Back to Tennessee

HB2005 • 2026

TennCare

AN ACT to amend Tennessee Code Annotated, Title 4, Chapter 3, Part 10 and Title 71, Chapter 5, relative to TennCare.

Healthcare Taxes

Active

The official status still shows this bill as active or still awaiting another formal step.

Sponsor: Clemmons, Yarbro
Last action: 2026-02-04
Official status: Assigned to s/c Tenncare Subcommittee
Effective date: Not listed

Plain English Breakdown

The bill summary does not provide specific details on how much federal funding will be available for the program.

TennCare Buy-In Act

This bill establishes a TennCare buy-in program for eligible Tennessee residents who are not covered by Medicare or other TennCare categories and requires them to pay monthly premiums based on their income.

What This Bill Does

Establishes a new TennCare buy-in program for eligible individuals who meet specific criteria, such as being a resident of Tennessee, aged between 18 and 65, not eligible for Medicare or other TennCare categories, and meeting citizenship requirements.
Sets up a sliding scale premium system based on household income to ensure affordability while generating revenue for the program's sustainability.
Requires annual renewals and eligibility determinations within 60 days of receiving complete applications.
Ensures that benefits are delivered through managed care organizations and provider networks used for other TennCare populations.

Who It Names or Affects

Residents of Tennessee who meet eligibility criteria such as age, income level, and citizenship status.
The Department of Finance and Administration which will manage the program.
Managed care organizations and other entities contracted to implement the program.

Terms To Know

TennCare: A medical assistance program in Tennessee that provides health coverage for eligible individuals.
Federal Poverty Level (FPL): The income level below which a family or individual is considered to be living in poverty according to the U.S. Department of Health and Human Services guidelines.

Limits and Unknowns

It remains unclear when the TennCare buy-in program will become operational after receiving necessary approvals from federal authorities.
The bill does not specify how much federal funding will be available for the program.

Bill History

2026-02-04 Tennessee General Assembly
Assigned to s/c Tenncare Subcommittee
2026-02-04 Tennessee General Assembly
P2C, ref. to Insurance Committee
2026-02-02 Tennessee General Assembly
Intro., P1C.
2026-02-02 Tennessee General Assembly
Passed on Second Consideration, refer to Senate Commerce and Labor Committee
2026-01-22 Tennessee General Assembly
Filed for introduction
2026-01-22 Tennessee General Assembly
Introduced, Passed on First Consideration
2026-01-21 Tennessee General Assembly
Filed for introduction

Official Summary Text

This bill requires the department of finance and administration ("department") to
establish a TennCare buy-in program to provide medical assistance coverage to eligible individuals
("program")
.
In order t
o be eligible for the program, an individual must
meet all of the following criteria ("eligible individual"):



Be a resident of this state
.


Be at least 18 but less than 65
.


Not be eligible for medicare
.


Not be eligible for medical assistance under any other TennCare eligibility category
.


Not be incarcerated
.


Meet citizenship and immigration status requirements applicable to medical assistance under Title XIX of the federal Social Security Act
.


Pay any required monthly premium in accordance
with this below.

PREMIUMS AND COST-SHARING.

This bill requires the department to
establish a monthly premium schedule for the program based on household income as a percentage of the federal poverty level. The premium schedule must
(i) b
e structured on a sliding scale such that premiums increase with income and
(ii) b
e designed to ensure affordability while generating revenue to support program sustainability.

The department may establish lower premiums or waive premiums for individuals whose household income falls below thresholds established by
rule
.
Premiums must be paid monthly and are due on the first day of each month.

This bill authorizes t
he department
to
establish a grace period not to exceed 30 days for premium payment.
The department must
terminate the coverage of an individual who fails to pay premiums within the grace period. An individual whose coverage is terminated for nonpayment of premiums
(i) m
ay be subject to a lockout period of up to three months before being permitted to re-enroll and
(ii) m
ust pay any outstanding premiums before re-enrolling.

This bill requires the department to
establish cost-sharing requirements, including copayments and deductibles, in accordance with federal law. The cost-sharing requirements must not exceed the cost-sharing limits applicable to medical assistance under Title XIX of the federal Social Securi
ty Act
.

BENEFITS

This bill requires the department to
enroll an eligible individual who is enrolled in the program in a managed care organization plan. Such enrollee is eligible for the full scope of medical assistance benefits provided under the TennCare program state plan, excluding non-emergency medical
transportation assistance.
Benefits
must be delivered through the same managed care organizations and provider networks used for other TennCare populations, unless the department determines that an alternative delivery
system is more appropriate and cost-effective.

