TennCare Medicaid for Long-Term Care
Medicaid pays for nursing home care for people who are both financially and medically eligible. (Medical eligibility is discussed on pages 35-36, under nursing home care.) To apply, call the Department of Human Services. You may own your home, 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 TennCare Medicaid for Long-Term Care for nursing home admission, contact the TennCare/Medicaid office for an assessment of income and assets. Tennessee now has an "income cap" and limits eligibility to nursing home patients with incomes of less than $1,869 per month (2007 guidelines). These figures change each year and certain exceptions may change them, according to your individual case. If your income is too high, you can still get Medicaid 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 income and a maximum amount of assets, set annually ($1,650 per month and $101,640, respectively, as of January 2007).
Lawyers not experienced in elder law may be unaware of the complexities of planning for future Medicaid 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. In 2006, new penalty rules changed how far back Medicaid looks for transfers (five years instead of three) and when the penalty period starts.
Without endangering TennCare Medicaid 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 Medicaid-paid nursing home care when there are resources left after the death of the patient. The likelihood of estate recovery has increased since a law was passed in July 2002 requiring a waiver or release from the TennCare program before an estate can be closed in Tennessee. Seek legal advice before transferring the title or deed to property; doing so may cause problems with eligibility for Medicaid. In any case, the community spouse can live in the family home for the remainder of his or her lifetime. Recovery of Medicaid costs would not be sought until after the death of the community spouse.
If you need more information about TennCare Medicaid for Long-Term Care, call Legal Aid of East Tennessee and ask for a publication called Getting Medicaid to Pay for Nursing Home Costs.
Programs that specifically help people stay at home who would otherwise have to enter a nursing home are:
- Options for Community Living – provides limited services in the home
- Statewide Home & Community Based Services Medicaid Waiver.
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