Tennessee Medicaid Renewal and Recertification (2026)

Ignoring a renewal packet can make families lose TennCare, Tennessee's Medicaid coverage, even when they still qualify. Federal law (42 CFR 435.916) requires the state to try an automatic renewal from data it already holds before asking you for a single document, but a packet that does reach you has to come back on time.

Renew at TennCare Connect · Call 1-855-259-0701

In This Guide

• The Tennessee Medicaid renewal and recertification cycle
• Ex parte Tennessee Medicaid renewal: the federal mandate
• How to renew TennCare, your Tennessee Medicaid coverage
• The 90-day TennCare reconsideration window
• Children's 12-month continuous eligibility
• Pregnant women and 12-month postpartum coverage
• Long-term care and CHOICES renewals
• Returned mail and your MCO
• Appeal rights when TennCare ends
• Special populations and renewal nuances
• What changes after 2026
• Common Tennessee Medicaid renewal mistakes
• Frequently Asked Questions
• Learn More

Renewal is the most consequential moment in a Medicaid beneficiary's year: eligibility is set at application, then redetermined every 12 months.1 Most procedural closures hit people who remained eligible and simply did not return the packet in time, which the 90-day reconsideration window below exists to fix.

TennCare covers roughly 1.4 million Tennesseans under the TennCare III Section 1115 demonstration, approved through December 31, 2030.4

The Tennessee Medicaid renewal and recertification cycle

TennCare redetermines eligibility for most members once every 12 months, but not under the same rule for everyone. Federal law caps a MAGI renewal at once every 12 months and no more often; for non-MAGI members (aged, blind, or disabled, long-term care, Medicare Savings Programs) it requires one at least every 12 months, a floor rather than a ceiling, so an ABD or CHOICES case can be reviewed more often.2 Your renewal month is fixed at approval: an October approval renews every October. TennCare calls this "re-enrollment," completed through the same TennCare Connect portal you used to apply.3

Renewals split into two paths by eligibility category:

• MAGI populations (children, pregnant women, and parent/caretaker relatives): renewed on Modified Adjusted Gross Income methodology. Tennessee has not adopted ACA Medicaid expansion, so there is no expansion-adult group; TennCare runs the traditional categories in its Eligibility Reference Guide, including Aged, Blind and Disabled (where SSI, Institutional Medicaid, Katie Beckett, and ECF CHOICES sit) and Medicare Cost Sharing (QMB, SLMB, QI 1 and QDWI). That last matters for older Tennesseans: 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.4
• Non-MAGI populations (Aged, Blind, and Disabled adults on SSI rules, CHOICES long-term services and supports, and Medicare Savings Programs): renewed under a framework with an asset test. Federal law requires every state to verify assets at renewal through an Asset Verification System (Section 1940 of the Social Security Act), so a non-MAGI renewal runs a check a MAGI renewal does not, typically calling for bank statements, retirement-account and life-insurance documentation, and your AVS authorization.5

Ex parte Tennessee Medicaid renewal: the federal mandate

The most important rule in modern Medicaid renewal is the ex parte default at 42 CFR 435.916(b)(1): before TennCare asks you for anything, it must redetermine without requiring information from you whenever it can do so from reliable information already in your account or otherwise available to the agency, including electronic data sources.2

In Tennessee it pulls from Social Security earnings, retirement, disability and SSI records, IRS tax data, state wage and unemployment records, SNAP records, Medicare entitlement data, and your prior cycle. If those confirm you remain within your category's income threshold and your household has not changed, the renewal is automatic: TennCare sends a notice of the determination and its basis, which you need not return unless something on it is wrong.2

When ex parte fails, TennCare must send a renewal form and give you at least 30 days from the date of the form (42 CFR 435.916(a)(3)) to respond, supply missing information, and sign. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI); if you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Tennessee may follow the same procedures but is not required to, so ask what deadlines apply to you.2 It most often fails on income that never reaches wage databases (self-employment, gig, cash, seasonal work), the asset-verification gap on ABD and CHOICES cases, and household changes. Because Tennessee is a Section 1634 state, one group skips the packet entirely: SSI recipients are enrolled automatically, so SSA's own redetermination drives their Medicaid renewal. And if SSI payments stop, TennCare must review you for every other eligibility category before ending your coverage.6

How to renew TennCare, your Tennessee Medicaid coverage

Under 42 CFR 435.916, a renewal may go in through any mode the agency offers, and no in-person interview may be required.2 In Tennessee that means online, phone, mail, fax, or assisted help, TennCare Connect being fastest.3

TennCare Connect is the state's self-service portal and the primary renewal channel.3 No account yet? Create one using any TennCare notice.

