Tennessee Medicaid Fee Schedule 2026: Rates, Eligibility Limits & What Providers Need to Know

There is no single public “TennCare Fee Schedule 2026” document covering all medical services. That surprises many providers. Tennessee Medicaid — known as TennCare — runs almost entirely through a managed care model.

This means reimbursement rates are negotiated between providers and the state’s three Managed Care Organizations (MCOs): BlueCare, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup).

That said, the state still sets specific funding benchmarks and mandated payment floors for 2026. CMS has also approved major directed payments for hospitals and primary care.

This article breaks down everything confirmed for 2026 — rates, eligibility thresholds, MCO portals, and what to watch out for.

Last Updated: June 2026 | Sources: CMS/Medicaid.gov, TennCare, Tennessee Department of Finance

Article Summary

• TennCare uses three MCOs — BlueCare, UHC Community Plan, and Wellpoint — so rates vary by contract
• CMS approved $3.2 billion in directed payments for inpatient and outpatient hospital services in 2026
• CMS approved a separate $51.7 million directed payment for primary care in 2026
• Governor Lee’s FY2026–27 budget includes $230 million in TennCare rate investments
• Primary care providers receive a $4 PMPM (per member per month) enhancement under the value-based payment structure
• 2026 nursing home income limit is $2,982/month; asset limit is $2,000
• The Tennessee Workers’ Compensation Medical Fee Schedule is completely separate from TennCare — do not confuse the two

What Is the Tennessee Medicaid Fee Schedule?

Tennessee Medicaid (TennCare) does not publish one master fee schedule the way traditional fee-for-service Medicaid states do. Instead, each of the three MCOs negotiates rates with providers independently.

The state sets minimum benchmarks and directs specific payments through CMS-approved mechanisms — but the actual rate a provider receives depends on their individual contract.

Think of it this way: TennCare sets the rules and funding floors. The MCOs fill in the details through your provider agreement.

How TennCare’s Managed Care Model Affects Rates

Under the managed care model, TennCare pays a fixed monthly capitation rate to each MCO per enrolled member. The MCO then pays providers from that pool. This structure means:

• Rates differ between BlueCare, UHC, and Wellpoint contracts
• Medicare benchmarking is commonly used — many contracts pay a percentage of the Medicare Physician Fee Schedule
• State-mandated floors exist for specific services like CHOICES home care and behavioral health

Why You Won’t Find a Single Published Rate Table

TennCare has explicitly confirmed that no comprehensive public fee schedule for all services exists. Provider-specific rates are proprietary to each MCO contract.

For a detailed breakdown of how income limits and eligibility rules are calculated, use a Medicaid eligibility calculator to estimate whether a patient qualifies before billing.

2026 CMS-Approved Directed Payments for Tennessee

CMS has approved two major state-directed payment programs for Tennessee in 2026. These are the most concrete, confirmed financial figures available.

These directed payments apply to managed care and are incorporated into the MCOs’ capitation rates. They ensure hospitals and primary care providers receive enhanced funding beyond standard contract rates.

Inpatient and Outpatient Hospital Directed Payment

CMS approved a uniform percentage increase for inpatient and outpatient hospital services for the rating period January 1, 2026 through December 31, 2026.

Source: CMS Medicaid.gov — Tennessee Directed Payment Approval (Hospital)

This payment is not made directly to providers. It flows through TennCare to the MCOs, which then adjust provider payments accordingly. Hospitals should verify their expected share with their contracted MCO.

Primary Care Directed Payment (Value-Based)

CMS also approved a separate directed payment for primary care services, also covering January 1, 2026 through December 31, 2026.

Source: CMS Medicaid.gov — Tennessee Directed Payment Approval (Primary Care)

This payment uses a risk-based rate adjustment, meaning higher-acuity patient panels generate a larger share. Primary care providers under Patient-Centered Medical Home (PCMH) contracts should expect the $4 PMPM to be factored into their MCO payments.

