Tenncare provides prenatal services to pregnant women.
TennCare is the State of Tennessee's Medicaid program. Medicaid is a government subsidized health care program for low-income residents and their families. TennCare was established in 1994, and provides health care for more than 1 million Tennessee residents. Because the TennCare program pays for a variety of health care services and benefits, recipients must meet certain eligibility requirements to qualify.
Description
According to the Tennessee Government, TennCare is mostly for low-income children, parents, pregnant women and elderly and disabled adults. TennCare provides "managed care" services to beneficiaries, meaning all TennCare recipients receive health coverage through a Managed Care Organization. Behavioral and mental health, as well as long-term care services, are also provided through TennCare. Applicants are enrolled through their local Tennessee Department of Health and Human Services. Enrollees are evaluated by DHS staff and are subject to telephone or in-person interviews to determine eligibility. Once qualified, enrollees are free to choose one of two Managed Care Organizations in their local region.
Medicaid Eligibility
To be eligible for TennCare Medicaid, you must belong to one of several qualified groups. TennCare Medicaid covers children under age 21; pregnant women; caretakers of an eligible minor child; physically or mentally disabled persons; women with breast or cervical cancer; and people who qualify for Supplemental Security Income (SSI). People who belong to these groups must meet income eligibility requirements. Each group has different income limits, as well as limits to the amount of resources available to the beneficiary.
Medical Eligibility
Some TennCare beneficiaries must be "medically eligible" to receive benefits. To qualify as medically eligible, the beneficiary must be under the age of 19 with a family income that is below 200 percent of the Federal Poverty Level (FPL). Further, the beneficiary cannot have access to other health insurance through an employer or a parent's employer. Medically eligible TennCare recipients qualify for TennCare Standard, which is slightly different from TennCare Medicaid. TennCare Standard is for beneficiaries who were previously enrolled in Medicaid but no longer qualify. TennCare Standard provides coverage for beneficiaries with a health condition that makes them uninsurable in the private health market.
Spend Down Eligibility
TennCare Standard Spend Down is for adults who do not necessarily fit into other Medicaid categories, such as pregnant women or medically needy young adults. Qualification is based on income and the amount of medical bills the recipient has. Spend Down beneficiaries must be at least age 65, blind or disabled. Spend Down recipients may also be the caretaker of a minor child, or have a health or mental health problem that is expected to last longer than 30 days.
Tags: pregnant women, Spend Down, TennCare Standard, care services, health care, TennCare Medicaid, beneficiaries must
