While everyone hopes to age gracefully and spend their twilight years in their own homes, medical issues frequently arise that necessitate the need for long-term care in a nursing home. As such, seniors, aging couples, and families with elderly parents should be aware of what this entails and make plans according to any likelihood or imminence of needing long-term care, whether in the home or at a nursing home.
As part of such planning, you should familiarize yourself with Medicaid, the federal health insurance program managed by the state of Tennessee as “TennCare.” This program provides healthcare coverage for low-income individuals, including seniors with long-term care needs.
Long-term care for seniors in Tennessee is expensive. On average, in-home care costs over $30 in the state, while a private room in a nursing home in Nashville, Franklin, and across Middle Tennessee can top $100,000 per year.
Such costs can quickly deplete an uninsured senior’s assets, so exploring all possible government assistance, such as Medicaid, makes sense. Additionally, the Medicaid eligibility requirements for seniors needing long-term care with TennCare support are not as restrictive as you might think in Tennessee.
Let’s examine Medicaid/TennCare long-term care support for seniors and its complex eligibility requirements so that you can include it in your senior care planning efforts.
What is TennCare, and Who Does it Cover?
TennCare was established in 1994 as a healthcare reform initiative to control rising Medicaid costs and increase public access to affordable healthcare. The program administers the federal Medicaid program to help ensure that those with limited income and financial resources receive necessary medical care. In addition to providing long-term care for eligible seniors, it offers healthcare support to low-income families, pregnant women, children, and physically disabled adults. It also has services that address opioid addiction, the high cost of pharmaceuticals, and other healthcare needs in Tennessee.
TennCare Financial Eligibility Requirements
TennCare provides Medicaid long-term care support for seniors 65 and older under its CHOICES program, which also supports younger adults with physical disabilities. The financial eligibility criteria under CHOICES include income and asset limits. For income, the limit is computed at 300% of the Federal Benefit Rate, which in 2025 amounted to $2,901 per month for individual applicants or twice that for married applicants who are both applying. If only one spouse is applying, the income of the non-applicant spouse is not counted, allowing them to retain more income for living expenses.
The asset limits are $2,000 for individual applicants and $4,000 for married applicants who are both applying. If only one spouse applies, the non-applicant spouse can retain $148,620 in assets as spousal impoverishment protection. Specific properties and possessions are exempted from the asset limit, including:
- The primary home, provided they intend to return to it or a spouse or dependent lives there.
- One automobile.
- Personal possessions like clothes, furniture, and other personal belongings.
- Prepaid funeral plans and irrevocable burial trusts.
These asset limits are considered retroactive as applicants cannot “have given away or sold anything for less than what it’s worth in the last five years.”
Medicaid Long-Term Care Support Under Choices
To qualify for Medicaid long-term services and support under CHOICES, applicants must also demonstrate the need to receive a level of care typically provided in a nursing home. Along with medical care, this includes assistance with daily living activities like bathing, eating, and dressing. In addition to Medicaid support for those who need nursing home care, CHOICES provides it to those who qualify for nursing home care but choose to receive home care services instead. It also provides support to those who don’t qualify for nursing home care but are at risk of needing such without in-home care.
Planning Ahead to Qualify for Medicaid
The sooner you start planning for long-term care for seniors, the more success you will have in navigating TennCare’s CHOICES program and securing eligibility for Medicaid support. For example, with time, the senior applicant can work on what’s known as “Medicaid spend down.” This involves spending down income and assets to reduce them below Medicaid eligibility thresholds. With income, seniors can spend income exceeding the threshold on medical expenses like hospital bills, prescriptions, and home health care.
With assets, a senior can use those exceeding financial limits to pay for medical bills, long-term care expenses, primary home improvements, debt repayment, and purchasing exempt assets. Gifting or transferring assets to others within five years of applying for Medicaid long-term care support can delay eligibility, providing another reason to begin long-term care planning as soon as possible.
A Qualifying Income Trust is another option to help meet Medicaid long-term care eligibility requirements in Tennessee. Also known as a “Miller Trust,” this financial account allows seniors to deposit excess monthly income to meet eligibility thresholds. These trusts must be established using specific legal language required by Medicaid, and there are distinct restrictions on how its funds are used.
Do you need Help Navigating Medicaid eligibility in Tennessee? Understand TennCare with a Dedicated Elder Lawyer in Nashville
Most people find navigating the complexities of Medicaid/TennCare long-term care for seniors overwhelming. Those who delay long-term care planning or fail to follow the strict applicant guidelines can experience unexpected denials or delays in Medicaid support, leading to potential financial hardship.
An experienced elder law attorney in Tennessee can help strategize the best means of securing governmental long-term care support for seniors, focusing on preserving assets, protecting spouses and other family members, and ensuring optimal care.
The legal specialists at Elder Law of Nashville have a stellar record of compassionately helping Middle Tennessee-area families secure the best outcomes in their long-term care planning efforts and Medicaid support. If you’re ready to begin your long-term care planning for seniors or need assistance with other elder law issues, schedule a consultation with us today.