Tennessee CHIP Program: Eligibility, Benefits, and How to Apply

Tennessee’s CHIP program is called CoverKids, and it provides no-premium health, dental, vision, and mental health coverage to uninsured children under 19 and to pregnant women in households earning at or below 250 percent of the federal poverty level.¹ It fills the gap between TennCare (Tennessee’s Medicaid program) and private insurance: families whose income is too high for TennCare but who still cannot comfortably buy coverage on their own.

Who Qualifies for CoverKids

Every CoverKids application is screened first for TennCare eligibility. A child or pregnant woman who qualifies for TennCare is enrolled there instead of in CoverKids.¹

Children Under 19

A child qualifies if they are under 19, a Tennessee resident, a U.S. citizen or qualified non-citizen, and living in a household at or below 250 percent of the federal poverty level. CoverKids must be the child’s only health plan; a child already enrolled in any other insurance is not eligible. There are no pre-existing condition exclusions.²¹

Pregnant Women

Pregnant women qualify at the same 250 percent FPL income ceiling. Unlike the rule for children, a pregnant applicant can keep CoverKids even if she already has another health plan, as long as that plan does not include maternity benefits. No immigration documents are required for pregnant applicants.²

What 250 Percent FPL Looks Like

The dollar thresholds adjust each year. As published by the state, the current income ceiling is $54,100 per year for a family of two and $82,500 per year for a family of four.²

What CoverKids Covers

Well-child visits and vaccinations are free. Sick visits and medications carry low copayments.³ Covered services include:

Doctor visits, hospital stays, developmental screenings, and vaccinations.
Behavioral health and substance use disorder services.
Physical, speech, and occupational therapy, each capped at 52 visits per calendar year.
One vision exam and one set of lenses per calendar year, with new frames every two years.
Prenatal care, delivery, and postpartum services for eligible pregnant women.
Hearing aids: one per ear each calendar year for children under five, and one per ear every two years for older children.
Home health nursing up to 125 visits per calendar year.

These service limits come from managed care organization handbooks and apply generally across plans.⁴

Dental and Orthodontic Care

Dental coverage for children through age 18 is a major part of CoverKids. Routine preventive services such as oral exams, X-rays, and fluoride treatments carry no copayment. Since January 2025, medically necessary orthodontic treatment has been covered with no lifetime maximum and no out-of-pocket cost for approved cases.⁵ Braces are covered only for children diagnosed with a handicapping malocclusion; purely cosmetic orthodontia is not covered.⁶ Routine dental care is not available to pregnant women age 19 and older.⁴

Diapers for Children Under Two

Children under age two enrolled in CoverKids or TennCare can receive up to 100 diapers per month (or 200 per 60-day period) at no cost and without a prescription. The benefit was approved by CMS on May 17, 2024, under an amendment to the TennCare III Section 1115 demonstration waiver, and launched in August 2024.⁷ It covers disposable diapers, pull-ups, and trainer diapers from major brands, distributed through participating pharmacies statewide.⁸

What CoverKids Costs

There are no monthly premiums.¹ Copayments apply to some services, and the amount depends on whether household income falls in the lower tier (below 200 percent FPL) or the higher tier (200 to 250 percent FPL):⁹

Physician office visit: $5 lower tier, $15 to $20 higher tier.
Inpatient hospital admission: $5 lower tier, $100 higher tier.
Generic prescription: $1 lower tier, $5 higher tier.
Non-preferred brand-name prescription: $5 lower tier, $40 higher tier.
Non-emergency use of the emergency room: $10 lower tier, $50 higher tier.

Pregnant enrollees and children in hospice care owe no copayments. Ambulance rides, emergency care, routine checkups, immunizations, and lab work are also exempt. Federal law caps total annual out-of-pocket spending on CoverKids at five percent of household income. A child cannot be dropped from CoverKids for missing a copay, though a provider may decline a non-emergency service when a copay goes unpaid.⁹

Which Health Plan You’ll Use

Care is delivered through three managed care organizations, each with its own provider network:¹⁰

BlueCare Tennessee, operated by Volunteer State Health Plan, an affiliate of BlueCross BlueShield of Tennessee: 888-325-8386.
Wellpoint (formerly Amerigroup), operated by AMERIGROUP Corporation: 833-731-2153.
UnitedHealthcare Community Plan, operated by UnitedHealthcare Plan of the River Valley: 866-600-4985.

All three are accredited by the National Committee for Quality Assurance.¹⁰⁴¹¹

How to Apply

Applications go through TennCare, which handles eligibility for both TennCare and CoverKids and will screen every applicant for Medicaid first.¹² You can apply four ways:

Online at the TennCare Connect portal, tenncareconnect.tn.gov.
By phone, by calling TennCare Connect at 855-259-0701.
By mail or fax, using the paper application from tn.gov/coverkids. Mail to TennCare Connect, P.O. Box 305240, Nashville, TN 37202-5240, or fax to 855-315-0669.
In person at a local health department, which is an option available to pregnant women.

Coverage begins on the day a completed, signed application is received or the day all eligibility criteria are met, whichever is later.¹²

Keeping Your Coverage

Once enrolled, a child receives 12 months of continuous coverage. Income changes during those 12 months do not interrupt the child’s coverage. At the end of the year, the state tries to renew automatically from information already on file. If it cannot, a renewal packet is mailed, and the family needs to return it to keep coverage going.¹³

Postpartum Coverage

Postpartum coverage length depends on which category the mother is enrolled in. Adult pregnant women enrolled in the CoverKids Pregnant Woman category receive coverage through a 60-day postpartum period. Pregnant children under 19 enrolled through the CoverKids Child category receive 12 months of postpartum coverage.¹⁴ Newborns of CoverKids-enrolled mothers are evaluated at birth and placed in whichever program they qualify for, with coverage retroactive to the date of birth.¹²

If Your Application Is Denied

You can appeal a denial, a coverage termination, incorrect income or family-size information in your file, or a decision that has been pending more than 45 days. File by phone at 855-259-0701, online through the TennCare Connect portal, or in writing using the TennCare Eligibility Appeal Form. Mail written appeals to Eligibility Appeals, P.O. Box 23650, Nashville, TN 37202-3650, or fax them to 844-563-1728.¹⁵

Free legal help is available through the Legal Aid Society of Middle Tennessee and Legal Aid of East Tennessee. The TennCare Advocacy Program, at 800-758-1638, assists individuals with mental illness.¹⁵

1
Kid Central TN. CoverKids
2
Tennessee Department of Finance and Administration. CoverKids Eligibility
3
Tennessee Department of Finance and Administration. CoverKids Home
4
BlueCross BlueShield of Tennessee. BlueCare CoverKids Member Handbook
5
DentaQuest. CoverKids Dental Member Handbook
6
Tennessee Division of TennCare. Dental Services
7
Tennessee Division of TennCare. CMS Approves TennCare III Amendment
8
Georgetown University Center for Children and Families. Tennessee to Begin Providing Diapers for Children Under Age 2 in Medicaid
9
Tennessee Secretary of State. CoverKids Administrative Rules
10
Tennessee Division of TennCare. CoverKids Managed Care Information
11
Wellpoint. Wellpoint CoverKids Member Handbook
12
Tennessee Division of TennCare. CoverKids Frequently Asked Questions
13
Tennessee Division of TennCare. CoverKids Frequently Asked QuestionsWellpoint CoverKids Member Handbook
14
Tennessee Division of TennCare. CoverKids Policy Manual
15
Tennessee Division of TennCare. How to File an Eligibility Appeal