TennCare CHOICES (Medicaid) for Long-Term Care in a Facility or as a Home & Community Based Service
Medicaid pays for nursing home care and, in some instances, for in-home care, for people who are both financially and medically eligible. (Medical eligibility is discussed under nursing home care.) There are two parts to the application process, medical and financial. If you already have TennCare, call your TennCare health plan (MCO). If you do not have TennCare, call the East TN Area Agency on Aging & Disability. The Department of Human Services makes the decisions on financial disability. To start the financial application, call the Department of Human Services.
You may own your home if your equity in the home is under $536,000 (as of 2013), a car, a limited amount of life insurance, and, in some cases, jointly held property, and still be eligible. The value of these possessions is not counted when establishing eligibility; all other assets are considered. You will need documentation or verification of bank accounts, stocks, bonds, IRAs, CDs, and real estate owned in addition to your home.
When you can see that you or your spouse are within about 30 days of needing funding from CHOICES for Long-Term Care for nursing home admission, call the Area Agency on Aging & Disability for assistance. They will send your application to the Department of Human Services for an assessment of income and assets. You can also call the Department of Human Services directly. Tennessee has an “income cap” and limits Medicaid eligibility to nursing home patients with incomes of less than $2,130 per month (2013 guidelines). These figures change each year and certain exceptions may also change them, according to your individual case. If your income is too high, it may be possible to get CHOICES by using a special kind of trust called a Qualified Income Trust (sometimes called a “Miller” Trust). For more information, contact an elder-law attorney, Long-Term-Care Ombudsman, or Legal Aid of East Tennessee.
The spouse who is not in the nursing home (called the “community spouse”) is entitled to a minimum in-come and a maximum amount of assets, set annually—$1,892 per month and $115,920 (as of January 1, 2013), respectively.
Lawyers not experienced in elder law may be unaware of the complexities of planning for future CHOICES financial assistance for nursing home costs. Penalties can be applied for transferring assets for less than fair market value into the name of someone other than the person entering a nursing home.
Without endangering CHOICES eligibility, you may deposit approximately $6,000 into an irrevocable burial trust fund, using the contract provided by a funeral home, or purchase a prepaid burial insurance policy.
Federal law has authorized states to recover the costs of CHOICES-paid nursing home care when there are resources left after the death of the patient. There is a law that requires a waiver or release from the TennCare program before an estate can be closed in Tennessee, making the likelihood of estate recovery much greater than it used to be. Seek legal advice before transferring the title or deed to property; doing so may cause problems with eligibility for CHOICES. In any case, the community spouse can live in the family home for the remainder of his or her lifetime. Recovery of CHOICES costs would not be sought until after the death of the community spouse.
CHOICES: Home & Community-Based
If you want to get care in your home instead of in a nursing home, you may still apply for CHOICES. If you already have TennCare, contact your TennCare insurance plan. If you do not have TennCare, call the East TN Area Agency on Aging & Disability.
Applicants must meet Medicaid’s financial eligibility and medical-need requirements for nursing home admission. The services provided must not cost more than nursing home care would cost for the individual. Many services are available, including adult day care, assisted living, home delivered meals, homemaker, minor home modifications, pest control, and others. Click here for information.
If you need more information about TennCare CHOICES for Long-Term Care, call Legal Aid of East Tennessee and ask for a publication called Paying for Nursing Home Costs with the CHOICES Program, or call the Long-Term-Care Ombudsman.
A program called Options for Community Living provides limited services in the home for those who are eligible. Click here for contact information.
Back: Action Guide Home Page