Report: Shelby County Most Reliant on Federal Safety Net

Shelby County residents got nearly $2 billion from federal safety net programs last year.

Shelby County is more reliant on federal safety net programs — and more sensitive to cuts — than any other county in Tennessee, according to a new study by the Sycamore Institute.

Federal Safety Net Programs in Tennessee

In 2024, Shelby County residents received nearly $2 billion in funds from federal safety programs Medicaid, TNAF, WIC, and SNAP, according to the Sycamore Institute study.

President Donald Trump has promised deep cuts to these programs, meant to support low-income people and families. The federal budget bill enacting these cuts is now progressing through Congress.

In Memphis, the cuts could have an outsized effect on Black children, the largest collective group living here below the poverty line. The 2024 Poverty Fact Sheet from the University of Memphis says 27 percent of the city’s Black population lives below the federal poverty level. It says 36 percent of its impoverished population is under age 18.

The biggest of these safety net cuts are promised for Medicaid, a healthcare block grant to help states pay for health care benefits for low-income populations. It’s called TennCare in Tennessee.

The cuts could mean thousands of citizens of Memphis and Shelby County would lose their access to healthcare.

The Sycamore Institute, a Nashville-based policy think tank for Tennessee, said 26.6 percent of Shelby County’s population is enrolled in TennCare. As of March, that was 241,804 people, the highest number of enrollees of any Tennessee county. Shelby County also has the largest population of any Tennessee county, outpacing second-ranked Davidson County by about 200,000 people.

Cuts to TennCare could also means hundreds of millions of dollars might leave the Shelby County economy. Last year, TennCare paid health care providers $1.4 billion for claims for these Shelby-County enrollees. It paid hospitals $175 million for uncompensated care for these patients and those without health insurance.

Cuts to TennCare could strain the budgets of Memphis and Shelby County hospitals and healthcare providers, forcing them to make tough choices. Tennessee’s refusal to expand the state’s Medicaid budget has brought the closure of several rural hospitals in the state.

That decision, made by the Tennessee General Assembly, was a political, Obama-era decision by the state GOP to oppose the Affordable Care Act. That decision leaves $1.4 billion on TennCare’s table each year even through the Trump presidency.

The Tennessee Justice Center says more than 300,000 Tennesseans are uninsured, with no access to healthcare. Medicaid expansion would cover this population, support 15,000 new jobs, lower uncompensated care costs for hospitals, and offer better long-term health outcomes.

Sycamore Institute’s report showed Shelby County also has the largest statewide enrollment in other federal safety net programs including SNAP, TANF, and WIC.

Here’s a look at each of those:

SNAP – Supplemental Nutrition Assistance Program

This program provides food benefits for low-income families.