SSA-1020 and refers them to TennCare automatically.7

A senior who qualifies for both full TennCare (through CHOICES, for example) and an MSP becomes a "full-benefit dual eligible", the categories CMS calls "QMB Plus" and "SLMB Plus": the MSP help with Medicare costs plus the full TennCare benefit package. The two are not equivalent on cost-sharing, though. QMB Plus carries QMB's protection against being billed for Medicare Part A and B cost sharing; SLMB pays the Part B premium and does not carry that protection, so a SLMB Plus is protected through what Medicaid covers rather than through the QMB billing bar. If your Medicare costs are the problem, it is worth checking whether you qualify as QMB rather than SLMB.7

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

TennCare runs entirely on managed care, and with the exception of people in TennCare Select, everyone eligible for TennCare, including dual eligibles, is enrolled in a managed care organization. TennCare contracts with three MCOs, each available in all three Grand Divisions, and it lists TennCare Select alongside them on its own health-plan tables without saying which three its count refers to, so do not read TennCare Select out of the picture. What TennCare does say plainly is which plans a CHOICES member calls:4,5

For LTSS members, the MCO assigns a Care Coordinator or Support Coordinator, and contacting that coordinator is one of the ways TennCare lists for raising a complaint. It is not the only one, and a member unhappy with the plan itself should know the routes that do not run back through it: ask the plan for its CHOICES Consumer Advocate or ECF CHOICES Member Advocate, call TennCare's Beneficiary Support System at Disability Rights Tennessee on 1-888-723-8193, or call the Long-Term Care or Community Living Supports Ombudsman on 1-866-836-6678.4

Know which track you are on, because picking the wrong one costs you the remedy. TennCare states that a complaint or grievance is not what you file when services are denied, reduced, or terminated. That is an adverse benefit determination, and it carries an appeal and a state fair hearing instead, with the notice telling you how to file. You have 60 days from finding out there is a problem.4,10

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.6
• 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.13

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.13

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.14
• 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.