Health Insurance For Low-Income
With the introduction of Obamacare (the Affordable Care Act), Tennessee opted to not expand their Medicaid programs. Regardless, there are several coverage options available for which you may qualify.
Tennessee Medicaid Plan Options
TennCare is the Medicaid program for the state of Tennessee. There are several different groups that can qualify for coverage based on income, the number of people living in the household, and age.
A few examples of demographics covered include:
- Children under 21
- Pregnant women
- Parents with dependents
- Women with breast or cervical cancer
- Nursing home or long-term care residents
TennCare Standard is for children under 19 years of age that are already enrolled in Medicaid and do not have access to a group health insurance plan through their parents or a caregiver. The family income also needs to be below 211% of the Federal Poverty Limit (FPL).
Major Medicaid Eligibility Categories in Tennessee
The following categories are eligible for various types of Medicaid in Tennessee:
- Children - Eligibility is determined based on age, family size, and income level. The is mandatory for all states.
- Pregnant Women - Eligibility is determined based on family size and income level. This is also mandatory for all states.
- Parents with dependents - Eligibility is determined based on family size and income level. Again, mandatory for all states.
- Newborns - Babies born to women utilizing Medicaid are eligible for their first 12 months of life. This is a mandatory category.
- Medically Needy - Children and young adults up to 22 years of age and pregnant women that have large medical expenses that negate their higher income level. This is an optional category.
- Institutional Individuals - Individuals that need to be in a nursing facility or who use Home and Community-Based Services and meet household income requirements. This is an optional category.
TN Breast and Cervical Screen Program
Women with Breast or Cervical Cancer (BCCP) - Women that need treatment for breast and cervical cancer that received their screening through a CDC approved Early Detection Program. To be eligible, you must be uninsured or underinsured, under 65 years of age, diagnosed, and below 250% of the FPL.
Workers with Disabilities (HWD) Program
The Workers with Disabilities Program allows employed individuals (16 - 64 years of age) with disabilities to purchase medical coverage by paying a monthly premium based on their income.
Medicare Costing Savings programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services.
The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for those eligible and enrolled in Medicare Part A.
The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income.
The Qualified Individual (QI-1) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the SLMB program except for excess income.
Services and Programs Provided by Tennessee Medicaid
- TennCare Kids - Program developed to promote healthy behaviors in kids 0 - 21 years of age. It provides check-ups and proactive services like vaccinations and health screenings.
- Tennessee Asthma Management - Program developed to promote lung health, assist with asthma education, and eliminate the disparity of asthma resources available.
- Children’s Special Services (CSS) Program - Program that provides comprehensive coverage for kids with physical disability.
- Children and Youth With Special Health Care Needs - Consists of community-based services to help provide coordinated services to special needs children and their families.
- Welcome Baby - Provides education to parents and coordinated care services to help ensure that babies get the best start possible.
- Employment and Community First CHOICES - This new program began July 2016 and was developed to help connect intellectually disabled individuals with employment opportunities and support in order to live independently.
- CHOICES - This program is for adults with a disability or seniors (over 65) that can still live independently, but may need assistance with preparing meals, bathing, or household chores. The goal is to allow independence and to stay in their existing community as long as possible.
Program of All-Inclusive Care for the Elderly (PACE)
The Program of All-inclusive Care for the Elderly (PACE) is a managed care model of acute and long-term care individuals age 55 and older that meet state specific criteria for nursing home care placement. The goal of PACE is to empower the individual with the ability to reside in their current community and receive quality care. Ultimately, this should reduce the cost relative to the Medicare, Medicaid, and private-pay traditional payment systems.
Tennessee Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following individuals are eligible for Tennessee Medicaid:
- Children 0-18 with a household income less than 250% of the Federal Poverty Limit (FPL)
- Pregnant women with a household income less than 195% of the FPL
- Parents with dependents and a household income less than 105% of the FPL
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Tennessee, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Tennessee's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
- What is TennCare?
TennCare is the Medicaid option for pregnant women, newborns, and children offered through managed care programs. This is the program that provides the majority of the coverage for Tennessee residents that qualify for Medicaid.