Medicaid Eligibility Myths

Call an Elder Law Attorney Before Counting It a Lost Cause

Just like when you catch a cold, the moment you start talking about applying for TennCare/Medicaid benefits, it is likely you will find yourself suddenly surrounded by “experts.”  Tidbits of knowledge and advice are passed along like home remedies by well-meaning family members, friends, church associates, and even doctors or other health care professionals.  “You can’t qualify unless you sell your home.”  “Your parents have too many assets to qualify.”  “Uncle Bob got TennCare, and when he died, the State took everything from Aunt Sally.  Beware!”

Often these people seem reliable because of their profession or their direct experience.  However, it is critically important to remember this fact:  every single situation is unique.  What happened to one family may not happen to yours, especially if you plan in advance to avoid pitfalls.  Nobody is deliberately trying to mislead you, but many people will inadvertently deliver partial (and therefore inaccurate) information.  TennCare follows complicated rules about what types of assets and income count for eligibility and which ones don’t; which circumstances will allow the State to recover expenses and which will not; and how individuals qualify both medically and financially.  Even if you think you can’t possibly qualify or that the consequences of taking benefits will not be acceptable, it is prudent to speak with an experienced professional prior to making any big decisions, such as selling or gifting assets or giving up on benefits altogether.

Here are some of the top TennCare CHOICES myths and why you should seek professional guidance before assuming they apply to you:

  1. If I qualify for TennCare CHOICES, the State will come take my house/family farm after I die.

Does this happen?  Yes.  Is it inevitable?  No.  When a TennCare recipient dies, TennCare’s estate recovery provisions do allow the State to reclaim funds from the estate up to the amount that was spent on the person’s care during their lifetime.  However, with proper planning in advance, some assets (such as the family home) may be exempt from estate recovery.  Surviving spouses and children who meet certain qualifications may be able to continue living in the home.  It is critically important to understand the rules and how they apply to your family’s unique situation to know your rights and to plan accordingly.

  1. Dad has to sell his home in order to qualify for TennCare CHOICES.

Not all assets are equal in the eyes of TennCare.  Some are considered “countable,” and others are not.  The family homestead and a reasonable amount of land (as defined by TennCare) are typically excluded.  Even if the person qualifying for TennCare no longer plans to reside in the home, it may still be possible to qualify for benefits without selling this important family asset.  Once again, understanding the rules is necessary to know your rights and make good long-term decisions.

  1. We have too much money to qualify for CHOICES.

As with the family home, certain types of income and assets are countable whereas others are not.  Many people incorrectly assume they are over-resourced because they don’t know the complicated rules about how income and assets are counted.  Some folks only miss the mark by a narrow margin, and for those people, there are often legal and financial strategies that will allow them to become qualified.  Furthermore, if you plan well before a crisis occurs, you can ensure that you will qualify years later at the time when you need benefits.  Doing so could save you and your family thousands of dollars in the long run.

  1. Mom won’t qualify for CHOICES because she is not in a wheelchair and can feed herself.

To qualify for TennCare CHOICES, a person must meet standards for medical as well as financial need.  Sometimes family members overestimate their loved ones’ level of ability, especially where dementia is concerned.  Just because someone is physically able does not mean they are capable of living independently.  Having an objective third party evaluate the situation and coordinate with the TennCare assessor can make the difference between passing or failing the medical evaluation.  It’s all about knowing what signs to look for and how to thoroughly and accurately document the level of medical need, whether that need is physical, cognitive, or both.

  1. It is impossible to qualify for CHOICES after entering skilled nursing care.

Did you or your loved one enter nursing facility care with too many assets to qualify for TennCare?  You may have heard from friends, family, or even facility staff that you’re now stuck spending all the excess resources on private pay care until you or your loved one becomes qualified.  But the people giving you this information may not provide guidance about which assets do or do not have to be spent, and they are also unlikely to give accurate or detailed advice about ways in which the excess resources might be re-structured to meet the requirements sooner rather than later.  Treat this situation like you would a major medical diagnosis, and get a second opinion to make sure you’re moving forward with complete information.

  1. It is too late for me to seek help with CHOICES.

We always encourage planning early, well in advance of a crisis, to achieve the best results for the TennCare recipient and his or her family.  Seeking help before making important decisions can prevent costly missteps.  However, even if you find yourself well into a TennCare mess, there may be ways to remedy the situation.  Did you give money to a loved one only to find out that prevents you from qualifying?  Has a property transfer for less than full market value stalled your application?  Have you been denied benefits for financial and/or medical reasons?  A qualified professional may be able to remedy all of these scenarios and more.

The bottom line?  Don’t hesitate to get expert guidance.  The potential savings for your family are well worth the time you will spend getting the answers you need.