TennCare, Tennessee's Medicaid program, reported approximately 1.6 million enrollees in 2025, about 23% of the state's population. Nearly all of that enrollment runs through three statewide managed care organizations plus TennCare Select, which together covered roughly 1.44 million people in CMS's own 2024 managed care data. Unlike most states, TennCare's core authority is a single Section 1115 demonstration, TennCare III, rather than a separate managed care state plan amendment or 1915(b) waiver.
Three full-risk managed care organizations (BlueCare Tennessee, UnitedHealthcare Community Plan, and Wellpoint) have held statewide TennCare contracts since January 2023. A fourth statewide plan, TennCare Select, is administered by Volunteer State Health Plan, the same company behind BlueCare, but under a different arrangement: it's a state self-insured Prepaid Inpatient Health Plan, with TennCare bearing the cost of medical services rather than Select taking full financial risk, and it's not open to voluntary enrollment. TennCare Select covers children in foster care, Supplemental Security Income recipients, and members in certain institutional settings, and also functions as the program's statewide backup plan when another MCO reaches capacity. TennCare also runs one small PACE plan, operated by Alexian Brothers Community Services in Hamilton County. TennCare's program authority is structured unusually: almost the entire managed care model, including its managed long-term services and supports benefit, operates under the TennCare III Section 1115 demonstration (most recently approved through December 31, 2030) rather than a separate 1915(b) managed care waiver. Since the current contracts began, TennCare's Long-Term Services and Supports division started a five-year, $50 million investment in July 2025 to expand its home- and community-based services provider network, and CMS is reviewing a state-directed-payment proposal for TennCare's managed care plan contracts, submitted September 25, 2025 and revised January 30, 2026.
TennCare's managed long-term services and supports benefit, CHOICES, is built directly into the three MCOs' contracts under the TennCare III demonstration rather than delivered through a separate LTSS plan or a 1915(b) waiver; TennCare Select follows the same integrated structure for its own enrollees. A related program, Employment and Community First CHOICES (ECF CHOICES), extends the same 1115-authorized, MCO-integrated model to people with intellectual and developmental disabilities who need employment and independent-living supports. Outside this 1115-integrated structure, three narrower 1915(c) HCBS waivers serve a smaller population with intellectual disabilities, administered by the Department of Intellectual and Developmental Disabilities (DIDD): the Statewide Waiver, still open to new enrollment, and the Comprehensive Aggregate Cap and Self-Determination Waivers, both closed to new enrollment since July 1, 2016 except for limited transition cases (former residents of the state's developmental centers, and people who exceeded the Statewide Waiver's individual cost cap when it renewed in 2020). A fourth, related waiver, the Statewide HCBS Elderly and Disabled Waiver, has been terminated.
Integrated into managed care
Behavioral health is not carved out. TennCare briefly ran it through a separate prepaid limited benefit plan starting in 1996, but folded it back into the medical MCO contracts in 2007, and it has stayed there since; the three MCOs are responsible for behavioral health alongside physical health and pharmacy for their own members.
Carved in
No single statewide dental administrator exists; dental is a covered benefit administered by each MCO directly, consistent with the fully carved-in structure of TennCare's broader managed care contracts.
OptumRx administers TennCare's pharmacy benefit statewide as its own carved-out program (1,275,105 members in report year 2024), not folded into any single MCO's own medical enrollment.
Non-emergency medical transportation runs through two statewide brokers split by plan: Verida serves BlueCare and TennCare Select members, and Tennessee Carriers serves UnitedHealthcare and Wellpoint members. Both brokers have three to four hours to arrive for a pickup once notified (three hours in urban areas, four in non-urban areas).
Gainwell Technologies operates TennCare's Medicaid Management Information System. NTT DATA State Health Consulting separately holds a contract for MMIS business support services.
Last updated: Aug 29, 2026
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