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TennCare officials outline immigration-related eligibility changes taking effect in October 2026
Summary
TennCare staff told the Insurance Committee that some categories of noncitizens (refugees and those granted asylum) who are currently eligible for certain services will face eligibility changes beginning Oct. 1, 2026, under recently passed federal legislation; TennCare said Medicaid coverage for people here illegally is prohibited.
TennCare officials told the House Insurance Committee that federal legislation passed recently contains changes that will alter eligibility for some noncitizen categories. Director Steven Smith said that noncitizens who have been granted asylum or refugee status are currently eligible under certain Medicaid or CHIP provisions but that, "Starting 10/01/2026, that will no longer be the case," for some categories.
On member eligibility more broadly, Smith said the state is prohibited from serving people who are in the country illegally within the Medicaid program and that exceptions and program-specific provisions (for example, some CHIP or unborn-child coverage) can create nuanced outcomes. He told members the precise impact of the federal law will depend on forthcoming CMS guidance, which the agency expects by June, and said Tennessee will evaluate whether to pursue state rulemaking or legislative action depending on what the guidance allows.
Committee members requested more detailed counts and dollar amounts associated with qualified noncitizen claims; Smith provided a 2024 figure of 8,051 members with paid claims and estimated roughly $7 million in state costs (about $20 million total) for that group.
