How much money can you make and still qualify for TennCare?
Because Tennessee has not expanded Medicaid, there is no single income limit to qualify for TennCare. Instead, your monthly income limit depends entirely on your household size and which qualifying category you fall into.
Healthy adults without dependent children generally cannot qualify for TennCare regardless of how little money they make. Below are the maximum gross monthly income limits for the most common qualifying groups:
Does TennCare check your income?
Yes, TennCare checks your household income to decide if you qualify for benefits.
How TennCare Checks Income
- Verification Sources: TennCare checks electronic databases like the IRS, Equifax, and the Department of Labor to verify your reported earnings.
- Income Limits: The amount of money you can make depends on your household size and the specific group you fall into, such as pregnant women, children, or individuals with disabilities.
- Acceptance Rules: TennCare allows self-attestation if your income falls at or below standard limits, but they compare electronic records using a reasonable compatibility standard. They may ask for paper documentation if your reported numbers and data sources do not match closely.
Opinions on Reddit vary regarding how complex or secondary financial inflows like boarder rent or shared accounts are evaluated, but users generally advise full disclosure to avoid issues with the state.
What is the highest income to receive Medicaid?
In Medicaid expansion states, a single adult can earn up to 138% of the Federal Poverty Level (FPL), which is about $20,120 per year ($1,677 per month) in 2026.
General Income Limits
- Expansion States: The limit is 138% FPL for non-disabled, childless adults.
- Non-Expansion States: Income limits for general adults are much lower or non-existent, meaning childless adults often do not qualify regardless of how low their income is.
- Children and Pregnant Women: Limits are much higher—often ranging from 200% to over 300% of the FPL, depending on the state and program (like CHIP).
- Seniors and People with Disabilities: Limits vary widely, but special pathways or programs may allow higher limits or use asset tests rather than strict income caps alone.
You can check your specific eligibility by using the Medicaid Eligibility Calculator.
How much is TennCare a month?
TennCare has a $0 monthly premium, meaning it costs nothing per month to maintain coverage. Because it is Tennessee's version of Medicaid, it does not charge a standard monthly fee for individuals who meet the program's low-income guidelines.
While there are no monthly premiums, you may encounter other small, out-of-pocket costs depending on your specific situation:
Potential Out-of-Pocket Costs
- Copayments: Adults over the age of 21 may be required to pay a very small copay (usually a few dollars) for certain services, such as prescription drugs or doctor visits. There are no copays or premiums for children under age 19 or pregnant women.
- Long-Term Care Share of Cost: If you qualify for TennCare's nursing home or long-term care program (TennCare CHOICES Group 1), you do not pay a premium, but you are required to contribute nearly all of your monthly income toward the cost of your nursing facility care. You are only permitted to keep a small "personal needs allowance" of $30 to $50 per month.
- Spend-Downs for Medically Needy: If your monthly income is slightly over the limit but you have exceptionally high medical bills, you may qualify for the "Medically Needy" pathway. In this setup, you must incur a specific amount of medical expenses (called a spend-down) each month before TennCare coverage kicks in.
If you are trying to verify your eligibility or apply for benefits, you can do so directly online through the official TennCare Connect Portal or by calling their support line at 855-259-0701.
Are Medicaid and TennCare the same thing?
Yes, TennCare and Medicaid are the same thing, because TennCare is the specific name of Tennessee's Medicaid program.
Key Facts About TennCare
- State Program: Tennessee named its Medicaid program TennCare when it launched a managed care system in 1994.
- Funding: Like all Medicaid programs, it uses a mix of federal and state government money.
- Rules: It provides health coverage for low-income residents, children, pregnant women, and people with disabilities, but it follows Tennessee's specific rules and eligibility categories rather than standard federal fee-for-service rules.
Changes to TennCare eligibility
How much money can I make and still get TennCare?
How much money you can earn and still qualify for TennCare depends entirely on your category, because Tennessee has not expanded Medicaid under the Affordable Care Act (ACA). This means healthy, working-age adults without dependent children generally cannot get TennCare regardless of how little they earn.
The exact monthly gross income limits for the year 2026 vary drastically depending on your situation:
2026 Monthly Income Limits by Category
| Eligibility Category | Single Person Limit | Family of 3 Limit | Asset Limit |
|---|---|---|---|
| Parents / Caretaker Relatives (with children under 18) | ~$1,365 (105% FPL) | ~$2,325 | None |
| Pregnant Individuals | $2,596 (200% FPL) | $4,420 | None |
| Children (Ages 6–18) | $1,799 (138% FPL) | Varies by family size | None |
| CoverKids (CHIP for Kids) | $3,250 (250% FPL) | Varies by family size | None |
| Aged / Blind / Disabled (ABD) | $967 | $1,450 | $2,000 (Single) / $3,000 (Couple) |
| Long-Term Care / CHOICES Waiver | $2,982 (300% FBR) | $5,964 | $2,000 (Single) / $3,000 (Couple) |
Important Rules to Note
- Gross vs. Net Income: TennCare evaluates your gross income (your total earnings before taxes and other deductions are subtracted).
- The "Coverage Gap": If you are an adult under 65, do not have dependent children in your home, and are not disabled, you may fall into Tennessee's "coverage gap." If your income is under 100% of the Federal Poverty Level, you will not qualify for TennCare or federal marketplace health insurance subsidies.
