Tennessee has not expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 does not apply to a state expansion population. This model counts no Tennessee adults as subject. TennCare III 1115 'MEC Additions' adults (~17.7K parents/caretakers ≤100% FPL); near-all exempt as parents of a child <14.
The requirement matters for Tennessee in a different way: if the state expanded Medicaid later, its expansion adults would report from day one. The American Community Survey counts about 757,441 uninsured Tennessee adults with household income at or below 138% of the poverty line, the population an expansion would cover and the requirement would then reach.
Key figures
| Measure | Tennessee |
|---|---|
| Expansion state | No |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 0 |
| Adults subject, strict definition | 0 |
| Adults subject, permissive definition | 0 |
| Share of expansion pool subject | 0.0% |
| Projected coverage loss by 2034 | not quantified |
| Hardship exception status | Non expansion |
| Early implementer | No |
| Ex parte capability score (0 to 100) | n/a |
Counties in Tennessee: uninsured adults below 138% of poverty
Shelby County (96,960), Davidson County (83,765), and Knox County (54,435) hold the most uninsured low-income adults in Tennessee.
| County | Uninsured adults at or below 138% FPL | Poverty rate | Working-age population |
|---|---|---|---|
| Shelby County | 96,960 | 18.0% | 538,664 |
| Davidson County | 83,765 | 14.0% | 465,362 |
| Knox County | 54,435 | 12.0% | 302,416 |
| Rutherford County | 40,672 | 10.0% | 225,953 |
| Hamilton County | 40,164 | 12.0% | 223,135 |
| Williamson County | 27,289 | 4.0% | 151,607 |
| Montgomery County | 26,129 | 12.0% | 145,160 |
| Sumner County | 21,816 | 9.0% | 121,198 |
| Wilson County | 17,049 | 8.0% | 94,716 |
| Sullivan County | 16,683 | 15.0% | 92,681 |
| Washington County | 14,915 | 16.0% | 82,862 |
| Blount County | 14,590 | 9.0% | 81,055 |
| Bradley County | 11,876 | 13.0% | 65,978 |
| Maury County | 11,433 | 9.0% | 63,519 |
| Sevier County | 10,380 | 13.0% | 57,664 |
| Madison County | 10,376 | 18.0% | 57,644 |
| Putnam County | 8,982 | 16.0% | 49,898 |
| Anderson County | 8,194 | 15.0% | 45,524 |
| Robertson County | 8,174 | 10.0% | 45,412 |
| Greene County | 7,428 | 16.0% | 41,266 |
| Hamblen County | 6,776 | 17.0% | 37,646 |
| Tipton County | 6,610 | 11.0% | 36,724 |
| Coffee County | 6,135 | 17.0% | 34,084 |
| Hawkins County | 6,048 | 17.0% | 33,600 |
| Jefferson County | 6,015 | 11.0% | 33,418 |
| Dickson County | 6,013 | 11.0% | 33,404 |
| Carter County | 5,963 | 18.0% | 33,128 |
| Cumberland County | 5,735 | 13.0% | 31,862 |
| Roane County | 5,670 | 12.0% | 31,498 |
| McMinn County | 5,652 | 14.0% | 31,398 |
| Loudon County | 5,551 | 12.0% | 30,838 |
| Bedford County | 5,513 | 12.0% | 30,630 |
| Gibson County | 5,229 | 14.0% | 29,050 |
| Monroe County | 4,826 | 16.0% | 26,813 |
| Cheatham County | 4,640 | 9.0% | 25,780 |
| Lawrence County | 4,581 | 16.0% | 25,452 |
| Franklin County | 4,580 | 14.0% | 25,447 |
| Fayette County | 4,536 | 10.0% | 25,201 |
| Warren County | 4,386 | 17.0% | 24,369 |
| Campbell County | 4,129 | 19.0% | 22,937 |
| Dyer County | 3,783 | 16.0% | 21,017 |
| Marshall County | 3,777 | 16.0% | 20,986 |
| Cocke County | 3,765 | 20.0% | 20,914 |
| Lincoln County | 3,662 | 12.0% | 20,342 |
| Weakley County | 3,562 | 19.0% | 19,788 |
| Rhea County | 3,530 | 16.0% | 19,608 |
| Claiborne County | 3,502 | 18.0% | 19,458 |
| Henry County | 3,216 | 18.0% | 17,865 |
| Giles County | 3,127 | 14.0% | 17,371 |
| Obion County | 3,076 | 16.0% | 17,088 |
| Marion County | 3,046 | 16.0% | 16,922 |
| Henderson County | 2,914 | 18.0% | 16,188 |
| Carroll County | 2,902 | 16.0% | 16,124 |
| White County | 2,852 | 17.0% | 15,846 |
| Hardeman County | 2,784 | 16.0% | 15,469 |
| Macon County | 2,769 | 17.0% | 15,383 |
| Hickman County | 2,760 | 14.0% | 15,331 |
| Hardin County | 2,727 | 19.0% | 15,150 |
| Lauderdale County | 2,703 | 18.0% | 15,016 |
| McNairy County | 2,644 | 17.0% | 14,689 |
| Grainger County | 2,525 | 18.0% | 14,030 |
| Overton County | 2,398 | 17.0% | 13,320 |
| Morgan County | 2,364 | 21.0% | 13,134 |
| Scott County | 2,315 | 26.0% | 12,861 |
| DeKalb County | 2,208 | 20.0% | 12,265 |
| Smith County | 2,200 | 15.0% | 12,225 |
| Union County | 2,168 | 16.0% | 12,042 |
| Humphreys County | 1,975 | 12.0% | 10,973 |
| Johnson County | 1,927 | 22.0% | 10,704 |
| Fentress County | 1,924 | 20.0% | 10,690 |
| Polk County | 1,910 | 13.0% | 10,612 |
| Chester County | 1,849 | 16.0% | 10,272 |
| Wayne County | 1,838 | 20.0% | 10,212 |
| Unicoi County | 1,835 | 17.0% | 10,193 |
| Haywood County | 1,760 | 22.0% | 9,776 |
| Sequatchie County | 1,726 | 22.0% | 9,588 |
| Bledsoe County | 1,694 | 26.0% | 9,414 |
| Benton County | 1,577 | 18.0% | 8,763 |
| Cannon County | 1,566 | 15.0% | 8,702 |
| Trousdale County | 1,509 | 11.0% | 8,384 |
| Stewart County | 1,452 | 11.0% | 8,066 |
| Grundy County | 1,416 | 18.0% | 7,864 |
| Crockett County | 1,411 | 16.0% | 7,842 |
| Meigs County | 1,389 | 15.0% | 7,714 |
| Lewis County | 1,336 | 19.0% | 7,420 |
| Jackson County | 1,242 | 20.0% | 6,901 |
| Decatur County | 1,145 | 19.0% | 6,364 |
| Houston County | 867 | 13.0% | 4,819 |
| Perry County | 857 | 14.0% | 4,761 |
| Lake County | 807 | 28.0% | 4,484 |
| Clay County | 761 | 22.0% | 4,228 |
| Hancock County | 682 | 32.0% | 3,791 |
| Moore County | 680 | 10.0% | 3,780 |
| Van Buren County | 635 | 17.0% | 3,529 |
| Pickett County | 494 | 21.0% | 2,742 |
State brief and methodology
Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.