When Medicaid in Tennessee Will Pay for a Nursing Home, Assisted Living, or Home Health Care

With the average monthly cost of a private room in a nursing home in Tennessee approaching $9,300 in 2024, if you're likely to need long-term care, you should have a plan to pay for that care. People generally pay for long-term care (LTC) with:

• private funds (your own money)
• nursing home insurance (also called long-term care insurance), or
• Medicaid.

If you can't afford to pay privately and don't have long-term care insurance, Tennessee's Medicaid program might pay for your care.

Medicaid is a medical assistance program funded by the federal and state governments to pay for medical care for people who meet certain requirements, such as being over 65, disabled, or blind. Medicaid's long-term care program, however, has eligibility guidelines that differ from the eligibility rules for 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 can qualify for Medicaid LTC benefits. But you can qualify only if your income and resources meet the requirements of Tennessee's Medicaid long-term care programs.

Some limited services are also available for Tennesseans who still live at home but would otherwise require a nursing home. These services are provided through home-based waiver programs, for which similar income and asset rules apply. A few other programs exist in Tennessee for older people who might not require or want nursing home services but still need help with daily activities.

TennCare Coverage for Nursing Homes

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 get TennCare coverage for nursing home care, you must:

• be financially eligible, and
• 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.

Medicaid Income Rules in Tennessee for LTC

In Tennessee, a single person can have a monthly income up to $2,901 in 2025 and qualify for TennCare-paid nursing home care. (This is 300% of the SSI 2025 payment level.) The Medicaid income limit for a married couple, with both spouses applying for benefits, is $5,802 per month in 2025.

Tennessee's LTC income limits are higher than the income limit for other TennCare health care benefits from Medicaid. That means it's easier to qualify financially for Medicaid-paid long-term care than for other Medicaid services.

In determining Medicaid eligibility, any income you receive from any source is considered. But when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse doesn't count toward eligibility. That's to ensure the non-applicant spouse has enough funds to live on.

Additionally, if the non-applicant spouse doesn't have enough money of their own, they're entitled to get a minimum monthly needs allowance from the spouse living in the nursing home, which can range from $2,555 to $3,948, depending on the non-applicant spouse's housing expenses.

If you live in a nursing home paid for by Medicaid, you'll be expected to spend almost all your remaining income on your care. Tennessee allows nursing home residents receiving Medicaid to keep only $70 per month as a personal needs allowance.

Medicaid Asset Rules in Tennessee for LTC

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 (including recreational vehicles, like motor homes)
• IRAs and 401Ks
• bank and credit union accounts, and
• cash.

You'll have to total up all of these to determine how much you have in resources and whether it's over the limit.

If you're single, you can only have up to $2,000 in assets, with a few allowable exclusions such as a car and your home (up to a value of $730,000 in 2025). If you're married, your non-applicant spouse at home can keep half your joint assets, up to $157,920 worth.

Tennessee Medicaid Home and Community-Based Waiver Options

Tennessee's Medicaid program recognizes that individuals who qualify for nursing home coverage might prefer to live in their homes or alternate care environments—like assisted living residences. Living outside of a nursing facility can be less expensive for the state and more convenient and desirable for you, for various reasons.

Medicaid home and community-based service (HCBS) waiver programs will pay for some services to individuals who can appropriately be cared for outside a nursing home—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 2025, an individual applicant's monthly income is limited to $2,901, with no more than $2,000 in assets.)

TennCare itself is a managed care program that operates under a Medicaid waiver (a 1115 demonstration waiver). Waiver programs have more flexibility in delivering Medicaid benefits. Tennessee's HCBS program, TennCare CHOICES in Long-Term Services and Supports (CHOICES) is part of the demonstration waiver.

CHOICES provides coverage for HCBS options to assist with daily living activities and allows qualified applicants to be actively involved in their communities. You can receive CHOICES home and community-based services in:

• your home
• the home of your caregiver or family member
• an adult foster home, or
• an assisted living community.

CHOICES provides some care options in a nursing home, too, if needed.

TennCare CHOICES provides personal care services to assist eligible individuals with daily activities like:

• bathing
• dressing
• toileting
• eating
• grocery shopping, and
• cooking meals.

You can receive CHOICES services through an HCBS provider agency or, through "Consumer Direction," you have the option to choose your care provider. So, you could have a friend, neighbor, or family member you select serve as your caregiver. You hire, train, and supervise your caregiver, but the CHOICES program handles paying them.

You can find specific information about the CHOICES program by visiting the TennCare CHOICES website, contacting your local Area Agency on Aging and Disability (AAAD), or calling (866) 836-6678. Please note that because the CHOICES program has limited enrollment, you might find there's a waiting list for services.

Tennessee Adult Day Care Services and OPTIONS for Community Living Programs

Tennessee Adult Day Care is a state program that provides certain non-Medicaid services to adults who don't need institutional care services like those nursing homes provide, but who still need some daily supervision and social activity. (Tenn. Code §§ 71-2-401 to 71-2-416.) Adult Day Care programs also provide relief and assistance to caregivers—giving them time to rest and 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 older adults who require care and want to remain living at home. To be eligible, you must be at least 60 and need help performing activities of daily living (ADL) and instrumental activities of daily living (IADL), such as:

• bathing
• dressing
• toileting
• eating
• grocery shopping,
• cooking, and
• light housekeeping.

OPTIONS provides personal care services, meal delivery, and home maintenance assistance free of charge for those whose incomes fall below a certain level. But the program doesn't have a traditional income limit. Instead, it has a sliding scale for cost-sharing for services based on an applicant's income. Those with income over 600% of the SSI payment level ($967 per month in 2025) must pay the full cost of services rendered.

Having "countable assets" greater than the $2,000 Medicaid limit also won't make you ineligible for OPTIONS. But the program might give priority to participants with assets valued below that limit.

The Tennessee OPTIONS for Community Living program is funded by the state. You can learn more about the OPTIONS program and enroll through the First Tennessee Area Agencies on Aging and Disability (FTAAAD). For more information or to determine if you're eligible for OPTIONS, contact the FTAAAD Information and Assistance line at 1-866-836-6678 and request a screening.

Applying for Medicaid for Long-Term Care in Tennessee

You can apply for Tennessee Medicaid coverage for nursing home services using any of the following methods:

• submit an online application using the TennCare Connect web portal
• call TennCare Connect at (855) 259-0701
• visit the Department of Human Services (DHS) office in your county, or
• 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.