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HB 1393

TennCare - As introduced, directs the governor to seek a new TennCare waiver within 180 days of the effective date of this act to provide medical assistance coverage for individuals whose gross annual income is equal to or less than 138 percent of the federal poverty level; clarifies that the amendment takes effect upon federal approval. - Amends TCA Title 71, Chapter 5.

114th Regular Session (2025-2026) Introduced by Justin Pearson

HB 1393 requires Tennessee's governor to seek federal approval within 180 days to expand TennCare coverage to individuals earning up to 138% of federal poverty level, contingent on federal waiver approval.

Taken off notice for cal in s/c Tenncare Subcommittee of Insurance Committee
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Bill Summary · HB 1393

Legislative bill overview

HB 1393 directs Tennessee's governor to apply for a federal waiver within 180 days to expand TennCare (the state's Medicaid program) to cover individuals earning up to 138% of the federal poverty level. The bill clarifies that any expansion takes effect only upon federal approval of the waiver request.

Why is this important

Tennessee currently has one of the most restrictive Medicaid eligibility thresholds in the nation. This bill would potentially extend health coverage to tens of thousands of working Tennesseans who fall into the coverage gap—earning too much for current TennCare but too little to afford private insurance. The expansion mirrors the income threshold in the Affordable Care Act's Medicaid provisions.

Potential points of contention

  • Federal funding uncertainty: The bill assumes federal cost-sharing will be available, but recent administrations have taken different approaches to Medicaid expansion funding, creating budgetary unpredictability for the state
  • State fiscal impact: Even with federal matching funds, Tennessee would bear some operational costs for program administration and eligibility determination
  • Political ideology: Medicaid expansion remains contentious in conservative-leaning states; opponents view it as federal overreach or unsustainable entitlement spending, while supporters see it as closing a coverage gap

Compiled from official sources — confirm details with the bill’s official record.

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