2026 TennCare Provider Rate Investment

Beyond the CMS-directed payments, Tennessee’s own state budget adds significant funding to provider rates. These are provider-facing changes that affect what MCOs can realistically pay in 2026.

The state’s FY2026–27 budget signals a meaningful commitment to keeping TennCare provider rates competitive with commercial and Medicare rates.

Governor Lee’s $230 Million Rate Increase

Governor Bill Lee’s FY2026–27 budget allocates $230 million specifically to TennCare. This funding covers:

• Medical inflation adjustments
• Rising Medicare payment benchmarks used as reference rates
• Increased service utilization across TennCare-enrolled populations

This investment does not translate to a published rate sheet. Instead, it funds the capitation rates paid to MCOs, which in turn increases the rate ceilings MCOs can offer in provider contracts.

Medicare Benchmarking in 2026

Many TennCare MCO contracts pay providers as a percentage of Medicare. The CMS 2026 Medicare Physician Fee Schedule (PFS) Final Rule, effective January 1, 2026, serves as the federal baseline for these calculations.

If your contract specifies “X% of Medicare,” your 2026 rates adjusted automatically when the CMS Final Rule took effect. You do not need to renegotiate — but you should verify the update was applied correctly in your remittance statements.

Long-Term Services & Supports (CHOICES Program)

For home and community-based services under the CHOICES program, TennCare sets rates directly — not the MCOs. This ensures wage parity for frontline home care workers. The 2026 market rate for home health skilled nursing visits runs approximately $110–$180 per visit. TennCare waiver rates are designed to stay competitive with this range to preserve access.

Tennessee Health Link Behavioral Health Rates

Providers under the Tennessee Health Link program do not operate on a traditional fee-for-service schedule. Instead, the Tennessee Health Link manual outlines a value-based payment structure. Rates are tied to population management and outcomes, not individual CPT codes.

2026 TennCare Eligibility Income and Asset Limits

If you are a patient — not a provider — the “fee schedule” question often really means: “What are the income limits?” These figures determine whether you qualify for TennCare and what cost-sharing you may owe.

For a full comparison of how Tennessee’s thresholds stack up nationally, see Medicaid income limits by state in 2026.

The 2026 TennCare eligibility thresholds are confirmed as follows:

Nursing Home and Institutional Care Limits

To qualify for TennCare coverage in a nursing facility, an individual’s income cannot exceed $2,982 per month in 2026. Their countable assets must remain at or below $2,000. A spouse remaining in the community is protected under Minimum Monthly Maintenance Needs Allowance (MMMNA) rules, with an income floor of $2,705/month.

Community Spouse Resource Allowance (CSRA)

The community spouse — the partner who stays home — can keep up to $162,660 in assets in 2026 without disqualifying the institutionalized spouse. This is the maximum protected amount under federal CSRA rules and is adjusted annually.

⚠️ Critical Warning: Workers’ Comp Fee Schedule vs. TennCare

This is one of the most common and costly mistakes providers make when searching for Tennessee rate information.

When you search for “Tennessee Medical Fee Schedule 2026,” one of the first results is often a document from the Tennessee Bureau of Workers’ Compensation. That document does not apply to TennCare/Medicaid patients.

The Workers’ Compensation fee schedule is updated periodically (the last update covered services effective April 1, 2025 through March 31, 2026). It pays at significantly higher rates than TennCare. Using WC rates on TennCare claims will result in claim denials.

Source: Tennessee Department of Labor and Workforce Development — Medical Fee Schedule

How to Find Your 2026 TennCare Rate by MCO

Because TennCare rates are contract-specific, you must go directly to your MCO to find your 2026 fee schedule. Here is how to access rates for each of the three TennCare MCOs.

Each portal requires active provider credentialing. If you are not yet credentialed, contact the MCO’s provider relations team before attempting portal access.

