TennCare Shelter Enrollment Project

The National Health Care for the Homeless Council initiated the TennCare Shelter Enrollment Project in 1998 with support from a HUD Emergency Shelter Grant provided through the Tennessee Department of Human Services. The project is now supported by a contract with the Bureau of TennCare, Tennessee Department of Finance and Administration.

Project goals are to improve the health of homeless children by increasing their access to health insurance and to primary and preventive health care, and by assuring that public officials and contractors involved in Medicaid eligibility determination, enrollment and outreach understand and proactively address the special needs of homeless children.

The project has accomplished these goals by educating emergency shelter providers and the families they serve about TennCare (Tennessee’s Medicaid managed care program), and by working with a variety of stakeholders in communities across the state to identify and reduce obstacles to care. This outreach demonstration project has sustained collaborative relationships with over 50 homeless and domestic violence shelters across the state, which has served more than 26,364 homeless children since July 1998.

During the 14-year period since the TennCare Shelter Enrollment Project began (FY 1999–2015):

  • The percentage of homeless children enrolled in TennCare at the time of discharge from emergency shelters increased from 48% to 73%.
  • The percentage of homeless children without any health insurance at shelter discharge decreased from 30% to 3%.
  • The percentage of homeless children on TennCare reported to have a visit with a primary care provider during their shelter stay increased from 5% to 45%.

Participating shelters staff, families in shelter, and community workgroups have identified the following obstacles enrollment into health insurance coverage and using the health insurance when families are in a homeless situation:

  • Lack of awareness of TennCare eligibility criteria, enrollment procedures, and covered benefits through Healthcare.gov
  • Difficulty filling out applications and satisfying documentation requirements
  • Missed communications about eligibility and enrollment due to lack of a stable address
  • Difficulty obtaining transportation to complete the enrollment process and keep clinical appointments
  • Long delays between application and enrollment, resulting in discharge from shelters before families know whether or not their children have qualified for health coverage
  • Long waits for routine primary and behavioral health care appointments for children on TennCare

As a result of project efforts, some of these obstacles have been reduced or eliminated through:

  • Education of emergency shelter staff and homeless families about TennCare, health risks for children who are homeless, and the importance of preventive care
  • Education of enrollment through Healthcare.gov
  • Simplification of TennCare application and enrollment procedures, including development of facilitated enrollment procedures for homeless children
  • Outreach to family shelters by TennCare managed care organizations and provision of health and dental screenings onsite at selected family shelters
  • Dissemination of information about TennCare transportation services to sheltered homeless families


Cindy Phillips, BS, TennCare Shelter Enrollment Project Coordinator, at cphillips@nhchc.org

Sabrina Edington, MSSW, Director of Special Projects, at sedington@nhchc.org