Summary
Medicaid’s rules, benefits and name can all vary by state. In Tennessee, Medicaid is called TennCare. This article focuses on Tennessee Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different from regular Medicaid, which is for financially limited people of all ages.
Tennessee Nursing Home Medicaid Medicaid will cover the cost of long-term care in a nursing home for financially limited Tennessee seniors who require a Nursing Facility Level of Care through its CHOICES in Long-Term Services and Supports program. TennCare beneficiaries who live in a nursing home are considered to be in Group 1 by the CHOICES program. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Tennessee Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Tennessee Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
A Nursing Home Alternative – Tennessee Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Tennessee’s Money Follows the Person (MFP) program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.
Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help TennCare (Tennessee Medicaid) recipients who require a Nursing Facility Level of Care, or a hospital level of care, but choose to remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Tennessee residents who live in their home, the home of a loved one, community living support homes, assisted living residences or critical adult care homes. While Tennessee’s HCBS Waiver program will cover some long-term care services and supports in those settings, it will not cover room and board costs.
Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for an HCBS Waivers program in Tennessee, they are not guaranteed by law to receive the benefits. Instead, there are a limited number of enrollment spots. Once those spots are full, additional eligible applicants will be placed on a waitlist.
TennCare delivers its HCBS Waivers benefits through its CHOICES in Long-Term Services and Supports program. TennCare beneficiaries who require a Nursing Facility Level of Care but live in the community are considered to be in Group 2 by the CHOICES program.
CHOICES long-term care benefits include adult day care, live-in caregiver, home modifications, Personal Emergency Response Systems, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are available depending on the needs and circumstances of the TennCare beneficiary. They are delivered through a single Medicaid health plan that also includes the beneficiary’s medical and behavioral health coverage and is provided by a managed care organization, which has a network of care providers.
TennCare CHOICES beneficiaries can go outside of their managed care organization network with a consumer-directed option. This allows individuals to pick caregivers of their choice, including some family members, for certain long-term care services and supports, such as personal care assistance. Adult children, adult grandchildren, siblings, nieces and nephews can all be hired, but spouses, legal guardians and people with power of attorney for the beneficiary cannot be hired.
Tennessee’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare and long-term care benefits to Tennessee residents with limited financial means who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.
Tennessee ABD Medicaid beneficiaries who are at risk of being placed in a nursing home can receive long-term care benefits through the CHOICES in Long-Term Services and Supports program. These Tennessee ABD Medicaid beneficiaries are considered to be in Group 3 by the CHOICES program.
CHOICES long-term care benefits include adult day care, home modifications, Personal Emergency Response Systems, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are made available depending on the needs and circumstances of the applicant. This is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, Tennessee ABD Medicaid recipients will be evaluated by the state to determine what kind of long term care benefits they need and will receive.
Program of All-Inclusive Care for the Elderly (PACE)
Tennessee residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and non-medical personal needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Tennessee’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Tennessee’s PACE program is located in Chattanooga (Ascension Living Alexian PACE). To learn more about PACE, click here.
To be eligible for Tennessee Medicaid, which is called TennCare, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
Just For You: The easiest way to find the most current TennCare (Tennessee Medicaid) eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.
Financial Requirements
Tennessee residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through TennCare (Tennessee Medicaid). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Tennessee Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through TennCare is a combined $4,000, and the income limit is $2,829/month per spouse, for a total of $5,658/month combined. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Tennessee Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Tennessee has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through TennCare is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. Tennessee uses a Pre-Admission Evaluation (PAE) to determine level of care need for applicants. The evaluation will take into consideration the applicant’s need for help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their behavior, communication abilities, medication management capabilities and orientation (an awareness of people, places and events).
Financial Requirements
Tennessee residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers, which are delivered through the TennCare CHOICES program. For a single applicant in 2024, the asset limit for HCBS Waivers in Tennessee is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Tennessee is a combined $4,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Tennessee HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Tennessee has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for HCBS Waivers through TennCare CHOICES is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is normally associated with a nursing home. Tennessee uses a Pre-Admission Evaluation (PAE) to determine level of care need for applicants. The evaluation will take into consideration the applicant’s need for help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their behavior, communication abilities, medication management capabilities and orientation (an awareness of people, places and events).
Financial Requirements
Tennessee residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid through TennCare (Tennessee Medicaid). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for Tennessee ABD Medicaid for a single applicant is $943/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants, the 2024 asset limit for Tennessee ABD Medicaid is a combined $3,000 between the two applicants/spouses, and the income limit is a combined $1,415/month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.
Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Tennessee has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The only functional requirements to receive basic healthcare coverage through Tennessee Aged, Blind, and Disabled (ABD) Medicaid are being aged (65 and over), blind or disabled. For Tennessee ABD Medicaid applicants who require long-term care services and supports, the state will conduct an assessment using the Pre-Admission Evaluation (PAE) to determine their level of care need and what kind of long-term care benefits the state will cover. Tennessee uses a Pre-Admission Evaluation (PAE) to determine level of care need for applicants. The PAE takes into consideration the applicant’s need for help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their behavior, communication abilities, medication management capabilities and orientation (an awareness of people, places and events).
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.
Tennessee Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Tennessee and how you can protect your home from it, click here.
The first step in applying for TennCare (Tennessee Medicaid) Long Term Care coverage is deciding which of the three coverages discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for TennCare when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the TennCare applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Tennessee residents can apply for Medicaid online at TennCare Connect. They can also call 855-259-0701, or print out the necessary applications from this webpage, or they can applying at their local Department of Human Services office.
For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.
After being approved for nursing home coverage through TennCare (Tennessee Medicaid), seniors have to choose which Medicaid-accepting nursing home best meets their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have any available spaces. Finding the right residence can be time-consuming, especially if you’re looking in a specific location.
Tennessee has about 300 nursing that accept Medicaid with clusters of facilities grouped around the biggest cities. There are roughly 30 nursing homes that take Medicaid within 25 miles of Nashville, another dozen or so around Columbia and eight in the Clarksville area. Moving to Eastern Tennessee, there are approximately 25 nursing homes within 25 miles of Johnson City, about 25 more in the Knoxville area and roughly 12 around Chattanooga. In Western Tennessee, there are about 20 facilities in the Memphis area and nearly 20 more around Jackson.
Residents in some Tennessee communities regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, someone with TennCare would not be covered for nursing homes in Arkansas or North Carolina, even if facilities in those locations were well-suited or convenient for the Tennessee resident.
TOOLS: Tennessee residents can find and compare nursing homes using this Tennessee Health Care Association Facility Finder, which includes an interactive map. They can also use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.
When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in Tennessee.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
CMS data collected from 2019-2022 reveals that nursing homes in Tennessee fare well when it comes to health standards and fire safety. Tennessee nursing homes averaged 14.2 health deficiencies per facility during that three-year time period, while the national average was 25.7. And Tennessee nursing homes averaged 8.5 fire safety deficiencies per facility during that same time frame, and the national average was 13.5.
If you need Medicaid long term care but do not meet the financial eligibility criteria, consider working with a Medicaid Planning professional. These fee-based experts help families structure their finances to become eligible, while streamlining the application process and preserving assets for spouses and family members.
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