TennCare CHOICES is for adults aged 21 and older with a physical disability as well as seniors aged 65 and older. CHOICES offers Home and Community Based Services (HCBS) in the home, on the job, or in the community to assist with daily living activities and allow people to work and be actively involved in […]
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. The program uses evidence-based approaches including primary care, preventive care visits, and vision screening. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental […]
Employment and Community First (ECF) CHOICES is for people of all ages who have an intellectual or developmental disability (I/DD). It provides a range of supports and services to help the person with I/DD become as independent as possible including support to explore the possibility of working. It also includes support to be involved in […]
Episodes of Care is a state-wide value-based payment program incentivizing high-quality, cost-effective care for specific acute or specialized services over a specific time period, which is called an “episode”. The program includes 48 episodes. The program assigns a single principal accountable provider who has the most impact on the overall cost and quality of a […]
Health Starts aims to address members’ non-medical risk factors such as food insecurity, transportation, social supports and others. Through collaboration with the Managed Care Organizations and TennCare providers (including primary care, behavioral health, LTSS, BESMART, and others), program initiatives better screen, identify, and refer for non-medical risk factors. The program draws on evidence around the […]
The TennCare Katie Beckett Program is for children under age 18 with disabilities or complex medical needs who are not Medicaid eligible because of their parent’s income or assets. It helps to provide care for the child’s medical needs or disability that private insurance does not cover. Katie Beckett Part A (or “Part A” for […]
PCMH is a comprehensive care delivery model designed to improve the quality of primary care services for TennCare members, the capabilities of and practice standards of primary care providers, and the overall value of health care delivered to the TennCare population. Tennessee has built on existing PCMH efforts by providers and payers in the state […]
Population Health is the state of Tennessee’s care coordination effort to support TennCare Medicaid and Children’s Health Insurance Program (CHIP) populations. The program contracts with statewide managed care organizations to improve healthcare outcomes such as increasing child vaccinations, reducing preterm births, and enhancing behavioral health services for adults with substance use disorder. To advance those […]
This program covers a supply of 100 disposable diapers per month for TennCare and CoverKids-enrolled children under age two. Although TennCare has historically covered diapers and other incontinence products for individuals with illnesses or conditions that impact their ability to control their bladder or bowels, TennCare has not covered these products for children younger than […]
The primary objective of THL is to coordinate health care services for TennCare members with the highest behavioral health needs. Through better coordinated behavioral and physical health services, THL is meant to produce improved member outcomes, greater provider accountability and flexibility when it comes to the delivery of appropriate care for each individual, and improved […]
TennCare is the state of Tennessee’s managed Medicaid program. The program is a partnership between the state and federal government. TennCare contracts with statewide managed care organizations to provide healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children, and individuals who are elderly or have a disability. To get Medicaid, […]
