Do I Qualify for TennCare? Income Limits and Long-Term Care

TennCare eligibility in Tennessee turns on two things: whether you fit one of the program’s covered groups — pregnant women, children under 19, parents or caretakers of minor children, SSI recipients, or people who are elderly or disabled — and whether your household income (plus, for long-term care, your assets) falls below the limit set for that group. Tennessee has not expanded Medicaid under the Affordable Care Act, so most adults under 65 without children or a qualifying disability cannot qualify regardless of how little they earn.

Who TennCare Covers and the Income Limits

You must be a Tennessee resident who intends to stay, and a U.S. citizen or hold a qualifying immigration status such as lawful permanent residency or refugee status.¹ There is no minimum length of time you need to have lived in the state.

Coverage then breaks into categories, each with its own income threshold measured against the federal poverty level (FPL):²

Pregnant women qualify at household incomes up to 250% FPL. Coverage continues for 12 months after the pregnancy ends, regardless of income changes during that window.³
Children’s limits depend on age: 195% FPL for infants under one, 142% FPL for ages one through five, and 133% FPL for ages six through 18. Children in families up to 250% FPL who don’t qualify under regular TennCare may be eligible for CoverKids, Tennessee’s CHIP program.⁴
Parents and caretaker relatives of a dependent child under 18 (or 18 if a full-time student) qualify up to 100% FPL.⁴
If you receive Supplemental Security Income, Tennessee enrolls you in TennCare automatically. No separate application.⁵
People 65 or older, or with a qualifying disability, who are not on SSI may qualify through the CHOICES long-term care program, which has both income and asset tests.
Newborns born to a TennCare-enrolled mother are automatically covered for one full year.⁴

For the categories above (other than long-term care), TennCare uses Modified Adjusted Gross Income, which is your federal taxable income with certain deductions added back.⁶ There are no asset limits in these groups; your savings, car, or home value do not count against you. A built-in 5-percentage-point disregard also applies, so a parent slightly above 100% FPL — up to about 105% — may still qualify.

What the 2026 Limits Look Like in Dollars

The 2026 federal poverty level is $15,960 per year for a single person and $33,000 for a family of four.⁷ For a single-person household, the key thresholds translate to:

100% FPL (parents/caretakers): $15,960 a year, or $1,330 a month
133% FPL (children 6–18): $21,227 a year
142% FPL (children 1–5): $22,663 a year
195% FPL (infants under 1): $31,122 a year
250% FPL (pregnant women, CoverKids): $39,900 a year, or $3,325 a month

For larger households the numbers scale up. A family of four with two children ages one through five has an income limit of $46,860 at 142% FPL for the children’s coverage.⁸

Medically Needy Spend-Down

Pregnant women and children under 21 whose income exceeds the normal thresholds have one additional path. If you have high unpaid medical bills, you can subtract those costs from your countable income; once the remainder drops below the state’s medically needy level, TennCare picks up the rest.⁹ Spend-down is not available to parents, caretaker relatives, or childless adults.

Adults Without Children: Why Most Don’t Qualify

This is where most confusion happens. Because Tennessee has not adopted ACA Medicaid expansion, adults under 65 who are not pregnant, do not care for a dependent child, and do not have a qualifying disability generally cannot get TennCare at any income level. These individuals fall into what policy experts call the “coverage gap”: too little income for subsidized ACA marketplace plans (which begin at 100% FPL in non-expansion states) and no path into Medicaid.

If that describes your situation, the practical alternative is an ACA marketplace plan at healthcare.gov during open enrollment or after a qualifying life event.

Long-Term Care Eligibility (CHOICES)

If you are 65 or older, or have a qualifying disability, and you need nursing home care or home-based support, the rules change. CHOICES applies both an income test and an asset test.

The income ceiling is 300% of the SSI federal benefit rate — $2,901 per month for a single person as of 2025, updated each January. Countable resources (bank accounts, investments, other non-exempt assets) cannot exceed $2,000 for a single applicant.¹⁰

Your primary home is generally exempt, but Tennessee applies a home equity cap of $752,000. Above that, you don’t qualify unless a spouse, a child under 21, or a blind or disabled child of any age lives in the home. TennCare also reviews any assets you sold or transferred in the 60 months before applying; moving property for less than fair value during that window can trigger a penalty period of ineligibility.¹⁰

Protecting a Spouse’s Assets

When one spouse enters a nursing facility and the other stays home, federal rules keep the at-home spouse from being left impoverished. The community spouse can keep half of the couple’s combined countable resources as of the date the other spouse enters care, subject to a floor of $32,532 and a ceiling of $162,660 as of January 2026.¹¹ If the couple has $200,000 in countable resources, the community spouse keeps $100,000; if they have only $40,000, the spouse still keeps at least $32,532.

How to Apply

You can apply three ways:¹²

Online at TennCareConnect.TN.gov, where you can apply, upload documents, and track your status
By mail to TennCare Connect, P.O. Box 305240, Nashville, TN 37230-5240
In person at your local Department of Health office

Have these ready before you start:

A driver’s license, state ID, or other government-issued photo ID
Proof of Tennessee residence, such as a utility bill or lease
Recent pay stubs, tax returns, or Social Security or benefit statements
Social Security numbers for everyone applying, or proof an SSN was applied for¹³
For long-term care applications, bank statements, deeds, and records of asset transfers over the past five years

Online applications can sometimes return an instant answer when income and other data verify in real time. Otherwise, standard applications take up to 45 days; long-term services applications can take up to 90 days because medical eligibility is reviewed too.¹⁴ Respond quickly to any request for additional documents; delays can result in denial for failure to provide information.

If You’re Denied

A denial notice will state the reason. You have 40 days from the date on the notice to file an appeal with Tennessee Health Connection by phone at 1-855-259-0701, by fax at 1-855-315-0669, or by mail to P.O. Box 305240, Nashville, TN 37230-5240.¹⁵

If you already had TennCare and your coverage is being ended, there’s a shorter clock worth watching. Filing within 20 days of the termination notice, or before your coverage end date (whichever is later), keeps your benefits active while the appeal is pending. Miss that window and coverage stops even if the appeal continues.¹⁵ An administrative judge conducts the hearing, and you’re entitled to help preparing your case.

1
Justia Law. Tennessee Code 71-5-120 – Residency Requirement – Determination – Appeal
2
TN.gov. TennCare Medicaid
3
Centers for Medicare & Medicaid Services. CMS Approves Extension of Medicaid and CHIP Coverage For 12 Months After Pregnancy In Tennessee, South Carolina
4
TN.gov. Eligibility Reference Guide
5
TN.gov. SSI Cash Recipient
6
Cornell Law Institute. Tennessee Comp R Regs 1200-13-20-.06 – Financial Eligibility Determinations
7
Federal Register. Annual Update of the HHS Poverty Guidelines
8
TN.gov. TennCare Eligibility Reference Guide
9
Cornell Law Institute. Tennessee Comp R Regs 1240-03-03-.06 – Income Limitations for the Medically Needy and Standard Spend Down
10
TN.gov. TennCare Long Term Services and Supports Financial Rules Guide
11
TN.gov. Resource Assessment – Institutional Medicaid
12
TN.gov. How Do I Apply for TennCare?
13
Cornell Law Institute. Tennessee Comp R Regs 1200-13-14-.02 – Eligibility
14
TN.gov. TennCare Frequently Asked Questions
15
TN.gov. Appeals