UnitedHealthcare Community Plan of Tennessee

UHC’s policies are based on two frameworks:

• National reimbursement determinations (i.e., Medicare PFS)
• State government program rules set by TennCare

How to access: Log in to the UHC Provider Portal and navigate to the “Community Plan of Tennessee” fee schedule. Rate updates for 2026 are posted alongside policy bulletins.

BlueCare Tennessee

BlueCare is Tennessee’s only not-for-profit TennCare MCO and serves a large share of the state’s Medicaid population.

How to access: Contracted providers can view their fee schedule through the BlueCross BlueShield of Tennessee provider portal. Contact BlueCare Provider Services directly for non-portal access or to request a printed rate summary.

Wellpoint (Formerly Amerigroup Tennessee)

Wellpoint rebranded from Amerigroup in 2023 and continues to serve TennCare members statewide.

How to access: Log in to the Availity portal and select your Wellpoint/Amerigroup contract. Your 2026 fee schedule updates are available under the “Tennessee Medicaid” plan section. If your portal shows Amerigroup branding, the rates and policies have been updated to reflect the Wellpoint name change.

2026 TennCare Policy Changes: What Providers Should Know

Beyond the rate numbers, several policy directions are shaping how TennCare pays providers in 2026. These are not finished rules — but they are active legislative and regulatory priorities.

Staying ahead of these changes now helps you avoid contract surprises mid-year.

Rate Alignment with Medicare (Modernization Act)

Legislative efforts under the Tennessee Medicaid Modernization and Access Act continue to push for rate alignment between TennCare and Medicare for three service categories:

• Primary care
• OB/GYN services
• Mental health and behavioral health

The goal is to ensure TennCare rates for these services do not fall below the Medicare fee schedule floor. This is not fully enacted statewide, but MCO contract negotiations in 2026 are being influenced by this framework.

For additional context on how these changes fit into the national landscape, read our guide on the Medicaid fee schedule 2026 across all states.

Value-Based Payments Expanding

The $4 PMPM primary care directed payment is part of a broader state shift toward value-based care. Providers who demonstrate care management outcomes — particularly for high-risk and chronic disease populations — will be better positioned for enhanced payments in future TennCare contract cycles.

How to Apply for TennCare in 2026

If you are a patient trying to enroll in TennCare — not a provider looking for rates — here is how to apply in 2026.

1. Visit TennCare Connect at tennessee.gov/tenncare or apply at HealthCare.gov
2. Gather your documents: proof of income, ID, Social Security number, and proof of Tennessee residency
3. Complete the application online, by phone (1-855-259-0701), or in person at your local Department of Human Services office
4. Wait for eligibility determination — TennCare must process most applications within 45 days (90 days for disability-based applications)
5. Choose your MCO: if approved, you will be able to select BlueCare, UHC Community Plan, or Wellpoint
6. Receive your TennCare card and begin using your benefits immediately upon approval

Frequently Asked Questions: Tennessee Medicaid Fee Schedule 2026

Official Sources and Further Reading

• CMS/Medicaid.gov — Tennessee Hospital Directed Payment 2026: https://www.medicaid.gov/medicaid/managed-care/downloads/TN_Fee_IPH.OPH4_Renewal_20260101-20261231.pdf
• CMS/Medicaid.gov — Tennessee Primary Care Directed Payment 2026: https://www.medicaid.gov/medicaid/managed-care/downloads/TN_Fee.VBP_PC_Renewal_20260101-20261231.pdf
• Tennessee Bureau of Workers’ Compensation — Medical Fee Schedule: https://www.tn.gov/workforce/injuries-at-work/bureau-services/bureau-services/medical-fee-schedule.html
• TennCare — Official Program Information: https://www.tn.gov/tenncare

Next Step

Providers: Log in to your MCO portal today and pull your 2026 contract fee schedule. If your rates have not reflected the $230 million state investment or the updated Medicare benchmarks, contact your MCO’s provider relations team with your contract number.

Patients: If you are unsure whether you qualify for TennCare in 2026, use the Medicaid eligibility calculator to check your household income and asset levels against the confirmed 2026 thresholds before you apply.