Long-Term Care Medicaid in Tennessee: 2026 Guide

In Tennessee, Medicaid is called TennCare. It is run by the Division of TennCare, which also decides eligibility. Long-Term Care Medicaid in Tennessee is mainly delivered through CHOICES, which covers nursing home care and care at home, and through PACE in some areas. Tennessee is an income-cap state, so people with higher income may need a special trust. This guide explains the 2026 rules in plain language.

At a glance: Tennessee 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with TennCare before relying on them.

What Long-Term Care Medicaid covers in Tennessee

CHOICES. This is TennCare’s main long-term care program for older adults and adults with physical disabilities. Your TennCare health plan coordinates services. CHOICES has groups:

• Group 1: people of any age who get nursing home care.
• Group 2: people 65 and older, or 21 and older with a physical disability, who need a nursing home level of care and get services at home or in the community instead.
• Group 3: people who are “at risk” of needing nursing home care and get a smaller set of home care services. Slots for Group 3 are limited by funding.

Home and community services in CHOICES can include personal care visits, attendant care, home-delivered meals, adult day care, respite, personal emergency response systems, minor home changes and care in a community living setting such as assisted care living. CHOICES home care can have a limited number of openings.

PACE (Program of All-Inclusive Care for the Elderly). For people 55 and older who live in a PACE service area and need a nursing home level of care.

Employment and Community First CHOICES is a separate program for people with intellectual or developmental disabilities.

Assisted living. TennCare does not pay room and board in assisted care living facilities. CHOICES may pay for care services there.

Who qualifies

A person generally must:

• be 65 or older, or disabled (21 or older for CHOICES Group 2);
• live in Tennessee and be a U.S. citizen or qualified non-citizen;
• meet TennCare’s medical eligibility rules for nursing home level of care (or “at risk” level for Group 3). The assessment is usually arranged through your health plan or the Area Agency on Aging and Disability;
• meet the income and asset rules below, as decided by TennCare.

Income rules

Tennessee is an income-cap state. In 2026, total income must not be over 300% of the SSI rate, $2,982 a month for one person. This is the limit for CHOICES and the home care waivers.

If your income is above $2,982, you may still qualify by setting up a Qualified Income Trust (QIT), also called a Miller trust. Income above the cap is placed in the trust each month and used toward the cost of care. The trust must follow TennCare’s rules.

Once you are on TennCare in a nursing home, most of your income goes to the facility. You keep a personal needs allowance of $70 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable resources. For a couple who both need care, the limit is $3,000.

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home, if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within TennCare rules

Spousal protections

• Assets: The spouse at home keeps half of the couple’s countable resources, but not less than $32,532 or more than $162,660 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income. Part of the applicant’s income can go to them if theirs is low.

Look-back and penalties

When you apply, Tennessee looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($295.87 a day).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $295.87 is about 169 days (about 5.5 months) without TennCare payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Tennessee

Tennessee’s estate recovery program is run by TennCare.

• What is recovered: TennCare paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: TennCare can waive or put off recovery in some situations. Ask TennCare for the current rules.
• Tennessee’s probate process includes a step where TennCare is asked whether it has a claim. Family members and executors can contact TennCare Estate Recovery with questions.

How to apply

• Online: TennCare Connect, Tennessee’s benefits portal
• By phone: through TennCare Connect (the number is on the official How Do I Apply for TennCare? page)
• On paper: print the paper application and return it to a local Department of Human Services office, or mail or fax it to TennCare
• For CHOICES: if you already have TennCare, contact your health plan. If not, contact your Area Agency on Aging and Disability for help with the referral.

TennCare says a decision on a long-term care application can take up to 90 days, because medical eligibility must be checked as well.

After you apply. TennCare will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Tennessee

• TennCare and TennCare Connect: applications, eligibility and program questions.
• Area Agencies on Aging and Disability (AAADs): local information on long-term care options and help with CHOICES referrals.
• SHIP (State Health Insurance Assistance Program): Tennessee’s free Medicare counseling program.
• Tennessee Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and assisted care living facilities.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Tennessee:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Tennessee’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Tennessee’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• TennCare CHOICES

Frequently asked questions

What is CHOICES? It is TennCare’s long-term care program for older adults and adults with physical disabilities. It covers nursing home care and, for people who qualify, care at home or in the community.

My income is over $2,982 a month. Can I still qualify? You may, with a Qualified Income Trust. Income above the cap goes into the trust each month and is used toward your care.

How much can my spouse keep? In 2026, half of the couple’s countable resources, at least $32,532 and up to $162,660, plus the home, a car and belongings. Ask TennCare about the monthly income allowance.

How long does a decision take? TennCare says up to 90 days for long-term care, because it must check medical eligibility as well as finances.

How long is the penalty for a gift? Divide the gift by $295.87 to get the number of days. A $20,000 gift would mean about 68 days without TennCare payment for long-term care.

Will the state take my home after I die? TennCare can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with TennCare before relying on them.

Sources

• TennCare, LTSS Financial Rules Guide (updated March 2026)
• TennCare, Institutional Medicaid
• TennCare, Resource Assessment
• TennCare, Post-Eligibility Treatment of Income
• TennCare, Transfer of Assets and Penalty Periods
• TennCare, How Do I Apply for TennCare?
• TennCare, Frequently Asked Questions
• TennCare Connect
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.