Tennessee residents who need Medicaid to help pay for long-term care need to apply for TennCare CHOICES. This program pays for long-term services and supports in a nursing home, at an assisted living, or in the home. If you or a loved one is already in a rehab facility, you may be approached by facility staff about applying for CHOICES to pay for long-term care services. You can also apply before entering a nursing home or other facility.
How do I apply for TennCare CHOICES?
To apply for TennCare CHOICES, you have to file an application that demonstrates both medical and financial eligibility. Medically, this requires a process called a Pre-Admission Evaluation (PAE). Depending on where you reside and need care, the PAE will either be conducted by the nursing facility or by your local Area Agency on Aging and Disability. Financially, you can apply via a paper application that is mailed or faxed to the Tennessee Health Connection, or you may choose to apply over the phone. The application is very detailed and requires lots of supporting documentation including bank statements, deeds, vehicle titles, utility statements, and id and insurance cards.
What happens after I apply for TennCare CHOICES?
TennCare has 90 days to process an application for CHOICES. They try to do it in 45, but you cannot file for a delay until 90 days has occurred. Once your case has been opened at the agency, it will be assigned to a TennCare case worker. The case worker will review your application and may request additional statements or clarification on the spend down, which is the process of spending excess resources in order to qualify. Often there are very short timelines for answering TennCare’s questions, so it is important to open all mail received and respond quickly.
How do I get help?
The TennCare website lists resources you can turn to for help with an application. At Elder Law of East Tennessee, we recommend that folks who plan to apply for TennCare CHOICES consult with a qualified attorney who is well-versed in Medicaid law. Often the situation is not as straightforward as it appears because of the complicated ways TennCare assesses which resources “count” against qualification and which ones don’t. An elder law attorney who knows all the Medicaid and TennCare rules and who keeps track of changes to those rules can assess eligibility, recommend strategies to qualify sooner rather than later, and help to save your family money in the long run.