Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Tennessee program

Government health insurance for your child (TennCare)

TennCare is free health insurance for children under 19. It can sit behind insurance you already have.

What it is

TennCare is free health insurance for children under 19. It can sit behind insurance you already have.

TennCare covers children whose household income meets the limit for their age. A drop in pay can change the answer. Tennessee decides who counts in your child’s household and which income counts.

Eligibility rules
  • Your child must live in Tennessee and be under 19. The child income categories have no savings test.
  • Current monthly income is the test. A yearly figure divided by 12 is only an estimate.
  • The published base limits are 195% of poverty under age 1, 142% at ages 1–5, and 133% at ages 6–18. A five-point allowance raises those screens to 200%, 147% and 138%.
  • For a household of four, the 2026 base amounts are $5,363, $3,905 and $3,658 a month respectively. The infant upper screen is $5,500.
  • Your child must also meet the citizenship or immigration rules; the counselor can check your child's status and documents.
  • Through September 30, 2026, eligible noncitizen coverage follows status-specific rules, including five-year waiting periods and exceptions. Applicable verification cases allow a 90-day reasonable opportunity to supply evidence. Lawful presence alone does not establish eligibility.
  • A child who is a citizen can qualify. For a child who is not, the rules depend on their exact immigration status and how long they have held it, so ask the counselor to check your child's own papers before assuming either way.
Why discuss TennCare when your child already has insurance?
  • A work plan does not block ordinary child TennCare. The work insurer is billed first.
  • TennCare can cover services under its own rules, including rides and medically needed home nursing.
What needs checking
  • The hospital, cancer team and pharmacy need to work with the exact plans you use. Managing two plans means keeping both sets of coverage information clear.
  • For covered care approved as required, a hospital or doctor bound by TennCare’s billing rule generally cannot charge you the work plan’s deductible, coinsurance or copay. This protection can apply even when TennCare pays $0. The care team can check both plans and help correct a bill.
What you get
  • No monthly premium or child copays for covered care.
  • Hospital stays, chemotherapy, medicines, home nursing and rides, subject to the care rules.
  • Eligible bills from before the application can also be covered.
What the help covers
  • Nursing at home requires a separate review of your child’s medical needs. Rides have their own booking rules.
  • Your work plan is billed first. For covered care, the clinic cannot bill you the deductible or copay the work plan left, even when TennCare pays nothing extra. If a bill arrives anyway, ask the financial counselor to check it before paying.
  • Example only: a $5,000 private allowed charge, a $3,000 remaining deductible and 20% coinsurance leave $3,400 on the private statement. If the private insurer pays $1,600 and TennCare allows $1,200, TennCare may pay $0. For care protected by its payment-in-full rule, the participating provider cannot collect that $3,400 from your family.
If you decide to apply
  1. If you decide to pursue TennCare, the hospital’s financial counselor can help with TennCare Connect online or by phone.
  2. Current income information, insurance cards and earlier medical bills help the counselor review your options.
  3. The counselor can check temporary hospital coverage and which plans include your child’s cancer team.

TennCare Connect: 1-855-259-0701 · Official page ↗

After you ask
  • The usual application standard is 45 days, or 90 days when disability must be decided. Listed exceptions can delay a decision. Medical-care appeals normally must reach TennCare within 60 calendar days of the notice date, or awareness of the problem without a notice.
  • Ordinary child TennCare usually continues for 12 months even if income changes, with limited exceptions such as moving out of Tennessee or turning 19. Temporary hospital coverage and the separate Medically Needy Child route do not have the same 12-month rule.
  • For ordinary child-income TennCare, eligible care in the three months before the application month can be considered through 2026. A federal change shortens the child period to two months for applications from January 1, 2027; TennCare must confirm the rule for the child’s category and dates.
  • If a treatment is refused, you have 60 days to appeal. The plan looks again within 14 days, and a hearing follows if it still says no, usually within 90 days in all. When waiting could harm your child, ask for the urgent version, which is decided within about three days at each step.
  • If TennCare tries to stop a service your child already has, ask in writing within 10 days of the notice to keep it going during the appeal. If you lose the appeal, TennCare can ask for that cost back.
Good to know

Your work plan is billed first. Keeping both plans means checking that the hospital and cancer team can bill both.

Other details
  • A participating hospital’s own trained staff can check temporary TennCare. It begins when they find the child presumptively eligible; without a full application it ends on the last day of the next month. A timely full application lets temporary coverage continue until TennCare decides it; the hospital must confirm participation and your child’s dates.
  • The state adds a small allowance on top of the printed line, so a family just over it is worth an application.

Federal background: Medicaid. Medicaid alongside private insurance.

