Federal, exists in every state
Help with private health-insurance premiums
Some Medicaid programs help pay for private insurance when keeping it costs less than paying the medical bills.
What it is
Some Medicaid programs help pay for private insurance when keeping it costs less than paying the medical bills.
This card only matters if your child is in Katie Beckett Part A. Outside Part A, Tennessee does not pay a family's work-plan premium.
Katie Beckett hardship rules
- The child must have been uninsured when Part A started. Required coverage must cost more than 5% of family income, or family income must be below 400% of poverty with no employer coverage available.
- The 2026 benchmark is $466 a month. The program decides the actual assistance.
- The January 5, 2026 Katie Beckett policy links assistance to approval and the required coverage and payment steps. It does not promise reimbursement for earlier months or for ending an existing plan.
What you get
- Help with required private insurance for eligible Katie Beckett Part A families.
Other premium-help routes
- Katie Beckett Part A has hardship assistance for required private coverage. Its specialist calculates the child’s help, the first covered month and the remaining premium. The $466 monthly benchmark effective January 1, 2026 is not a guaranteed payment. TennCare Connect can confirm whether any separate general premium-help route operates and how it applies to your family. Any change to existing coverage needs a separate check.
If you decide to apply
- Ask the TennCare enrollment specialist whether the Katie Beckett hardship rules fit your child.
- Have ready: the insurance premium, your family income, employer coverage options and your child’s coverage history.
TennCare Connect, 1-855-259-0701 · Official page ↗
Good to know
Help with a premium and help with treatment bills are different. Ask whether approval changes your child’s health plan.
Official sources
“Could TennCare help with our insurance premium, through Katie Beckett or another route, and would that change our child’s coverage?”
Why I’m asking: I want to know whether we can reduce the premium without losing access to treatment.
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
Get the employer rate sheet, file the state form the month Medicaid is approved, and keep the plan active.
Your social worker
The social worker finds the state HIPP contact and checks whether approval would change your child's Medicaid plan.
The care team
Records and letters when the application asks for them.
- Who decides
- The state HIPP unit, on cost-effectiveness
- Ask HR
- “Can you show what I pay each pay period for my child's medical coverage? Medicaid needs that amount to check help with the premium.”
How to apply
First step: Once Medicaid approves your child, ask the social worker for the state HIPP contact. Request the application and employer premium form.
- Ask HR for the premium rate sheet for medical-only dependent coverage.
- Apply the month Medicaid is approved.
- Ask first whether HIPP changes the child's Medicaid plan.
Where it starts: State form after Medicaid approval
What to gather
- Employer premium rate sheet showing the employee share for medical-only coverage
- The plan's summary of benefits
- The child's Medicaid ID
How long: A cost-effectiveness review by the state. Ask for the expected turnaround when you file.
What a yes looks like
A letter naming the reimbursed amount and how it is paid (to you or to the employer).
What a no looks like, and the next move
“Not cost-effective” or “no employer plan”. Ask what changed the math and whether a new plan year reopens it.
Watch out
- Ask first whether help paying the work-plan premium moves your child out of the Medicaid managed-care plan (California: yes, fee-for-service only. Texas: no rule found).
- The state needs the employer's premium breakdown for medical-only coverage per pay period. Ask human resources for the rate sheet before you apply.
- Approval usually requires you to keep the employer plan. Deductibles are not always reimbursed.
Dates that change this
2026-07-31: The federal employer notice listing premium-assistance states was reissued July 31, 2026 (Illinois added, 39 states). Louisiana and Minnesota phone numbers from the January 2026 edition stand until the new PDF is quoted. (not yet confirmed against the final rule)
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
The family's employer premium reimbursed, often monthly, for as long as the state finds it cost-effective.
- Approved employee premium — Approved employee premium
Covers: Private plan stays primary. Medicaid coordinates behind it
Legal protection: A 60-day special-enrollment right in the employer plan follows premium-assistance eligibility or a Medicaid/CHIP loss
What it costs the family: State-specific.
The eligibility facts, as published
- Medicaid required
- yes
- Employer plan required
- enrolled or available
- Cost effectiveness
- yes
- Delivery system condition
- per state (CA fee-for-service only; TX none found)
Decisions this site cannot make: Cost-effectiveness review
Expect friction on: Employer rate sheet required · Periodic review
The trap: In some states help paying the work-plan premium moves the child out of the Medicaid managed-care plan (California: fee-for-service only. Texas: no rule found). Ask before you apply.
What changes by state: Whether it exists (38 states in the January 2026 federal list, Illinois added in July), the phone number, and the managed-care condition.
Where I read this
- Coordination of Benefits and Third Party Liability — Centers for Medicare & Medicaid Services, read August 27, 2026
- Model employer CHIP notice (premium assistance under Medicaid and CHIP) — U.S. Department of Labor, EBSA, read September 7, 2026