With the average monthly cost of a private room in a nursing home in Tennessee approaching $7,000 in 2019, those who are likely to need long-term care should have a plan to pay for that care. Long-term care (LTC) is usually paid for by private funds, nursing home insurance, or Medicaid. If a patient cannot afford to pay privately and does not have long-term care insurance, Tennessee's Medicaid program might pay for his or her care.
Medicaid is a medical assistance program funded by the federal and state governments to pay for medical care for persons who meet certain requirements, such as being over 65, disabled, or blind. Medicaid's long-term care program has different eligibility guidelines than other types of Medicaid services.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet the income and resource qualifications of Tennessee's Medicaid program.
There are also some limited services available for Tennesseans who still live at home but would otherwise require a nursing home. These are called home-based waiver programs, for which similar income and asset rules apply. A few other programs exist in Tennessee for those who might not require or want nursing home services but still need assistance with daily activities.
Tennessee's Medicaid program, called TennCare, provides coverage for nursing home residents who are age 65 or older, blind, or disabled and meet income and resource requirements. To obtain TennCare coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
To apply for Medicaid coverage for nursing home services, you can seek assistance from the state's TennCare Connect web portal. You can review additional information and submit an application online or by calling TennCare Connect at (855) 259-0701. You can also submit a paper application. Typically, your nursing care facility can assist you with the Medicaid application process or you can apply directly with TennCare Connect.
In Tennessee, a single person can have a monthly income up to $2,313 in 2019 and qualify for TennCare-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These LTC income limits are higher than the income limit for those applying for other health care benefits from Medicaid, meaning that it's easier to qualify financially for Medicaid-paid long-term care than other Medicaid services.
For purposes of determining Medicaid eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,160.50. (If the non-applicant spouse's own income falls beneath this minimum monthly needs allowance, he or she is allowed to keep some of the income belonging to the spouse living in the nursing home.)
If you live in a nursing home paid for by Medicaid, you'll be expected to spend almost all income on your care. Tennessee allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.
Medicaid has different resource rules for long-term care than those for other TennCare programs. Resources are assets like real estate, personal property, life insurance with a cash value, vehicles, motor homes, IRAs, bank accounts, and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets, with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
Tennessee's Medicaid program structure recognizes that individuals who qualify for nursing home coverage might prefer to live in their homes or alternate care environments, such as assisted living residences. Living outside of a nursing facility could be less expensive for the state and more convenient and desirable for the individuals, for various reasons.
Medicaid Home and Community-Based Services (HCBS) "waiver" programs will pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility, for example. These programs can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.
The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. (In 2019, an individual applicant cannot have monthly income greater than $2,313, and the eligible applicant's assets are limited to $2,000.)
TennCare offers state residents HCBS through a Medicaid waiver program called CHOICES in Long-Term Services and Supports (CHOICES). CHOICES provides coverage for home and community-based options, which can be delivered in the home, in the home of a caregiver or family member, in an adult foster home, in an assisted living community, or elsewhere in the community, to assist with daily living activities and allow qualified applicants to be actively involved in their communities. CHOICES provides care in a nursing home, too, if this is needed.
CHOICES provides personal care services to assist eligible individuals with daily activities like bathing, dressing, toileting, eating, grocery shopping and cooking, among others. The consumer-directed nature of the CHOICES program gives participants the option to select their care providers, which may allow for friends, neighbors, and family members to serve as caregivers.
You can find specific information about the CHOICES program by visiting the TennCare CHOICES website, contacting your local Area Agency on Aging, or calling (866) 836-6678. Please note that because the CHOICES program has limited enrollment, waiting lists may exist.
Tennessee Adult Day Care provides certain non-Medicaid services to adults who do not need institutional care services like those nursing homes provide, but still require some daily supervision and social activity. Adult Day Care programs also provide relief and assistance to caregivers, who may need rest and time to care for themselves. To learn more about Adult Day Care, visit the Tennessee Department of Human Services website or call (615) 532-6250.
Tennessee's OPTIONS for Community Living (OPTIONS) program provides personal care, meals, home maintenance, and other care and support services to seniors who require care and want to remain living at home. Eligible participants over 60 years of age must need assistance performing their activities, and instrumental activities, of daily living, such as bathing, dressing, toileting, eating, grocery shopping and cooking, among others. Although OPTIONS does not have an absolute income limit, the program might give priority to persons with assets valued below applicable Medicaid limits, and it applies a sliding scale for cost-sharing for services, based on an applicant's income. Those with income over 600% of the SSI payment level ($771 in 2019) are responsible for the complete cost of services rendered.
The Tennessee OPTIONS program is funded by the state, and the state's Commission on Aging & Disability administers OPTIONS. OPTIONS is available to eligible residents through Tennessee Area Agencies on Aging and Disability. For more information and enrollment in OPTIONS, contact your local Area Agency on Aging and Disability, or call (866) 836-6678.