The 90-day TennCare reconsideration window

If your coverage closed because you missed the renewal paperwork, you usually do not have to start over. Under 42 CFR 435.916, if you lose Medicaid for failure to return the renewal form (a procedural termination, not an eligibility-based one), the agency must reconsider your eligibility and treat the late-returned form as the renewal if you submit it within 90 days of the termination, without a new application (required for MAGI-based coverage; a state option otherwise), restoring coverage if you still qualify.2

Which kind of closure you had decides everything:

• Procedural: failure to return the renewal form, a missing signature, no documentation, or no response to a request for information. Reconsideration applies, 90 days from the termination date.
• Eligibility-based: TennCare determined you no longer meet income, residency, citizenship, age, disability, or another categorical criterion. It does not apply; file a new application or appeal.

Read the stated reason on your notice, and note that the 90-day clock starts on the termination date, not the notice date. To activate the window, submit the renewal form through any channel above; if you no longer have it, log in to TennCare Connect or call 1-855-259-0701 for a new one, and note the closure date so your case is routed correctly.3

Children's 12-month continuous eligibility

Section 5112 of the Consolidated Appropriations Act, 2023 requires every state to give children under age 19 in Medicaid or CHIP (CoverKids in Tennessee) 12 months of continuous eligibility from enrollment, effective January 1, 2024.1

Coverage is locked in for those 12 months regardless of changes in family income: if a parent loses TennCare mid-year because household income rose, the children stay covered until the next annual renewal. It ends early only if the child turns 19, moves out of Tennessee, or reaches the end of the 12-month period. Report an income increase anyway.

Pregnant women and 12-month postpartum coverage

Tennessee covers pregnant members and extends coverage for at least 12 months postpartum, using the permanent state option created by the American Rescue Plan Act and made permanent by the Consolidated Appropriations Act, 2023.1 Presumptive (prenatal) eligibility runs through county health departments, where self-attestation carries immediate interim coverage up to 250% of the Federal Poverty Level; the mandatory pregnancy category reaches 195% FPL, with the band above it covered under TennCare III flexibilities. TennCare may still ask for documentation before approving ongoing coverage. The 12-month postpartum period carries a condition: it runs only for a woman determined eligible for and receiving TennCare before her pregnancy ends, and one whose eligibility begins afterward keeps benefits just 60 days postpartum.7 Postpartum coverage continues regardless of income, and the annual cycle resumes afterward.

Long-term care and CHOICES renewals: two reviews at once

If you receive TennCare long-term services and supports through CHOICES (nursing facility or home and community based services), your renewal has two independent components, both of which must stay current.

Financial redetermination

Run on the annual cycle, this review includes the asset test federal law requires through the Asset Verification System.5 In 2026, TennCare CHOICES checks income and assets against a resource limit of $2,000 for an individual or $3,000 for a couple where both spouses apply, on your AVS authorization, which stays effective until your eligibility ends or you revoke it in writing.8,5 Three Tennessee figures drive the rest of the budget:

• Income cap. Tennessee is an income-cap state: gross monthly income above the Medicaid Income Cap of $2,982 (300% of the 2026 SSI federal benefit rate of $994) must route the excess through a Qualified Income Trust (Miller Trust), which must keep functioning at renewal.9
• Patient liability. The post-eligibility budget subtracts a Personal Needs Allowance before the rest of your income goes to the cost of care, and its size depends on where you live: $70 per month in a nursing facility or ICF/IID. If the resident is a veteran, or the surviving spouse or child of one, whose VA pension is limited to $90 a month, that $90 never enters total income at all, so it is kept on top of the $70 rather than absorbed by it, and that $90 limit does not apply to someone receiving HCBS or living in a state veterans home.10 A CHOICES member receiving HCBS at home keeps far more: 300% of the SSI federal benefit rate, or $2,982 in 2026, the same figure as the income cap.9
• Spousal impoverishment. If you are married, the community spouse's protected share (TennCare calls it the CSRMA) is the greater of three things: one half of the couple's combined countable resources, bounded by that year's minimum and maximum; a court-ordered amount; or an amount an appeals officer sets for hardship. The 2026 bounds are $32,532 and $162,660, and two details decide your figure. Those bounds are the ones for the year of your resource-assessment snapshot, not the year you renew, so a couple whose snapshot was taken in 2025 uses $31,584 and $157,920. And $162,660 caps the one-half computation only, not what a community spouse may keep, because the court-order and hardship routes sit outside it. On the income side the Maintenance Needs Standard is the Standard Maintenance Amount of $2,705 per month (effective July 1, 2026) plus any Excess Shelter Allowance, not the $2,705 alone, up to the federal maximum of $4,066.50. Keep two things current: protected resources must be transferred within 12 months of the assessment, and the community spouse's income allowance comes out of patient liability only if the money actually moves.8

