TennCare provides Medicaid coverage for residents of Tennessee.
In Tennessee, the state Medicaid program goes by the name of TennCare. The state obtained a federal waiver to run its Medicaid system as a demonstration program. TennCare is trying to show that states can use a managed care model for Medicaid and save enough money to extend coverage to groups of people who might not ordinarily fall under the Medicaid umbrella. The goal is to do this without compromising the quality of medical care provided.
Managed Care
Those who qualify for TennCare generally have a choice of joining any "at risk" managed care organization (MCO) in their region of the state. These MCOs provide medical and behavioral services. All care is coordinated by the enrollee's primary care provider at the chosen MCO. In addition, prescriptions are managed by a pharmacy benefits manager. Children under the age of 21 receive dental care through a dental benefits manager. Enrollees who need long-term care services receive those through nursing facilities (NFs). There are intermediate care facilities for people with mental retardation (ICFs/MR). Some home- and community-based services are also provided. The program is subject to change, so check the state website for the latest developments.
Applications
The state Department of Human Services (DHS) decides who is eligible for TennCare. All 95 counties in the state have a DHS office, and the addresses and phone numbers are available on the TennCare website. You can call the local office and have an application sent to you, drop by the office and pick one up, or print an application from the computer. You can also apply online. If you choose to fill out a paper application, it can be mailed, faxed or dropped off at a DHS office. Help is available for those who have questions or need assistance filling out the form.
Eligibility
TennCare is available to any state resident who qualifies for a Medicaid program. Many different groups of people may qualify for Medicaid, and there are different income limits for the various groups. In addition, eligibility in some groups may be based on how much you own, as well as how many individuals are in your household. Some of the groups that may be eligible for coverage include children under the age of 21, pregnant women, single parents, families with minor children when a parent's work hours have been cut, people who get supplemental security income, women being treated for breast or cervical cancer, and people on limited income who live in a nursing home.
Tags: benefits manager, groups people, managed care, Medicaid program