APPLICATION AND ENROLLMENT

This bill requires the department to
ensure that an individual
can
apply for enrollment in the program
through
the department's online portal
, b
y mail using a paper
application
, t
hrough a TennCare eligibility specialist
,
or
t
hrough authorized community partners and enrollment assistance providers.

The department
must
make eligibility determinations within 60 days of receiving a complete application.

Enrollment is effective on the first day of the month following the month in which eligibility is determined and the first premium payment is received.

An eligible individual must renew the individual's eligibility annually. The department
must
conduct annual redetermin
ations using available data sources and minimize administrative burdens on enrollees to the greatest extent possible.

PROGRAM ADMINISTRATION

This bill requires the department to
administer the program and has the authority to
do all of the following:



Adopt rules necessary to implement and administer the program, including

rules regarding
a
pplication procedures and eligibility verification
, p
remium payment and collection procedures
, e
nrollment and disenrollment procedures
, a
ppeals and fair hearing processes
,
and
p
rogram reporting requirements
.


Contract with managed care organizations, third-party administrators, or other entities as necessary to implement the program
.


Coordinate with the department of labor and workforce development and other agencies to verify employment and income information
.


Establish procedures for collecting premiums, including the use of electronic payment systems and automatic payment options
.


Implement measures to prevent fraud, waste, and abuse
.


Take any other actions necessary to effectively implement and administer the program.

FEDERAL APPROVAL AND FUNDING

This bill requires the department to
timely seek any necessary federal approvals to implement the program, including
a
state plan amendment under the federal Social Security Act

or
a
waiver under the federal Social Security Act, if required.

To the extent permissible under federal law, the department is authorized to seek federal financial participation for medical assistance subject to reimbursement at the federal
medical assistance percentage (FMAP) applicable to this state's medicaid program or to allocate shared-savings to support the program.

Premium revenues collected under the program must be deposited in a dedicated account and used solely for the purpose of defraying state costs of the program.

FISCAL REVIEW AND SUSTAINABILITY

This bill requires the department to
conduct a comprehensive fiscal analysis of the program within two years of implementation and every three years thereafter. The analysis must include
all of the following:



Actual versus projected enrollment and costs
.


Premium revenue adequacy
.


Federal match rate and any changes affecting federal funding
.


Impact on the state budget
.


Offsets from reduced uncompensated care costs
.


Recommendations for adjustments to premium schedules, eligibility criteria, or other program parameters to ensure long-term sustainability.

Current Bill Text

Read the full stored bill text

SENATE BILL 1852
By Yarbro

HOUSE BILL 2005
By Clemmons
HB2005
011572
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 4,
Chapter 3, Part 10 and Title 71, Chapter 5, relative
to TennCare.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, is amended by adding
the following as a new part:
71-5-1601. Short title.
This part is known and may be cited as the "TennCare Buy-In Act."
71-5-1602. Legislative findings.
The general assembly declares that:
(1) It is the intent of the general assembly to establish a TennCare buy-in
program that provides Tennesseans with an affordable path to health coverage
while ensuring fiscal responsibility through premium contributions and federal
cost-sharing;
(2) Creating a TennCare buy-in option would leverage this state's
existing TennCare infrastructure and provider networks to offer an affordable
coverage option for Tennesseans; and
(3) Such a program would reduce uncompensated care costs to hospitals
and healthcare providers, improve health outcomes for Tennesseans, and
support workforce stability.
71-5-1603. Part definitions.
As used in this part, unless the context otherwise requires:
(1) "Department" means the department of finance and administration;

- 2 - 011572

(2) "Eligible individual" means an individual who meets the eligibility
criteria established in § 71-5-1604;
(3) "Federal poverty level" or "FPL" means the most recently revised
poverty guidelines published by the United States department of health and
human services;
(4) "Program" means the TennCare buy-in program established under
this part; and
(5) "TennCare" means the medical assistance program administered
pursuant to this chapter.
71-5-1604. Establishment of program - Eligibility.
(a) The department shall establish a TennCare buy-in program to provide
medical assistance coverage to eligible individuals.
(b) To be eligible for the program, an individual must:
(1) Be a resident of this state;
(2) Be at least eighteen (18) years of age but less than sixty-five (65)
years of age;
(3) Not be eligible for medicare;
(4) Not be eligible for medical assistance under any other TennCare
eligibility category;
(5) Not be incarcerated;
(6) Meet citizenship and immigration status requirements applicable to
medical assistance under Title XIX of the federal Social Security Act (42 U.S.C. §
1396 et seq.); and
(7) Pay any required monthly premium in accordance with § 71-5-1605.
71-5-1605. Premiums and cost-sharing.