- Asset Tests: If you are applying based on age (65+) or disability, your personal assets (bank accounts, secondary vehicles, etc.) cannot exceed $2,000 for a single applicant. If you apply as a parent, child, or pregnant individual, your assets do not count against you.
To check your specific case, submit an application online through TennCare Connect.
What can stop you from getting Medicaid?
Several financial, administrative, and legal rules can stop you from getting Medicaid.
Income and Asset Limits
- High income: Making more money than your state allows for your household size stops approval.
- Too many assets: Having savings, investments, or property above your state limit (often $2,000 for single adults applying for long-term care) disqualifies you.
- Gifting money: Giving away cash or property within the 5-year lookback period creates a penalty period that delays coverage.
Administrative Issues
- Incomplete forms: Missing financial papers, tax records, or proof of identity leads to a denial.
- Not updating information: Failing to respond to renewal notices or requests for verification stops benefits.
Status and Work Rules
- Citizenship status: Not being a U.S. citizen or a lawful permanent resident stops most standard applications.
- Work requirements: Not meeting mandatory community engagement or work hours when required by your state risks your coverage.
What to do if income is too high for Medicaid?
If your income is too high for Medicaid, you can use state-specific pathways like a spend-down program or a trust to qualify, or look for alternative health insurance.
📉 Medically Needy "Spend-Down"
- How it works: Deduct medical expenses from your income until it reaches the state limit.
- Best for: People with high ongoing medical bills in participating states.
- Action: Save receipts for doctor visits, prescriptions, and care costs to submit to your state agency.
📊 Qualified Income (Miller) Trust
- How it works: Deposit excess monthly income into an irrevocable legal trust.
- Best for: Long-term care or nursing home applicants in income-cap states.
- Action: Work with an elder law attorney to set up the trust correctly naming the state as beneficiary.
💡 Affordable Care Act (ACA) Marketplace
- How it works: Apply for health coverage through the Official Health Insurance Marketplace.
- Best for: Non-elderly individuals who earn too much for Medicaid but under 400% of the federal poverty level.
- Action: Check your eligibility for sliding-scale tax credits to lower monthly premiums.
🗓 Community Health Centers
- How it works: Receive low-cost or sliding-fee primary and preventive care locally.
- Best for: Immediate, affordable access to basic doctor visits without insurance.
- Action: Find a local provider via the HRSA Health Center Finder.
Does Social Security count as income for Medicaid?
Yes, standard Social Security benefits count as income for Medicaid eligibility. However, the exact rules depend entirely on the specific type of Social Security benefit you receive.
Types of Benefits That Count
If you receive any of the following benefits, Medicaid will include them in your monthly income calculations, even if they are not considered taxable by the IRS:
- Social Security Retirement Benefits
- Social Security Disability Insurance (SSDI)
- Social Security Survivor’s or Dependent Benefits
The Major Exception: SSI
- Supplemental Security Income (SSI) does not count as income. SSI is a separate, needs-based program for low-income individuals who are elderly, blind, or disabled. In most states, receiving SSI actually qualifies you for Medicaid automatically.
How Medicaid Evaluates Your Income
Medicaid pathways look at income in two distinct ways depending on your eligibility category:
- MAGI Medicaid (Under Age 65 / Households): For most adults, parents, and children, eligibility is determined using Modified Adjusted Gross Income (MAGI). Under MAGI rules, your gross Social Security benefits are added directly to your household income total. (Exception: A child’s or tax dependent's Social Security check is generally excluded unless their personal income is high enough that they are legally required to file a tax return).
- Non-MAGI Medicaid (Aged, Blind, Disabled, or Long-Term Care): If you are 65 or older, blind, or disabled, you fall into "Non-MAGI" pathways. Your standard Social Security check still counts as monthly income, but your state will also factor in an asset/resource limit (such as savings and property).
What if Your Social Security Puts You Over the Limit?
Because Medicaid is administered locally, income limits fluctuate significantly depending on your state and whether your state adopted the Affordable Care Act (ACA) Medicaid expansion. If your Social Security benefit puts you slightly over your state's threshold, you may still qualify through alternative state options like "Spend-Down" programs (Medically Needy programs) or by setting up a Qualified Income Trust (Miller Trust), depending on your local regulations.
To check the exact income limits for your household size, review the guidelines on your state's official Medicaid Agency Website.
What are the income limits for Florida Medicaid in 2026?
The income limits for Florida Medicaid in 2026 depend on your age, household size, and specific program category.
Long-Term Care & Nursing Home Medicaid (SMMC-LTC / ICP)
- Single Applicant: $2,982 per month in gross income.
- Note: Florida is an "income cap" state. If your income is higher than $2,982, you can still qualify by setting up a Qualified Income Trust (Miller Trust).
Aged, Blind, and Disabled (MEDS-AD)
- Single Individual: Approximately $1,330 per month (100% of the Federal Poverty Level).
Parents and Caretaker Relatives
- Single Parent / Caregiver: Approximately $355 per month for a single-person limit, varying slightly by household size. Florida maintains strict limits for non-disabled adults without Supplemental Security Income (SSI) pathways.
Children and Pregnant Women (Effective April 2026 – March 2027)
- Pregnant Women (Family of 1): $2,608 per month
- Children under Age 1 (Family of 1): $2,807 per month
- Children Ages 1–5 (Family of 1): $1,930 per month
- Children Ages 6–18 (Family of 1): $1,836 per month