“How do I stay insured in the meantime?” It’s one of the first questions people ask after filing a disability claim in Tennessee, says Meghan Martin, an attorney at Martin Disability Law. The answer depends on which case gets approved. Tennessee has not expanded Medicaid, so for low-income adults here, qualifying for SSI is one of the few paths to Medicaid health coverage. SSDI approval, on its own, is not.

Tennessee is one of ten states that share the decision to not expand Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Texas, Wisconsin, and Wyoming. KFF’s tracker (updated May 21, 2026). Whether someone qualifies for coverage in Tennessee depends on which disability benefit comes through – SSI or SSDI.

Medicaid coverage gap

KFF’s Tennessee fact sheet estimates 81,000 adults fall into the state’s Medicaid coverage gap. Too wealthy for TennCare but too poor to qualify for subsidies in the marketplace. (COBRA is a separate option here – it extends a former employer’s plan, but at the full premium, so it doesn’t change this income math.)  The Tennessee Justice Center posted a higher figure. They say “over 300,000 people in Tennessee … are uninsured with no access to healthcare.” KFF’s 81,000 figure refers specifically to those who fall between TennCare and the marketplace. The Justice Center quoted a broader uninsured population from a previous year.

About 673,700 Tennesseans under age 65 lacked health insurance in 2024. That’s an 11.6% uninsured rate, compared to the nation’s 9.8% rate. That calculation comes from Census ACS data compiled by KFF. So those 81,000 people in the gap are about one-eighth of Tennessee’s uninsured population. About the same number of people live in Franklin, Tennessee.

“This is one of the biggest immediate concerns we address with people – how do I stay insured in the meantime?  Unfortunately there is not a lot of options.  We suggest healthcare.gov or marketplace plans.  There are other short term  health insurance plans out there, but we advise our clients to always be cautious if pre-existing conditions are covered or not. Other options with limited resources include local health departments, clinics, or ERs.”

  • Meghan Martin, Attorney at Martin Disability Law

 

Where we are, and where we’re not

The state’s expansion bill, HB1101, died in the TennCare Subcommittee of the House Insurance Committee on February 17, 2026. It failed on a party-line vote of 4 to 2. Both Democrats voted yes; all four Republicans voted no. TennCare has increased parent-income eligibility to 105% FPL, added adult dental, extended postpartum. These do not apply to the heart of the coverage gap – the low-income adults without minor children – and there is no proposal to fix that today.

TennCare enrollment topped out around 1.77 million amid the pandemic. As of May 2025, it was down to roughly 1.52 million. (KFF) As of October 2025, it was down to around 1.42 million, as eligibility redeterminations worked their way through the TennCare roster. That’s 350,000 people. Four times the number living in the coverage gap.

How an SSI approval leads to TennCare enrollment

Tennessee qualifies as what the federal rules refer to as a “§1634 state.” Section 1634 of the Social Security Act authorized these agreements. Thirty-four states, plus DC have entered into these agreements per SSA’s POMS SI 01715.010. In every one of those states, SSA’s SSI approval automatically enrolls people for Medicaid as well. One application, both programs.

TennCare does not independently verify income or resources for SSI recipients. It electronically accepts the case from SSA and automatically enrolls that person, with no separate TennCare application necessary. (TennCare ABD Manual §115.025) Enrollment normally happens within days of SSI approval, but not necessarily the same calendar day. But either way, a claimant does not complete two separate applications, and does not wait twice. Standalone Medicaid would cost a claimant both.

The remaining sixteen states fall into two categories. There are eight “209(b) states” which implement at least one Medicaid eligibility criterion that is more stringent than SSI’s: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, and Virginia. Meanwhile, eight states plus the Northern Mariana Islands allow SSI’s Medicaid criteria but still require a separate application: Alaska, Idaho, Kansas, Nebraska, Nevada, Oklahoma, Oregon, and Utah. Tennessee belongs to neither group.

“Our SSI clients usually are eager to start their health benefits or in some cases get it back.  We see this open the door to better healthcare access, providers and medications.”

  • Meghan Martin, Attorney at Martin Disability Law

 

Tennessee Facts & Figures

SSI: Better, faster, TennCare

Tennessee, December 2024: primary SSA data

160,102 residents of Tennessee received SSI payments. 149,532 of them qualified through blind-or-disabled category instead of age. The average payment was approximately $736/month across all categories. That’s well below the federal max. Other income and living arrangements pull most individuals’ checks below that level. SSA, SSI Recipients by State and County, 2024 ($117,872,000 monthly payments / 160,102 recipients)

SSDI: a much longer wait for coverage

Unlike SSI, SSDI includes no automatic Medicaid enrollment. Per SSA POMS HI 00801.146, Medicare entitlement begins the 25th month of benefit entitlement. Entitlement begins on the day SSA says the disability began, not on the day they mail the approval letter. The first check arrives five months after entitlement begins. Twenty-four months after entitlement begins Medicare kicks in. Total wait time? Call it two and a half years.

Two exceptions. The waiting period for Medicare is waived for patients with ALS. They get Medicare the same month they begin receiving benefits. ESRD patients typically qualify for Medicare in their fourth month of dialysis treatment, or at transplant.

SSA’s December 2024 state file, OASDI Beneficiaries by State and County, says Tennessee had 206,115 disabled workers drawing $318,816,000 per month between them. ($318,816,000 / 206,115 disabled workers = $1,547 average). Five months waiting at that rate is $7,734 before the first check arrives. The national average is higher; SSA’s COLA fact sheet says $1,630/month for 2026, which tracks pretty close to Tennessee’s lower wage base.

