Work Reporting Requirement for Tennessee Parents Would Harm Low-Income Families with Children

Top Lines

  • Tennessee's proposed working reporting requirement would affect the state's poorest mothers, as well as small towns and rural communities.
  • The loss of coverage for Tennessee's parents would affect their children - Tennessee was one of 9 states to see a significant increase in children lacking health coverage in 2017.

Key Findings

  • Tennessee’s proposal doesn’t address the most important question: how many parents and children could lose coverage. In Arkansas, which implemented a similar plan, almost one quarter (23 percent) of affected adults lost their health insurance. If Tennessee has a similar outcome, approximately 68,000 parents will lose their Medicaid coverage in Tennessee.
  • The new rules would predominantly affect Tennessee’s poorest mothers. The impact could hit hardest in the state’s small towns and rural communities, where parents are more likely to receive Medicaid and where jobs are harder to find.
  • Even if these parents work more hours, they are unlikely to have an offer of health coverage from their employers. Only 15 percent of Tennessee adults living in poverty receive employer-sponsored insurance.
  • The loss of coverage for parents would affect their children, creating more financial hardship for families and risking children’s access to health care. Tennessee was one of nine states to see a significant increase in children lacking health coverage in 2017.


Tennessee is seeking federal permission to impose a work reporting requirement on low-income parents and caregivers receiving health coverage through Medicaid. Under the proposal, these beneficiaries ages 19 to 64 would have to document that they are working at least 20 hours a week or participating in job-training, education, or volunteer activities in order to maintain their TennCare II coverage. One parent in a household with children under age 6 would be exempt. Because Tennessee has not expanded Medicaid under the Affordable Care Act, the only adults targeted are parents whose incomes are at or below 98 percent of the federal poverty level. The impact of the proposal could mean some of the state’s poorest parents would lose health coverage altogether. And that loss of coverage will affect their children, who may lose access to care, as well, even though they are technically exempt.

Tennessee’s proposal does not provide any estimate of how the new reporting rules would affect enrollment in TennCare if the Centers for Medicare and Medicaid Services (CMS) approve the request to amend the state’s section 1115 “TennCare II” demonstration waiver. Nor does the state even mention the real possibility that many of these parents (and some of their children) would become uninsured.

Full Report

Download the full report here.

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