Category Archives: Insurance

TennCare Presumptive Eligibility Prenatal Program

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By: Brenda B. Kyles

Manager, Tennessee Breast & Cervical Cancer – TennCare Presumptive

Shelby County Health Department

Early entry into prenatal coverage results in improved health outcomes for both the mother and the baby. The TennCare Presumptive Eligibility (TPE) category provides Medicaid coverage for a 45-day time period for all eligible pregnant women. Real time online enrollment into TPE provides an opportunity for the pregnant woman to begin receiving full Medicaid covered services the same day that she is approved. These services include prenatal care at the earliest possible time during her pregnancy. In order to continue the Medicaid coverage throughout the pregnancy and beyond the 45-day time period, the pregnant woman must complete the 2nd step of the TPE process.

Eligibility criteria consists of the following: (Both steps are completed in person during the scheduled interview appointment.)

First Step

  • Pregnancy verification confirmed through a medical provider
  • Tennessee resident living within the State
  • Valid Social Security number which verifies citizenship into the country
  • Household gross income at or below 200% of the federal poverty level
  • Selection of a Managed Care Organization (MCO) from the following:
    • AmeriGroup Community Care
    • BlueCare
    • United Health Care

Second Step

  • Application completed with an onsite Navigator or
  • Application submitted online via healthcare.gov or
  • Application processed via phone at 1-800-318-2596 or
  • Contact the following Navigator agency for assistance: Get Covered TN Consumer Assistance (SEEDCO) 1-866-720-1711

Only one period of TPE per pregnancy can be approved. To schedule an appointment contact the following:

Shelby County Health Department

Regional One Health (Adams Pavilion Building)

842 Jefferson Ave., 4th Floor (Room A432) (901) 545-8722