TennCare CHOICES for Long-Term Care
Medicaid pays for nursing home care. In some instances, it pays for care in the home or in some assisted living facilities. People must meet financial and medical eligibility criteria. There are two parts to the application process–medical and financial. If already enrolled in TennCare, call the health plan (MCO). If not enrolled in TennCare, call the East TN Area Agency on Aging & Disability. TennCare Connect makes decisions on financial eligibility, so call that agency to start the financial application.
One may own the home if their equity is under $688,000 (as of 2023), a car, limited amount of life insurance, and, in some cases, jointly held property, and still be eligible. The value is not counted when establishing eligibility; all other assets are considered. Documentation or verification of bank accounts, stocks, bonds, IRAs, CDs, and real estate owned in addition to the home will be needed.
When determining if 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. The agency will send the application to TennCare Connect for assessment of income and assets. One also can call TennCare Connect directly. Tennessee has an “income cap” and limits Medicaid eligibility to nursing home patients with incomes of less than $2,742 per month (as of 2023).
These figures change each year, and certain exceptions may apply by individual case. If your income is too high, it may be possible to get CHOICES by using 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. Tennessee also limits the value of the individual assets, but several exceptions apply.
The spouse not residing in the nursing home (called the “community spouse”) is entitled to a minimum income of $2,288.75 per month (as of 2023). This means if the community spouse’s income is less than that amount, they can receive a portion of the income of the spouse in nursing care in order to reach that minimum amount. The allowable income for the community spouse can rise to a maximum of $3,715.50 per month (as of 2023), increasing dollar for dollar from the minimum amount by the amount their housing costs exceed $686.68 (as of 2023). The community spouse can also hold assets valued up to $148,620 (as of 2023).
Lawyers not experienced in elder law may be unaware of the complexities of planning for future CHOICES financial assistance for nursing home costs. Penalties that can significantly delay an applicant’s ability to qualify for CHOICES can be applied to gifts or to transfers of assets for less than fair market value into the name of someone other than the person entering a nursing home.
Federal law authorizes states to recover the costs of CHOICES-paid nursing home care when resources are left after the death of the patient. This is called “estate recovery.” A waiver or release from the TennCare program is required before an estate can be closed in Tennessee. Seek legal advice before transferring the title or deed to property, as doing so may cause problems with CHOICES eligibility. 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 one wants to receive care in the home instead of a nursing facility, they may still apply for CHOICES. If already enrolled in TennCare, contact your insurance plan. If not enrolled in TennCare, call the East TN Area Agency on Aging & Disability.
Applicants must meet the same financial eligibility and medical need requirements as 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.
If more information about TennCare CHOICES for Long- Term Care is needed, ask Legal Aid of East TN for the publication, Paying for Nursing Home or Home-and- Community-Based Care with the CHOICES Program, or call the Long-Term Care Ombudsman.
Options for Community Living is a different program that provides limited services in the home for persons not eligible for CHOICES.