Tennessee CHIP Fact Sheet

Key Highlights:

Program type: Tennessee operates a combination CHIP program called CoverKids.

Number of children covered: In FFY 2018, 112,635 children were covered by CoverKids. (Data from CHIP Annual Report Template System)

State’s enhanced federal match rate*: For FFY 2020, the federal match is 87.15 percent.

Participation rate: In 2017, 94.9 percent of eligible children in Tennessee participated in either Medicaid or CoverKids.  (Urban Institute)

*The Affordable Care Act increased the federal CHIP match rate by 23 percentage points. The HEALTHY KIDS and ACCESS Acts maintained this increase through FFY 2019, and reduced it to 11.5 percentage points in FFY 2020. The federal CHIP match rate returns to states’ regular enhanced match rate in FFY 2021 and beyond.

Premiums and selected cost sharing in CoverKids, 2019

Family Income Level Premiums Office Visits Inpatient Services Prescription Drugs
≤199% FPL None $5 $5 $1-$5
200-250% FPL None $15-$20 $100 $5-$40

Strategies to Simplify Enrollment and Renewals in Tennessee

Strategy Used
Use of presumptive eligibility No
Use of 12-month continuous eligibility Yes
Use of express lane eligibility No
Premium assistance No

For definitions of strategies in this chart, see the Centers for Medicare & Medicaid Services December 2009 State Health Official letter here.

Other Characteristics of Tennessee’s CHIP Program

Does Tennessee…
Require a waiting period?[1] No
Offer a buy-in option?[2] No
Cover dependents of public employees? Yes
Cover lawfully residing children without a five-year waiting period? No

Source: Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey. Kaiser Family Foundation and Georgetown University Center for Children and Families.

Health Services Initiatives

States can develop Health Services Initiatives (HSIs) to improve the health of low-income children and youth by using a portion of their existing CHIP administrative dollars. After covering regular CHIP program administrative costs, states can use any remaining funds – within the 10 percent cap – for an HSI project. The federal share of the HSI project cost is funded at the state’s CHIP match rate. States have used HSIs to support poison control centers, school health services, lead abatement efforts, and other unique prevention and intervention projects. Tennessee currently does not have an HSI.

Quality Measures

States may report on a core set of quality measures for children. Tennessee reported on 23 measures for federal fiscal year 2018. Among the measures is access to primary care providers, listed below.

Percentage of children and adolescents visiting a primary care provider, by age (FFY 2018)

12 – 24 months 25 months – 6 years 7 – 11 years 12 – 19 years
Tennessee 91.8% 84.5% 88.5% 85.1%

Source: Department of Health and Human Services, 2019 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP, September 2019. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years who visited a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: This includes CHIP data only.

[1] States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP.

[2] States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP.

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