Medicaid Eligibility in Tennessee for 2026: Complete Guide

Last Update: 6 January 2026, by Akash Biswas

Quick Answer: Do You Qualify for Tennessee Medicaid (TennCare) in 2026?

Tennessee Medicaid, called TennCare, does NOT cover all low-income adults. You must fit into a specific group AND meet income limits.

You might qualify if you are:

• A parent or caretaker with a child under 18 and income below $33,758/year (family of 4)
• Pregnant with income below $64,300/year (family of 4) – coverage lasts 12 months after birth
• A child under 19 with family income below $80,375/year (family of 4)
• Age 65 or older and need help with daily care
• Disabled and need long-term care services
• Receiving SSI (Supplemental Security Income)

You probably DON’T qualify if:

• You’re a healthy adult without children (even with $0 income)
• You don’t fit any of the categories above

Good News for 2026 – New Benefits You Should Know:

• Free dental care for adults – fillings, crowns, root canals, exams
• Free diapers – 100 diapers per month for babies under age 2
• Longer coverage after pregnancy – full 12 months instead of just 60 days

Don’t Qualify? You Still Have Options:

• CoverRx – cheap medications if you earn less than $21,677/year (single adult)
• CoverKids – free health coverage for kids in families earning up to $80,375/year (family of 4)
• Marketplace insurance – federal subsidies if you earn more than $15,060/year (single adult)

Why Tennessee Medicaid Is Different

Many people assume Medicaid works the same in every state. It doesn’t.

Tennessee did not expand Medicaid, which means being poor is not enough to qualify. You must be pregnant, a parent, a child, elderly, or disabled. Thousands of low-income adults fall into what’s called the “coverage gap” – they earn too little for marketplace subsidies but don’t fit a TennCare category.

However, if you DO qualify, TennCare now offers better benefits than ever before. The dental coverage alone saves families hundreds or thousands of dollars per year.

This guide explains everything you need to know about TennCare eligibility in 2026 in simple language. You’ll learn exactly who qualifies, how much you can earn, what’s covered, and where to apply.

What Is Medicaid Eligibility 2026 in Tennessee?

Medicaid in Tennessee, known as TennCare, is a state and federally funded health insurance program for eligible residents who cannot afford private health coverage. It is administered by the Tennessee Bureau of TennCare.

Critical fact for 2026: Tennessee remains a non-expansion state for Medicaid. This means eligibility for TennCare is NOT based solely on having a low income. You must fit into a specific demographic category (such as being a parent, pregnant, a child, or disabled) AND meet strict income limits.

Most healthy adults without dependent children do not qualify for TennCare, regardless of how low their income is, creating a “coverage gap” for many residents.

TennCare focuses on providing access to healthcare services like doctor visits, hospital care, prescriptions, mental health services, long-term care, and now includes enhanced benefits like adult dental care and diapers for young children.

Who Qualifies for TennCare in 2026?

Medicaid eligibility in Tennessee is based on both income and category. Being low-income alone is not enough to qualify.

You may qualify for TennCare in 2026 if you are:

Parents & Caretaker Relatives: Eligible if you have a dependent child under 18 living with you and your household income is at or below 105% of the Federal Poverty Level (FPL). This is a recent increase from previous years.

Pregnant Women: Eligible with household income up to 200% FPL. Coverage includes prenatal care, delivery, and extends for a full 12 months postpartum (a permanent expansion from the previous 60-day limit).

Children (TennCare & CoverKids):

• TennCare Medicaid: For children with income up to 142% FPL (ages 1-5) or 133% FPL (ages 6-18)
• CoverKids (CHIP): For children up to age 19 with income up to 250% FPL who don’t qualify for Medicaid

Seniors & Disabled (CHOICES): For those needing long-term services. Income limit is 300% of the Federal Benefit Rate (approximately $2,901/month in 2025, rising with 2026 COLA). Asset limits ($2,000 for individuals) apply.

