Can anyone with income below a certain threshold enroll in Medicaid? In some states, this is true. However, Medicaid eligibility in Tennessee is more complicated. To be eligible for TennCare (Tennessee’s Medicaid program), an individual must first fall into one of TennCare’s covered categories. Each category has different household income limits for determining eligibility.
The Affordable Care Act (ACA) allows states to expand Medicaid eligibility to all adults with incomes up to 138% of the federal poverty level (FPL) – regardless of their health or parental status. Tennessee has not expanded TennCare eligibility under the ACA. As a result, very few non-disabled, childless adults are eligible for TennCare.
TennCare primarily serves:
- Low-income children.
- Low-income pregnant women.
- Low-income parents and caretaker relatives.
- Low-income individuals ages 65+.
- Low-income individuals with a disability.
- Low-income individuals in need of a level of care traditionally provided in a nursing home.
The image below summarizes TennCare’s main eligibility categories and category-specific income limits.
Additional Factors for Determining Medicaid Eligibility in Tennessee
TennCare also has other eligibility categories that are not pictured, and some categories have additional criteria for determining eligibility. For example:
- In addition to income limits, some eligibility categories also have resource limits. Low-income individuals ages 65+, for instance, can have no more than $2,000 in resources and assets (for a household of 1) to qualify for full TennCare coverage.
- TennCare covers uninsured women with household incomes below 250% of FPL and have had breast or cervical cancer detected by the Tennessee Breast and Cervical Cancer Screening Program. While not publicly available, enrollment numbers for this category are likely relatively low. From 2011 to 2015, the screening program detected about 970 cases of breast and cervical cancers and premalignant lesions.
Comprehensive information about TennCare eligibility can be found on the state’s website:
For more background and context on TennCare, read Understanding Medicaid and TennCare: Key Concepts and Context to Know.