Tennessee
What Is Long-Term Care Medicaid in Tennessee?
Medicaid is a state and federally funded health program for low-income individuals of all ages. This guide focuses specifically on Medicaid options for elderly Tennesseans aged 65 and older who require long-term care. Beyond nursing home coverage, Tennessee’s Medicaid program (TennCare) helps seniors access assisted living, adult foster care, and a variety of in-home services aimed at allowing them to remain safely in their communities.
What Types of Long-Term Care Programs Does Tennessee Medicaid Offer?
What Is Institutional / Nursing Home Medicaid?
This program provides care exclusively in licensed nursing homes. It is an entitlement program, meaning that all who meet the qualifications are guaranteed to receive services without a waiting list.
What Are Medicaid Waivers or Home and Community-Based Services (HCBS)?
These programs are designed to provide care in non-institutional settings, such as one’s own home, adult day care, or assisted living. Enrollment is limited and may be subject to waitlists. The goal is to delay or avoid placement in a nursing facility.
What Is Regular Medicaid for the Aged, Blind, and Disabled (ABD)?
This program offers in-home and community support services to qualifying individuals. It is also an entitlement program and includes benefits like personal care assistance or adult day health care.
What Are the Financial Requirements for TennCare Long-Term Care in 2025?
Each Medicaid program has distinct income and asset rules, which can also vary by marital status. Below is a reference table for 2025 to help determine possible eligibility.
| Type of Medicaid | Single | Married (both applying) | Married (one applying) |
|---|---|---|---|
| Institutional / Nursing Home Medicaid | $2,901/mo income $2,000 assets Nursing Home Care | $5,802/mo income $4,000 assets Nursing Home Care | $2,901/mo income $2,000 applicant assets $157,920 spouse assets Nursing Home Care |
| Medicaid Waivers / HCBS | $2,901/mo income $2,000 assets At Risk or Nursing Home Care | $5,802/mo income $4,000 assets At Risk or Nursing Home Care | $2,901/mo income $2,000 applicant assets $157,920 spouse assets At Risk or Nursing Home Care |
| Regular Medicaid / ABD | $967/mo income $2,000 assets Help with ADLs | $1,450/mo income $3,000 assets Help with ADLs | $1,450/mo income $3,000 assets Help with ADLs |
*Most income must be used toward nursing home costs, minus a $70 personal needs allowance and other permitted deductions.
†Waiver income limits may vary based on the setting of care.
How Does Medicaid Count Income in Tennessee?
What Income Sources Count Toward the Limit?
Income from employment, pensions, Social Security, retirement accounts, alimony, and investments is considered. Certain sources, like Holocaust restitution and VA Aid & Attendance, are excluded from countable income.
What Happens When Only One Spouse Applies?
Only the applying spouse’s income is counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) to prevent impoverishment. For 2025, this allowance is $2,643.75/month, potentially rising to $3,948/month based on housing and utility costs.
How Is Income Counted for Regular Medicaid?
When applying for Regular Medicaid, the income of both spouses is considered, and there is no spousal allowance like in the nursing home or waiver programs.
How Are Assets Evaluated for Eligibility?
What Are Countable vs. Exempt Assets?
Countable assets include cash, bank accounts, stocks, bonds, and non-residential property. Exempt assets typically include a primary residence (under certain conditions), one car, personal items, and burial funds up to $6,000. In Tennessee, IRA and 401(k) funds are counted.
How Are Assets Handled for Married Couples?
All marital assets are considered jointly owned. A Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to keep up to $157,920 in 2025. If their share is under $31,584, they may retain the full amount up to that threshold.
What Is the Medicaid Look-Back Rule?
Tennessee enforces a 5-year look-back period for asset transfers. Gifts or sales below fair market value may result in a penalty period of ineligibility. The IRS gift exemption does not apply to Medicaid’s rules.
Is the Home Always Protected for Medicaid Eligibility?
When Is a Home Considered Exempt?
A home is generally exempt if the applicant or their spouse lives in it. If no one resides there, the applicant must have Intent to Return. The 2025 home equity interest limit is $730,000. This cap does not apply to Regular Medicaid.
Can Medicaid Reclaim the Home After Death?
Yes. Under the Estate Recovery Program, TennCare can seek reimbursement from a deceased enrollee’s estate, including the home. Legal and financial planning can help protect the home from this claim.
What Level of Medical Need Is Required?
Applicants must demonstrate a need for care equivalent to what is provided in a nursing facility (NFLOC). Waiver applicants may qualify if they are at risk of requiring this level of care. For Regular Medicaid, needing help with daily activities may be enough.
Can Seniors Qualify If They Exceed Income or Asset Limits?
How Do Qualified Income Trusts (QITs) Work?
QITs, or Miller Trusts, are tools that allow individuals over the income limit to qualify by placing the excess in an irrevocable trust. Funds are managed by a trustee and used only for approved expenses. Tennessee must be named a trust beneficiary.
What Is an Asset Spend Down Strategy?
Seniors over the asset limit may qualify by converting countable assets into exempt ones, such as home modifications, debt repayment, or prepaid burial arrangements. Keep receipts to avoid violating the look-back rule.
When Should Someone Consider Medicaid Planning?
Many individuals are over-income or over-asset yet unable to afford long-term care. Medicaid Planning professionals can develop strategies to help gain eligibility while protecting assets like the family home.
What Specific TennCare Programs Help Seniors?
CHOICES in Long-Term Services and Supports Program
CHOICES provides support for eligible individuals to receive care in their home or a community setting. Benefits may include personal care, respite, adult day services, transportation, and emergency alert systems.
Program of All-Inclusive Care for the Elderly (PACE)
PACE integrates Medicaid and Medicare services for qualifying seniors. In addition to long-term care, services may include dental, vision, prescription coverage, and more, all under one coordinated plan.
How Can Someone Apply for TennCare Long-Term Care Benefits?
Seniors can apply online at TennCare Connect, call 855-259-0701, apply in person at a DHS office, or submit a paper application. Existing TennCare enrollees seeking CHOICES should contact their health plan. Non-enrollees should reach out to their local Area Agency on Aging and Disability (AAAD). For assistance, call the LTSS Help Desk at 877-224-0219.
Why Is It Important to Prepare Before Applying?
It’s crucial to ensure you meet the program’s eligibility criteria before applying. If you are unsure or exceed income or asset limits, consult a Medicaid Planning expert to improve your chances of approval and preserve family assets.