Level of care reassessment

Separately, a Pre-Admission Evaluation (PAE) confirms you still meet nursing-facility level of care; your MCO Care Coordinator manages it for CHOICES members. Group 1 (nursing-facility care) carries no enrollment target and no waiting list, while the HCBS groups run under statewide targets that put qualified applicants on a waiting list once reached, unless they meet the reserve-capacity or exception criteria.11 Those targets and the Group 3 expenditure ceiling are in TennCare CHOICES. You can pass one review and fail the other: if level of care is not approved, CHOICES ends, though you may continue on standard TennCare for non-LTSS coverage if otherwise eligible.

Returned mail and your MCO

The federal rule that required an agency to search for a new address before acting on returned mail, 42 CFR 435.919, was removed effective July 31, 2026. Federal law now says only that the agency may act without advance notice when your whereabouts are unknown (42 CFR 431.213(d)), and that coverage must be reinstated if your whereabouts become known while you are still eligible (42 CFR 431.231(d)).12 Tennessee may still have its own procedures, so if your packet came back undeliverable, call TennCare at 1-855-259-0701.

Your MCO matters at renewal too. Tennessee's plans are BlueCare, Wellpoint, UnitedHealthcare Community Plan, and TennCare Select for special populations.13 Wellpoint is the plan formerly known as Amerigroup, so older mail naming "Amerigroup" means Wellpoint.14

A deadline for dual eligibles, and it lands this year. If you have both Medicare and TennCare and you are in a Medicare Dual Eligible Special Needs Plan (D-SNP), your D-SNP and your TennCare health plan must be the same company by December 31, 2026. A D-SNP with BlueCare, UnitedHealthcare or Wellpoint that does not match your TennCare plan by then means disenrollment into Original Medicare, leaving you to pick a Part D drug plan yourself. Two ways to line them up: change your TennCare health plan, for which TennCare opened a special enrollment period running June 1 through October 31, 2026, or change your D-SNP, for which a dual eligible has a monthly special enrollment period into a fully integrated dual special needs plan and can also switch during Medicare's annual enrollment, October 15 to December 7.13 Changing MCOs is protected: the receiving plan must continue your CHOICES or ECF CHOICES home and community based services for at least 30 days, and may not reduce them until it has done a new needs assessment and plan of care and started services under it.14

To avoid a returned-mail closure, update your address in TennCare Connect after a move, with your MCO too, and file a USPS change-of-address form.13

Appeal rights when TennCare ends your coverage

If your renewal is denied or coverage terminated, you have a federal right to a fair hearing under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220, and it reaches more than an eligibility denial. It covers six categories of person, one of which matters to families already in long-term care: any resident who believes a nursing facility has wrongly determined that he or she must be transferred or discharged. Spend-down determinations, cost-sharing amounts, PASRR determinations and prior-authorization decisions are appealable too, with one carve-out at 431.220(b): no hearing where the sole issue is a law requiring an automatic change affecting beneficiaries generally.1 The 90 days in 42 CFR 431.221(d) is a ceiling on what a state may allow, not a floor you are owed.15 A renewal denial or termination puts you on TennCare's eligibility track, where an appeal is timely within 40 days of the notice; a medical (service) appeal runs 60 days, and continuation of benefits is a separate, earlier clock.15 Work to the date on your own notice.

Tennessee adjudicates its own fair hearings internally, an Administrative Judge deciding, on two tracks:

• Eligibility appeal (a denial, a coverage ending, an income or family-size error, or a delayed decision): file with TennCare Connect at 1-855-259-0701, online, or by mail to the Eligibility Appeals Unit, P.O. Box 23650, Nashville, TN 37202-3650. Waited more than 45 days for a standard decision, or 90 days on a long-term-care application? Request a delayed hearing.15
• Medical (service) appeal (a denied, reduced, or terminated covered service, including a CHOICES service): file with TennCare Member Medical Appeals at 1-800-878-3192. You have 60 days after learning of the problem, and it is usually decided within 90 days.15

Continuation of benefits (aid paid pending). Federal law continues your Medicaid during an appeal if the agency sent the required advance notice and you request the hearing before the action takes effect (42 CFR 431.230(a)). It gives way only where both halves of one exception are met: the sole issue is determined at the hearing to be one of federal or state law or policy, and the agency promptly tells you in writing that services are to be cut pending the decision. Asking after the action took effect, 42 CFR 431.231(a) still lets the agency reinstate services when you request within 10 days of it.