Children with Disabilities (Katie Beckett Waiver): For children with disabilities and/or complex medical needs who would otherwise be ineligible due to their parents’ income. This is a critical option for middle-class families with special needs children.

You generally must also:

• Live in Tennessee
• Be a U.S. citizen or have qualified immigration status
• Meet income guidelines for your eligibility group

2026 Income Limit Guidelines

Data Accuracy Note: The income figures below reflect the 2025 Federal Poverty Level, which are typically used for early 2026 eligibility determinations.

The official 2026 FPL adjustments are expected in late January 2026 and will likely increase these limits slightly.

For seniors and disabled individuals needing long-term care services, the income limit is approximately $2,901/month (300% of Federal Benefit Rate).

What’s New for TennCare in 2026: Enhanced Benefits

TennCare has introduced several major benefit enhancements that many residents don’t know about:

Comprehensive Adult Dental Coverage (Added 2023)

TennCare now covers dental care for all adult members, not just children or pregnant women. Covered services include:

• Routine dental exams
• X-rays
• Fillings
• Crowns
• Root canals
• Extractions

This is a significant expansion that addresses one of the most common unmet healthcare needs among low-income adults.

Monthly Diaper Benefit (New for 2024-2026)

TennCare and CoverKids now provide 100 diapers per month for children under age 2. This benefit offers massive financial relief for young families, as diapers can cost $70-$80 per month or more.

12-Month Postpartum Coverage (Permanent Extension)

Pregnant women who qualify for TennCare now receive coverage for a full 12 months after giving birth, rather than the previous 60-day limit.

This ensures new mothers can access critical postpartum care, mental health services, and family planning.

What Tennessee Medicaid Covers vs What It Doesn’t

Covered Services

• Doctor visits and clinic care
• Hospital stays
• Prescription medications
• Preventive care
• Mental health services
• Maternity and postpartum care (12 months)
• Adult dental care (exams, fillings, crowns, root canals)
• Diapers for children under 2 (100 per month)
• Long-term care (for eligible individuals)
• Emergency services

Not Typically Covered

• Cosmetic procedures
• Treatments not medically necessary
• Most over-the-counter drugs
• Experimental treatments
• Non-medical personal services
• Services outside TennCare approval
• Luxury or elective services

Coverage may vary depending on your eligibility group and managed care plan, but essential medical services and the enhanced benefits listed above are generally included.

Step-by-Step: How to Apply for TennCare

Step 1: Review Your Personal Situation

Start by identifying whether you fit into a qualifying category. TennCare eligibility depends on age, pregnancy, disability status, or caregiving role, not income alone.

Step 2: Gather Required Information

Having documents ready helps prevent delays. You may need:

• Proof of identity and Tennessee residency
• Social Security numbers for all household members
• Income documentation (pay stubs, benefit letters, tax returns)
• Medical or disability-related records, if applicable
• Information about current insurance coverage
• Proof of pregnancy (if applicable)

Step 3: Submit Your Application

The official application portal is TennCareConnect.tn.gov. This is the only official online application system.

You can also apply:

• By phone
• By mail
• In person through local Department of Human Services offices

Online applications are typically the fastest and easiest to track.

Step 4: Respond to Verification Requests

After applying, TennCare may ask for additional documents. This is a normal part of the process. Responding quickly helps avoid denial or delays.

Step 5: Receive an Eligibility Decision

Most applications are reviewed within a few weeks. Processing may take longer if disability or long-term care eligibility is being evaluated.

Important Rules, Limits, and Requirements

Tennessee Medicaid has several rules that beneficiaries must follow:

• Eligibility is category-based, not income-only
• Coverage must be renewed periodically, usually once a year
• Changes in income, address, or household size must be reported within 10 days
• Some services require prior approval from your managed care organization
• Not all healthcare providers accept TennCare (always verify before scheduling)
• Most members are enrolled in a managed care organization and must select a primary care provider

A common misunderstanding is assuming TennCare works like Medicaid in expansion states. In Tennessee, the qualifying category is often the deciding factor, not just income level.

