In 1994, the state of Tennessee completely changed the Medicaid program for its residents and called the new program TENNCARE. TENNCARE provides health care benefits to individuals formerly covered by Medicaid and also covers a large number of uninsured individuals. Unlike the former Medicaid program, you do not have to be poor to qualify for certain types of TENNCARE.

Individuals who receive aid to families with dependent children (AFDC) or supplemental security income (SSI) are automatically eligible for TENNCARE.

Low-Income individuals who have large medical bills can qualify for TENNCARE under the spend down TENNCARE program. Low-income individuals who have a Medicare card can qualify for TENNCARE under the spend down TENNCARE program and can also qualify for a qualified Medicare beneficiary TENNCARE card called QMB. If you qualify for QMB, TENNCARE will pay for your Medicare premiums.

Individuals who are in long-term health care institutions such as nursing homes may have their nursing home care paid for under the old Medicare program.

If you think you may qualify for TENNCARE as a low-income individual, you should apply at your nearest county Department of Human Services. There are standards or rules of eligibility that must be met to receive each type of TENNCARE benefit. Tennessee Law provides for certain deductions and exclusions from income in determining TENNCARE eligibility, these deductions, exclusions, and income guidelines change from time to time. If you do apply and are turned down, you have the right to appeal the decision. It is very important that you read your TENNCARE letters carefully so you do not miss a time to challenge the decision of the Department of Human Services. These letters also advise you of your responsibility to report changes in your situation that might affect your eligibility.

If you need medical assistance and do not believe you qualify for TENNCARE as a low income individual, you may be eligible for TENNCARE as an uninsured individual. You may be able to receive TENNCARE if you do not have access to private medical insurance. TENNCARE is also available for individuals who cannot obtain private health insurance because of a health condition. Even if you have insurance but it does not cover a pre-existing health problem, you may be able to get TENNCARE to cover just that health problem. Individuals who have a Medicare card may be able to qualify for TENNCARE if they cannot purchase a private Medicare supplement policy. If your income is over a certain amount, you will be required to pay monthly premiums to cover your TENNCARE benefits.

If you believe you are eligible for TENNCARE benefits, you need to fill out an application and send it to the state of Tennessee. Applications are available at the Department of Human Services and the county health department.

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