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Learn About Requirements for Medicaid in Tennessee

UPDATE: In 2020, Medicaid is not expected to undergo any significant changes.

Learning what are the requirements for Medicaid in Tennessee is the initial step in determining if you qualify for coverage under the state system. TennCare Medicaid benefit eligibility criteria varies depending on many factors including the age and income of the applicant. In addition to age, several other non-financial TN Medicaid eligibility requirements apply to those seeking subsidized care from state and federal programs.

What are the Income Requirements for Medicaid in Tennessee?

Finding out who is eligible for Medicaid in Tennessee is in most cases a matter of determining a petitioner’s financial status. Financial Medicaid benefits eligibility is mainly based upon income and size of the household, with lower-income households reflecting a higher need for coverage.

To find out if you meet the medical eligibility requirements, you must calculate your total household income and count the number of persons in your care, including yourself. Benefits petitioners new to the state need not worry what are the Medicaid application guidelines in TN, as the income requirements are set by the federal government and they apply to all states.

To more specifically answer the question, “What are the income requirements for Medicaid in Tennessee?” a petitioner must not have a household income more than 106 percent of the Federal Poverty Level. As mentioned above, the two factors that determine a person’s eligibility is their income, as determined by earnings and assets, as well as the size of their household.

The Medicaid benefits eligibility income requirement for households made up of just one person is up to $16,395. While two-member households can earn up to $22,108 in combined annual income and still be eligible for benefits. The income limit increases approximately $6,000 with the addition of each family member.

To determine the Medicaid benefits eligibility requirements, for various household sizes, refer to the information provided below:

  • 3 members: $27,821
  • 4 members: $33,534
  • 5 members: $39,248
  • 6 members: $44,961
  • 7 members: $50,688
  • 8 members: $56,429
  • 9 members: $62,169
  • 10 members: $67,910
  • 11 members: $73,651
  • 12 members: $79,392

Households with more than 12 members can determine what are the income requirements for Medicaid in Tennessee by adding $5,741 for each additional household member.

What Are the Non-Financial Medicaid Requirements in Tennessee?

Tennessee Medicaid benefits eligibility are not solely determined by the income of a petitioner. Other important factors that can qualify someone for benefits under TennCare include age, disability whether or not you have certain medical conditions. Furthermore, all Medicaid beneficiaries must have in-state residency and be a US citizen or otherwise have legal presence status. Explore the different Medicaid requirements by downloading our informative guide.

Generally, petitioners meet Medicaid TN eligibility requirements if they fall into any of the following categories:

  • Are 65 years of age or older
  • Are blind or disabled
  • Are younger than 21 years of age
  • Are pregnant women
  • Are caretakers of minor children
  • Are women in need of treatment for breast or cervical cancer

In addition to the above mentioned groups, who is eligible for Medicaid is also determined by other factors such as the participation in other federal benefits programs, specifically for those who receive Social Security benefits. Supplemental Security Income (SSI) recipients are eligible for Medicaid.

Also, medical benefits eligibility extends to SSI check recipients who have received a Social Security check in the same month at least once since April of 1977 and who continue to receive a Social Security Check. Additionally, persons who live in a nursing home and have an income below $2,199 per month or receive long-term care services paid for by TennCare are also considered non-financial beneficiaries of Medicaid.

To answer the question of “what are the requirements for Tennessee Medicaid in the case of caretakers of a qualifying child,” the parent receives benefits if the child’s other parent is one of the following: deceased, unemployed, under employed or not living with the child.

Program beneficiaries must prove they meet the Medicaid eligibility requirements by furnishing proof of their claims in the form of income tax returns, legal presence documents, power of attorney forms and any other acceptable documents.

Learn About Tennessee Medicaid Through Other Program Enrollment

Alternative benefits for residents who do not meet the Tennessee Medicaid eligibility criteria are available for children and adults through the state and various community non-profit organizations. Families who do not otherwise meet Medicaid eligibility requirements still have plenty of low-cost health care options to choose from to help supplement their medical needs.

Petitioners who were denied benefits after figuring out how to qualify for Medicaid can instead take advantage of services offered through TennCare Standard, CoverKids, CoverRX and at health departments, dental clinics and community health centers throughout the state. Such agencies offer medical and mental health care services on a sliding scale, based upon a patient’s household income.

Children younger than 19 years of age whose TN Medicaid benefits eligibility is coming to a close may be eligible for coverage under TennCare Standard. Dependents who qualify for the program are those who are at risk of being without medical coverage as neither of their parent’s insurance plan cover them due the child being uninsurable in the private healthcare marketplace. Usually, this is due to the child having a pre-existing medical condition.

Households with an income that is more than 211% of poverty qualify for the program. An example of the yearly income limit for TennCare Standard is, a family of four cannot have an income greater than $51,273 per year while a family of two’s income shall not exceed $33,803. Learn more about Medicaid requirements by downloading our comprehensive guide.