- 3 - 011572

(a) The department shall establish a monthly premium schedule for the program
based on household income as a percentage of the federal poverty level. The premium
schedule must:
(1) Be structured on a sliding scale such that premiums increase with
income; and
(2) Be designed to ensure affordability while generating revenue to
support program sustainability.
(b) The department may establish lower premiums or waive premiums for
individuals whose household income falls below thresholds established by rule.
(c) Premiums must be paid monthly and are due on the first day of each month.
The department may establish a grace period not to exceed thirty (30) days for premium
payment.
(d) The department shall terminate the coverage of an individual who fails to pay
premiums within the grace period. An individual whose coverage is terminated for
nonpayment of premiums:
(1) May be subject to a lockout period of up to three (3) months before
being permitted to re-enroll; and
(2) Must pay any outstanding premiums before re-enrolling.
(e) The department shall establish cost-sharing requirements, including
copayments and deductibles, in accordance with federal law. The cost-sharing
requirements must not exceed the cost-sharing limits applicable to medical assistance
under Title XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq.).
71-5-1606. Benefits.
(a) The department shall enroll an eligible individual who is enrolled in the
program in a managed care organization plan. Such enrollee is eligible for the full scope

- 4 - 011572

of medical assistance benefits provided under the TennCare program state plan,
excluding non-emergency medical transportation assistance.
(b) Benefits must be delivered through the same managed care organizations
and provider networks used for other TennCare populations, unless the department
determines that an alternative delivery system is more appropriate and cost-effective.
71-5-1607. Application and enrollment.
(a) The department shall ensure that an individual may apply for enrollment in
the program:
(1) Through the department's online portal;
(2) By mail using a paper application;
(3) Through a TennCare eligibility specialist; or
(4) Through authorized community partners and enrollment assistance
providers.
(b) The department shall make eligibility determinations within sixty (60) days of
receiving a complete application.
(c) Enrollment is effective on the first day of the month following the month in
which eligibility is determined and the first premium payment is received.
(d) An eligible individual must renew the individual's eligibility annually. The
department shall conduct annual redeterminations using available data sources and
shall minimize administrative burdens on enrollees to the greatest extent possible.
71-5-1608. Program administration.
(a) The department shall administer the program and has the authority to:
(1) Adopt rules necessary to implement and administer the program,
including, but not limited to, rules regarding:
(A) Application procedures and eligibility verification;

- 5 - 011572

(B) Premium payment and collection procedures;
(C) Enrollment and disenrollment procedures;
(D) Appeals and fair hearing processes; and
(E) Program reporting requirements;
(2) Contract with managed care organizations, third-party administrators,
or other entities as necessary to implement the program;
(3) Coordinate with the department of labor and workforce development
and other agencies to verify employment and income information;
(4) Establish procedures for collecting premiums, including the use of
electronic payment systems and automatic payment options;
(5) Implement measures to prevent fraud, waste, and abuse; and
(6) Take any other actions necessary to effectively implement and
administer the program.
(b) Rules adopted pursuant to this section must be promulgated in accordance
with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
71-5-1609. Federal approval and funding.
(a) The department shall timely seek any necessary federal approvals to
implement the program, including, but not limited to:
(1) A state plan amendment under Section 1902 of the federal Social
Security Act (42 U.S.C. § 1396a); or
(2) A waiver under Section 1115 of the federal Social Security Act (42
U.S.C. § 1315), if required.
(b) To the extent permissible under federal law, the department is authorized to
seek federal financial participation for medical assistance subject to reimbursement at

- 6 - 011572

the federal medical assistance percentage (FMAP) applicable to this state's medicaid
program or to allocate shared-savings to support the program.
(c) Premium revenues collected under the program must be deposited in a
dedicated account and used solely for the purpose of defraying state costs of the
program.
71-5-1610. Fiscal review and sustainability.
(a) The department shall conduct a comprehensive fiscal analysis of the
program within two (2) years of implementation and every three (3) years thereafter.
The analysis must include:
(1) Actual versus projected enrollment and costs;
(2) Premium revenue adequacy;
(3) Federal match rate and any changes affecting federal funding;
(4) Impact on the state budget;
(5) Offsets from reduced uncompensated care costs; and
(6) Recommendations for adjustments to premium schedules, eligibility
criteria, or other program parameters to ensure long-term sustainability.
SECTION 2. If any provision of this act or its application to any person or circumstance
is held invalid, then the invalidity does not affect other provisions or applications of the act that
can be given effect without the invalid provision or application, and to that end, the provisions of
this act are severable.
SECTION 3. The headings in this act are for reference purposes only and do not
constitute a part of the law enacted by this act. However, the Tennessee Code Commission is
requested to include the headings in any compilation or publication containing this act.
SECTION 4. This act takes effect upon becoming a law, the public welfare requiring it.