For those two years without Medicare, a claimant pays for health insurance on their own. KFF has Tennessee’s benchmark ACA premium at $711/month for 2026. The standard mid-level silver plan. Few will pay that amount. The enhanced subsidies available during the pandemic ended at the end of 2025. But $1,547/month works out to about 118% of the federal poverty guideline, which still qualifies a claimant for ACA premium tax credits. A claimant would pay hardly any of that $711.

$711 might be a substantial portion of a claimant’s monthly income, though, if they’re living on $1,547/month. But we know what figure really hurts. $7,734 in checks lost waiting for that first SSDI payment to arrive. Now add what was paid for insurance premiums and cost-sharing over those two years. TennCare wouldn’t have cost anything. Nearly anything. SSI approval severs that tether immediately, with no premium and nominal cost-sharing.

“We see clients exercise other options in the meantime.  Some keep current providers on a cash pay basis.  A lot of our clients are Veterans with access to VA and can seek care that route. Others have workers compensation paying some medical bills.  Others rely on COBRA.  Some clients buy a marketplace plan and carry that in the interim.   Some are covered by spouses or other retirement provided clinics.”

  • Meghan Martin, Attorney at Martin Disability Law

File SSI and SSDI together

The difference between SSI and SSDI is why attorneys commonly file both claims simultaneously. SSDI might end up paying the higher check, but filing an SSI claim alongside an SSDI claim will mean TennCare almost as soon as approval comes through. Yes, even if the SSDI claim is denied, so long as SSI is approved TennCare follows. Warning. If an SSDI check is high enough to push someone over SSI’s income limit, Medicaid stops when SSI does. §1634 only links Medicaid to SSI. Section 1619(b) may preserve Medicaid for someone who returns to work. Each of these provisions carries its own requirements. Whether to file both claims or just SSDI depends on the facts of the claim. Run it by an attorney.

“There are always different scenarios for each person based on the circumstances. We cant really give a blanket answer, but we can advise each person on a case by case basis.  We always warn and explain to our clients what healthcare coverage issues they may face.  For example, what we refer to as the medicare “29 month rule”  Just like SSDI backpay has a 5 month rule from the onset date, medicare does too.  However medicare then adds a 24 month wait after that.   For some people their case’s retroactivity makes this a non issue.  For others, they are actually approved and on SSDI for several months before they get to use their medicare.  Many of our clients are shocked to find this out.  They assume medicare will start as soon as their SSDI does.  But, thats not the case.  Some of those people do get to carry medicaid during that waiting time.   Again, this is a very case by case issue.   For example, some others may turn 65 and get it automatically prior to their 29 months wait time running out.”

  • Meghan Martin, Attorney at Martin Disability Law

2026 SSI federal benefit rate: $994/month, $11,928/year. About 76% of the $15,650 annual poverty guideline SSA and Medicaid use this year. Substantial gainful activity, SSA’s earnings ceiling for keeping benefits, checks in around $1,690/month, about $9.75/hr for full-time work. In most cases, SGA is an earnings test. Earn more than that, and the rules assume the person is doing substantial work no matter what their doctor says.

Short takeaway for Tennessee disability claimants:

In most states, the SSDI disability decision and the health coverage decision are two different processes. In Tennessee, those two decisions are the same… but only if SSI was filed.

This article is general information about how Tennessee’s programs work, not legal or financial advice about any individual claim. Filing decisions depend on each person’s income, work history, and household situation.

Methodology

SSA doesn’t publish the $1,547 and $736 averages directly. Both come from dividing SSA’s Tennessee totals for December 2024 by its recipient counts for the same month. The $7,734 figure is that $1,547 average times five months. The “one in eight” figure is 81,000 divided by 673,700, KFF’s count of uninsured Tennesseans under 65 in 2024. The 24-month Medicare wait wasn’t priced at the full benchmark premium, since Tennessee’s average SSDI benefit puts a typical claimant at about 118% of the poverty guideline, still within range for ACA premium tax credits per the Congressional Research Service. The full premium would have overstated the real cost. All figures are rounded; the source totals are SSA’s, KFF’s, and CRS’s, the arithmetic connecting them is ours.

Sources

  1. KFF: Status of State Medicaid Expansion Decisions
  2. KFF: Tennessee Medicaid Fact Sheet
  3. KFF: Uninsured Rates for People Ages 0-64, by State (2024 ACS)
  4. KFF: Marketplace Average Benchmark Premiums
  5. Tennessee Justice Center: MedEx
  6. Tennessee General Assembly: HB1101 Bill History (also tracked on LegiScan)
  7. SSA POMS SI 01715.010: Medicaid and SSI, including the §1634, 209(b), and SSI-criteria state lists
  8. SSA POMS HI 00801.146: Medicare entitlement for disabled workers
  9. TennCare Aged, Blind and Disabled Manual, §115.025
  10. SSA: 2026 COLA Fact Sheet
  11. SSA: OASDI Beneficiaries by State and County, 2024 (Tennessee)
  12. SSA: SSI Recipients by State and County, 2024 (Tennessee)
  13. Congressional Research Service: Enhanced Premium Tax Credit and 2026 Exchange Premiums FAQ

About Martin Disability Law

Martin Disability Law is a family-owned firm representing clients across Middle Tennessee in Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and VA disability claims. Founded by Daniel Martin, the firm has represented disability claimants for more than a decade from offices in Clarksville and Brentwood, serving Montgomery, Robertson, Dickson, Houston, Stewart, and Cheatham counties as well as the greater Nashville area. The firm offers free consultations to all prospective clients.