The Coverage Gap: Understanding Who Does NOT Qualify

This is critical information: If you are an adult without dependent children and are not disabled, elderly, or pregnant, you generally cannot qualify for TennCare, even if you have $0 income.

Additionally, if your income falls below 100% of the Federal Poverty Level, you may not qualify for ACA Marketplace subsidies either, leaving you in what’s called the “coverage gap.”

For a single adult in 2026, this means earning less than approximately $15,060/year puts you in a situation where you qualify for neither TennCare nor subsidized marketplace coverage.

Alternatives If You Don’t Qualify for TennCare

CoverRx: Pharmacy Assistance Program

If you do not qualify for full TennCare, you may be eligible for CoverRx, which provides affordable medication coverage.

Eligibility:

• Ages 19-64
• Income at or below 138% FPL (approximately $21,677/year for an individual in 2026)

Benefit:

• Access to over 200 generic medications at deeply discounted prices
• No monthly premium

How to Apply: Through TennCareConnect.tn.gov or by calling TennCare

Health Insurance Marketplace

If your income is above 100% FPL, you may qualify for subsidized health insurance through the federal Health Insurance Marketplace at HealthCare.gov. Many people can find plans with monthly premiums under $50 with subsidies.

Community Health Centers

Federally Qualified Health Centers (FQHCs) throughout Tennessee provide care on a sliding fee scale based on income. You can receive care even if you don’t qualify for TennCare or cannot afford insurance.

Katie Beckett Waiver

For families with children who have disabilities or complex medical needs, the Katie Beckett Waiver allows the child to qualify for TennCare based on their own income rather than the parents’ income. This is essential for middle-class families whose children need extensive medical care.

What Happens After You’re Approved or Denied

If Approved

You’ll receive a TennCare ID card and enrollment details by mail. Most members are placed in a managed care organization (MCO) such as:

• BlueCare
• Amerigroup
• UnitedHealthcare Community Plan

You may need to select a primary care provider within your MCO’s network. Coverage typically starts shortly after approval. In some cases, TennCare may help cover recent medical expenses if you were eligible during that time.

If Denied

You’ll receive a written notice explaining the reason for denial. You have the right to appeal the decision within 90 days. The notice will include instructions on how to request an appeal hearing.

If you’re denied, also consider:

• Applying for CoverRx if you’re under 65
• Exploring Marketplace coverage if your income is above 100% FPL
• Seeking care at community health centers
• Reapplying if your circumstances change (pregnancy, disability, birth of a child)

Helpful Tips for Success

• Apply as soon as your situation changes: Pregnancy, job loss, birth of a child, or disability diagnosis
• Keep copies of everything: All applications, documents submitted, and correspondence received
• Check your mail and TennCareConnect account regularly: Missing a request for information can result in denial
• Report changes immediately: Income increases, address changes, or household composition changes must be reported within 10 days
• Use the official portal: Always apply through TennCareConnect.tn.gov to avoid scams
• Ask about enhanced benefits: When you’re approved, specifically ask about adult dental coverage and the diaper benefit if you have a child under 2
• Don’t assume you don’t qualify: Many people are eligible for CoverKids or CoverRx even when they don’t qualify for full TennCare

Frequently Asked Questions

Conclusion

Understanding Medicaid eligibility 2026 in Tennessee starts with knowing that TennCare is more limited than Medicaid in expansion states, but has become significantly more valuable with enhanced benefits like adult dental coverage, diapers for young children, and extended postpartum care.

While the program remains restricted to specific categories (parents, pregnant women, children, elderly, and disabled individuals), the income thresholds have increased for some groups, and new benefits address critical needs that were previously unmet.

If you think you may qualify, applying is worth the effort. Even if you don’t qualify for full TennCare, programs like CoverRx and CoverKids may provide the assistance you need. With the right information, careful preparation, and timely follow-up, you can navigate the process confidently and access the best healthcare options available to you in Tennessee.

Take action today: Visit TennCareConnect.tn.gov to check your eligibility and apply online.