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Overview of Hospital Presumptive Eligibility

TennCare is implementing a Hospital Presumptive Eligibility (PE) process. The Hospital PE process allows qualified hospitals to determine whether applicants qualify for a period of temporary TennCare eligibility. Qualified hospitals use TennCare Access to determine if applicants are eligible for temporary coverage through Hospital PE. Qualified hospitals also help all applicants for Hospital PE to complete the application for full, ongoing TennCare eligibility beyond the temporary coverage. Using the Hospital PE process, participating hospitals can screen and provide immediate coverage to qualified uninsured individuals and help these patients complete the regular TennCare application process.

Qualified hospitals may only enroll individuals whom they believe meet TennCare’s eligibility rules. Those patients or individuals who would be eligible for TennCare coverage through Hospital PE must fall into one of the following TennCare categories:

  • Children (younger than age 19) who fall within the TennCare income range;
  • Pregnant women who fall within the TennCare income range;
  • Parents or caretaker relatives of dependent children who fall within the TennCare income range; and
  • Former foster care children up to age 26.

Hospitals base the PE determinations on preliminary information reported by individuals. Under the federal rules, qualified hospitals rely on self-reported information for applicants and do not ask applicants to provide verifications of any information.

Information about becoming a qualified hospital for Hospital PE.

More information about Hospital PE operations and training.

list of hospitals participating in the Hospital PE program.