If you were cut off without advance notice, reinstatement is a right rather than a favour. Under 42 CFR 431.231(c) the agency must reinstate and continue services until a decision when all three hold: the action was taken without the advance notice 431.211 or 431.214 requires; you request a hearing within 10 days of receiving the notice (receipt deemed 5 days after the date on it unless you show otherwise); and the agency determines the action came from something other than the application of law or policy. It is the route most often missed. If TennCare's action is later upheld, it may recoup the cost of services furnished solely by reason of that continuation.16

In Tennessee, benefits continue on the eligibility track if you file within 20 days of the notice (or before the coverage end date, if later). Past 20 days, ask anyway: both TennCare deadlines yield to a showing of good cause. Two cautions. The 40-day and 20-day windows come from TennCare's Administrative Manual policy 200.055, whose version history ends in December 2015, so confirm them with TennCare Connect. And no TennCare source sets a continuation window for the medical (service) track, so do not carry the 20 days over to it or assume services keep running there.15

Special populations and renewal nuances

Medicare Savings Programs

QMB, SLMB, QI, and QDWI eligibility is redetermined on the same 12-month non-MAGI cycle, ex parte attempt first, which works well because Social Security and SSDI income sits in the federal data hub.2 See Tennessee Medicare Savings Programs.

Refugees and qualified immigrants

When the agency cannot promptly verify a declared citizenship or immigration status, federal law (42 CFR 435.956) requires a reasonable opportunity period, generally ending the earlier of verification or 90 days, during which it may not delay, deny, reduce, or terminate benefits for someone it otherwise finds eligible. The clock starts when you receive the notice, deemed 5 days after the date on it unless you show otherwise. The 90 days is not a hard stop, and a state may not cap how many such periods you get.17

What changes after 2026: the move toward 6-month renewals

Section 71107 of the 2025 budget-reconciliation law (H.R.1, Public Law 119-21) requires states to redetermine eligibility once every 6 months rather than every 12, for the ACA expansion-adult population, for renewals scheduled on or after January 1, 2027, plus that same population where a state covers them under a waiver equivalent to minimum essential coverage; everyone else is outside the provision rather than excepted from it.1 Because TennCare III covers no expansion-adult group, the 6-month cadence currently reaches essentially none of TennCare's roughly 1.4 million members.4

The same law also shortens retroactive eligibility for applications filed on or after January 1, 2027, to two months before the application month for most enrollees, down from the three-month federal default.1

In Tennessee there is almost nothing left to shorten. TennCare III waives Section 1902(a)(34) and 42 CFR 435.915 outright, except for pregnant women (plus 60 days postpartum), infants under one, and individuals under 21. Aged, blind and disabled applicants and every CHOICES group get nothing before the filing date, so that date is what your family is protecting: file the day a nursing-home stay begins, not after the first bill arrives.18

Common Tennessee Medicaid renewal mistakes

1. Treating the renewal packet like junk mail. Ex parte clears only some renewals; the rest need the packet back by the deadline printed on it.2
2. Updating your address with Social Security or one MCO but not with TennCare.12
3. Refusing or revoking the AVS authorization. It holds until a final adverse decision, until your eligibility ends, or until you revoke it in writing. Revoking or refusing it is not neutral: federal law lets the State determine you ineligible on that basis alone (42 U.S.C. 1396w(f)). The State must tell you its duration and scope, and the records cost you nothing.5
4. Letting the Qualified Income Trust lapse. If your income exceeds the income cap, the QIT must keep functioning at every renewal, not just at initial approval.9
5. Waiting too long to protect benefits during an appeal. Request continuation within 20 days of the notice, earlier than the 40 days that keep an appeal timely; past that, ask anyway and show good cause.15

Tennessee Medicaid renewal: contacts and resources

For renewals, reinstatements, and appeals:

To check whether your renewal has been processed, log in to TennCare Connect or call 1-855-259-0701.3,13 For eligibility itself, see the Tennessee Medicaid hub and the national Medicaid hub.

Learn More

Find personalized help navigating your Tennessee Medicaid renewal 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.