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Navigating TennCare/Medicaid: What You Need to Know

What is TennCare? What’s the difference between that and Medicaid? How do you know if you’re eligible for it, and what can you do about it if you aren’t?

Fear not, dear reader, we’ll answer all of those questions and more as we dive into what you need to know about TennCare/Medicaid!

What is TennCare/Medicaid?

Simply put, each state has a name for its own Medicaid program. TennCare is the state of Tennessee’s Medicaid program. It’s a way of saying “Tennessee Medicaid” in fewer syllables. 

In terms of what TennCare actually does, it’s a healthcare program that provides medical assistance to low-income individuals, pregnant women, children, and individuals with disabilities. It is funded by both the Tennessee and federal governments, and the primary goal is  to ensure that everyone has access to essential healthcare services. 

Who is eligible for TennCare?

To be eligible for TennCare, you have to meet specific income requirements and fall into a certain category. If you’re a low-income adult, a child, a pregnant woman, an elderly individual, or an individual with a disability, you’re in an eligible category. However, you still need to qualify based on your specific circumstances and resources available within the program. 

Why is it important to understand TennCare?

Understanding TennCare (Medicaid) is crucial because it can provide you and your family with affordable access to healthcare services. 

Most seniors are on a fixed income. The median retirement income for Tennesseans is just under $2,000.00-but the cost of a nursing home averages around $7,500 a month. Even if your loved one has savings that can be allocated toward their care, those savings can be depleted quickly. Knowing the eligibility criteria, application process, and coverage options can help ensure that those in need can receive the necessary medical care.

At Graceful Aging Legal Services, we have experience with TennCare applications. We’d be happy to discuss how you can protect your savings and your spouse while still qualifying for TennCare. 

Another good resource is Tennesse Justice Center, if you’ve got any questions.

What’s Covered?

The purpose of TennCare is to make sure that you have access to essential healthcare services that help you to maintain your well-being. With that in mind, there are a wide range of medical services covered under TennCare. However, some services, like nursing home care, require further application.

Services include:

  • Doctor visits, hospital stays, preventative care, and emergency services
  • Prescription drugs for managing health conditions
  • Counseling, therapy, and other treatments for mental health conditions
  • Dental and vision care

Applying for TennCare/Medicaid

Find out about the application process and what documents and identification information you’ll need to apply – and what not to do, so you can avoid delays. 

Application Process

Applications are no one’s idea of a good time, but they are unfortunately necessary for TennCare. Luckily, the process isn’t as grueling as it used to be. You can do it online, by mail, over the phone, or in person, so pick whatever is easiest for you. If you have questions about the process or want someone to help you through it, that’s what we do for some of our clients! 

To make the process easier, prepare all of the documents and information that will be needed for your application ahead of time. That will make filling out the actual paperwork go by much faster!

Required documents and information

Documents to prepare:

  • Identification documents
  • Medical history
  • Proof of income 
  • Health insurance information

Information to have on hand:

  • Social security numbers of everyone applying
  • Dates of birth for everyone applying
  • Current income
  • Current address
  • Contact information
  • Citizenship and immigration status
  • Car and property value
  • Bank and financial statements (3 months)
  • Vehicle title (Kelley Blue book value)
  • Life insurance policy information

Common mistakes to avoid

Mistakes mean delays or denials of coverage, so here are major mistakes to avoid:

  • Providing incorrect or incomplete information
  • Failing to include required documents
  • Not reporting changes in income or household size
  • Transferring property or making large gifts
  • Sharing bank accounts and funds with someone other than a spouse

Renewing and Managing TennCare/Medicaid

Here are the key steps to renew and manage your TennCare plan.

Renewal process

TennCare coverage is not permanent and needs to be renewed periodically. TennCare will try to renew your coverage using the information they already have on file, but they may need further information. Keep an eye out for a renewal packet, and fill out the required information as soon as possible.

Reporting changes in income or household

It is essential to report any changes in income or household size to TennCare. These changes can impact eligibility and may require you to update your information or submit additional documents. Failing to report changes promptly can lead to complications in coverage.

Appealing decisions

If your TennCare application or renewal is denied, there is an appeals process in place. This allows you to challenge the decision and provide further information or evidence to support your eligibility. If you get to this point we recommend working with an advocate, such as a lawyer or non-profit agency like the Tennessee Justice Center. 

Want to Know How We Can Help You Qualify for TennCare?

Graceful Aging Legal Services is here to help! Contact us today to set up an appointment to talk about TennCare and estate planning, or caring for someone who needs advanced care without the resources to pay for it.