Official sources
Ask your social worker

“Could TennCare reduce our treatment bills, and what would managing it alongside any insurance we have involve? If it would help, could you work through the application with us?”

Why I’m asking: I want treatment covered without losing access to our child’s cancer team.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on TennCare Connect today, report this month’s income and any insurance, and name the months that already have bills.

Your social worker

The oncology social worker or financial counselor files with you, asks the hospital to open temporary TennCare that day, and chases the 45-day answer.

The care team

Nothing for ordinary child TennCare. Medical records matter only for the Katie Beckett route.

Who decides
TennCare checks the income. The health plan you pick then runs the coverage.
Ask your social worker
“Can you help me file on TennCare Connect today and ask the hospital for temporary coverage while we wait? Can we list bills from the three months before, and check the hospital and the oncology group are in the plan we pick?”

How to apply

First step: Discuss whether this route fits your child’s care and existing coverage with the social worker. If you choose it, the financial counselor can help with TennCare Connect and the relevant dates.

  1. Discuss whether this route fits your child’s care and existing coverage with the social worker. If you choose it, the financial counselor can help with TennCare Connect and the relevant dates.
  2. List the months that already have bills so the look-back covers the admission.
  3. Pick a health plan the hospital and the oncology group are both in.

Official application / program page ↗

Where it starts: Apply at tenncareconnect.tn.gov or call 1-855-259-0701. Ask the hospital’s financial counselor for temporary TennCare the same day if you are at East Tennessee Children’s, Erlanger or Vanderbilt.

What to gather

  • Child’s birth certificate or ID and Social Security number
  • A Tennessee address
  • This month’s income for each parent (recent pay stubs)
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: Tennessee gives itself 45 days, and 90 when the case turns on disability. The state says an online application can come back with an answer straight away. Temporary coverage from a participating hospital can start the same day.

What a yes looks like

A notice with coverage dates and a choice of health plan. Check the hospital and the oncology group are in that plan before you choose. Twelve months of continuous coverage follows.

What a no looks like, and the next move

Find out whether the answer turned on income, a missing document or the category. If it was income, ask about CoverKids in the same application, and appeal by the date on the notice.

Watch out

  • Tennessee counts the group the state uses for this category and this month’s income, not last year’s tax return and not everyone under the roof.
  • Your child can keep private insurance and have TennCare too. Do not drop the work plan to apply.
  • The five-point allowance lifts the real line above the printed one, and Tennessee has not published those dollar cells. If you are a little over, apply anyway.

Dates that change this

2026-01-01: The income table uses the 2026 poverty guidelines. Tennessee does not publish the date it adopts a new table each year, so check the figure when you apply.

2027-01-01: Coverage can reach back three months before the month you apply. Federal law shortens that to two months for applications made on or after January 1, 2027; Tennessee has published nothing yet on how it will do that.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full TennCare with no premium. For a home of four the lines are $5,363 under age 1, $3,905 at ages 1 to 5 and $3,658 at ages 6 to 18.

  • $3,658/month — Ages 6 to 18, home of 4, published line (133 percent of poverty)
  • $3,905/month — Ages 1 to 5, home of 4, published line (142 percent)
  • $5,363/month — Under age 1, home of 4, published line (195 percent)
  • $5,500/month — Under age 1, home of 4, published upper screen (200 percent, allowance included)
  • $3,028/month — Ages 6 to 18, home of 3, published line (133 percent)

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21, through TennCare Kids · Private-duty nursing and personal care at home when the plan approves it · Rides to appointments · Dental and vision

Legal protection: Twelve months of continuous coverage once a child is approved, with listed exceptions

What it costs the family: No premium and no copays for a child in this group.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
Published base lines 195 / 142 / 133 percent of poverty by age band, with a five-point allowance lifting the screens to 200 / 147 / 138 percent
Resources
no asset test in the child income categories
Insurance status condition
none: TennCare is the payer of last resort and sits behind private insurance
Residency
Tennessee
Continuous eligibility
12 months for children under 19, with listed exceptions
Retroactive months
3 now; 2 for applications from 2027-01-01 under federal law
Processing standard
45 days, or 90 days when the case turns on disability

Decisions this site cannot make: TennCare Connect income determination · Hospital presumptive eligibility at a participating hospital

Expect friction on: Choosing a health plan the oncology group is in · The state gives itself 45 days, and says an online answer can come back sooner

The trap: Tennessee adds a five-point allowance on top of the published line, so the real screens are 200, 147 and 138 percent of the poverty line by age. The state has never published the dollar cells for two of those three, so a family just above the printed figure should still apply and let the state run the numbers.

Where I read this

← Back to your options