How to Qualify for TennCare, Tennessee’s Medicaid Program

With costs in the thousands of dollars per month, paying for long-term care at home or in an assisted living or nursing home can be a huge financial hit for an individual or family. TennCare CHOICES, Tennessee’s Medicaid program for long-term care benefits, is often the solution that helps people get the care they need. To get TennCare CHOICES benefits you have to qualify both medically and financially.

The medical qualification is established through a process called a Pre-Admission Evaluation (PAE). This evaluation looks at whether or not you can do certain everyday activities without help. These are activities like bathing, dressing, and eating meals. Depending on where you live and where you will require care, the PAE will be conducted either by the nursing facility or by your local Area Agency on Aging and Disability (AAAD). It is scored on a point scale of 26 and requires a minimum score of 9 to show that you require a nursing home level of care, which qualifies you medically for Medicaid through TennCare CHOICES.

The financial qualification is established through the application process. You have to show that you have income less than $2,250* a month (or that you have a Miller Trust/Qualified Income Trust, or QIT) and that you have assets under $2,000*. A married spouse of an applicant can keep between $24,720* and $123,600* of the countable assets of a couple. Certain of your assets don’t count towards the asset requirement. A limited list of these resources includes the home, one vehicle, prepaid burial and funeral plans, cemetery plots, and term life insurance.

A qualified elder law attorney who knows the ins and outs of Medicaid can assess your assets and income to determine which of your assets will and won’t count toward eligibility. Sometimes people who think they don’t qualify are surprised to find that they do, or that they can make a few minor changes to become qualified sooner rather than later. Others may not be able to qualify soon, but by planning in advance they can maximize which assets are saved. If you think you or a loved one may need TennCare benefits now or in the future, don’t listen to word on the street to do a self-assessment; call a professional who can guide you through the process and get the best results for your situation.

*Figures are based on year 2018 amounts. TennCare/Medicaid income and asset limits are subject to change over time.