Keeping our clients informed of the ever-changing eligibility criteria for public benefits is a big part of my Elder Care Coordinator duties. We all know better than to assume that the services offered and the eligibility standards of public benefits programs will remain static. For the layman, keeping up with the changes to these programs and understanding all the ins and outs is confusing at best and impossible at worst. That’s why it is often necessary to consult a professional for assistance in understanding these complicated programs.
First, a bit of clarification: in Tennessee, the terms Medicaid, TennCare, and CHOICES are synonymous terms. They can be used interchangeably. This is not the case in all states, which may have different programs or may only use the term “Medicaid.” Do not be confused by this abundance of titles; in reality, all three of these programs are one and the same.
Elder Law of East Tennessee clients are especially affected by changes to state-financed long-term care benefits which fall under Tennessee’s CHOICES program. CHOICES offers in-home services, funding for approved adult day care centers, partial payment to approved assisted living facilities, and full funding for long-term care in a nursing home. In 2012, in order to qualify for CHOICES, Tennesseans have had to meet some strict financial and functional guidelines. In a February 12, 2012 presentation, TennCare outlined new eligibility requirements set to take effect in July of 2012. Prior to July 2012, individuals with only one deficit in activities of daily living (ADLs) met the functional eligibility criteria for CHOICES. According to TennCare, this standard is substantially more generous than most other states. The new eligibility criteria which will bring Tennessee in line with most other states are as follows:
• Functional deficits in four ADL areas
• ADL deficit and related clinical criteria will be weighted on a scale of 0 – 5 depending upon the type and amount of assistance required.
• The applicant’s cumulative score represents their acuity of need.
• Establishes a minimum acuity score for nursing home (NH) admission or for home and community based services (HCBS).
• The new eligibility criteria apply only to applicants after July 1, 2012.
• Existing CHOICES beneficiaries will be grandparented in.
This is what we know. There is a lot we still don’t know. For example, it is unclear how the weighting formula will work. We haven’t seen the evaluation tool. We don’t know if there might be variability among evaluators. We don’t know what the triggering score might be. Of course, our concern is that nursing home admission may become even more difficult for our clients, or that those who want to avoid nursing home placement and desperately need community based services or help with the cost of assisted living will suffer. It is unfortunate that these changes to TennCare seem to have been enacted without any public discussion with the Tennessee taxpayers who underwrite them.
I will be attending programs in the near future where I hope to get clarification on some of the unknowns. Please don’t hesitate to give me a call even if you are not a current Elder Law of East Tennessee client (865-951-2410). I will be happy to share what I learn along the way. It is always our goal to be good advocates for our clients and to help them get the care they need and rightfully deserve.