Navigating the complexities of healthcare financing can be daunting, especially for individuals and families seeking financial assistance to help pay for long-term care in Tennessee. TennCare, Tennessee’s Medicaid program, offers a critical safety net for many residents requiring assistance with daily living activities, including those residing in assisted living facilities. This article provides an overview of the qualifications needed to qualify for TennCare benefits and how they can be utilized to cover assisted living costs.
Understanding TennCare
TennCare is a state-funded program designed to provide healthcare coverage to low-income individuals, including the elderly, disabled, and certain low-income families. In particular, it helps cover costs associated with long-term care, including nursing homes and assisted living facilities; however, qualifying for TennCare can be a complex process, requiring an understanding of financial, medical, and eligibility criteria. A person with significant assets can still qualify for TennCare benefits under certain circumstances, but it usually requires some advanced estate planning tools and techniques.
From the TennCare website: “TennCare is the state of Tennessee’s Medicaid program. It provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children, and individuals who are elderly or have a disability. To get Medicaid, you must meet the income and resource limits. You can apply anytime for TennCare. There are several different groups of people that may qualify. And each group has different income limits. Some of the groups also have limits on how much you own “resources.” These are things like bank accounts, cars, and land. The number of people who live in your household counts, too.”
Eligibility Criteria for TennCare
To qualify for TennCare benefits, applicants must meet specific eligibility requirements related to income, assets, and medical necessity.
- Income Limits: TennCare operates under stringent income guidelines that vary based on household size and the type of TennCare coverage sought. As of 2023, the income limit for individuals aged 65 and older or those with disabilities is typically set at 100% of the Federal Poverty Level (FPL). For example, in 2023, this amount is approximately $1,133 per month for a single individual. However, the limits can change annually, so it’s crucial to consult the latest information from the Tennessee Department of Human Services (TDHS).
- Asset Limits: In addition to income requirements, applicants must also consider asset limits. For those applying for TennCare, the asset limit is generally around $2,000 for an individual (the exact number varies yearly.) Exempt assets may include:
- The primary home (if the applicant lives there)
- One vehicle
- Household goods and personal belongings
Assets exceeding these limits may disqualify individuals from receiving benefits. However, strategies such as asset spend-down—where individuals reduce their assets to meet eligibility criteria—may be permissible under certain conditions. Additionally, a TennCare Asset Protection Trust (TAPT) is an advanced estate planning tool that can be used to minimize eligible assets for TennCare qualification purposes.
- Medical Necessity: To qualify for TennCare benefits for assisted living, applicants must demonstrate medical necessity. This involves showing that the individual requires assistance with daily living activities, such as bathing, dressing, or medication management. Documentation from healthcare providers, including assessments and care plans, can support this claim.
- Level of Care Assessment: TennCare utilizes a Level of Care (LOC) assessment to determine eligibility for long-term care services, including assisted living. This assessment evaluates the individual’s functional limitations and the need for assistance. A qualified assessor will review the individual’s health history, living conditions, and support systems.
The Application Process
The application process for TennCare can be complex and may take several weeks. Here are the key steps involved:
- Gather Documentation: Compile necessary documentation, including proof of income, assets, medical records, and identification.
- Complete the Application: Applications can be submitted online through the TennCare website, via mail, or in person at local Department of Human Services offices.
- Schedule an Assessment: Once the application is submitted, a Level of Care assessment will be scheduled to evaluate the individual’s needs.
- Await Determination: After the assessment, applicants will receive a notice regarding their eligibility status. If approved, they will be informed about the specific benefits available.
Coverage for Assisted Living
Once approved for TennCare, individuals can utilize their benefits to help cover the costs of assisted living; however, it is essential to note that not all assisted living facilities participate in the TennCare program. Applicants should confirm that their chosen facility is an approved provider. The benefits typically cover:
- Room and board
- Personal care services
- Assistance with daily living activities
- Health-related services
Planning for TennCare Benefits
For families considering assisted living for their loved ones, planning ahead is crucial. Here are a few strategies to facilitate the application process and ensure eligibility:
- Start Early: Begin the application process as soon as the need for assisted living is identified. This can help alleviate financial strain as care becomes necessary.
- Consult a Professional: Engaging a Medicaid planning expert or elder law attorney can provide valuable insights into the application process, asset management, and legal requirements.
- Stay Informed: Regularly check for updates to TennCare eligibility requirements and guidelines. Changes in federal or state policies can impact benefits.
Conclusion
Qualifying for TennCare benefits to pay for assisted living in Tennessee involves navigating a set of financial and medical criteria that can be complex. Understanding income and asset limits, demonstrating medical necessity, and completing the application process are vital steps for individuals seeking assistance. With careful planning and the right resources, individuals can access the support they need to enhance their quality of life in assisted living facilities and otherwise. For more detailed information, consult the Tennessee Department of Human Services (CHOICES program: https://www.tn.gov/tenncare/long-term-services-supports/choices.html) or a qualified professional who specializes in Medicaid planning. Vermillion Law can help with TennCare and Medicaid planning through the use of Elder Law legal documentation. Contact us to find out more.
Link to the application for qualification: https://www.tn.gov/content/dam/tn/tenncare/documents/TEDSPaperApp.pdf
Map of AAAD office by county in Tennessee: https://www.tn.gov/content/dam/tn/tenncare/documents/AAADMap.pdf
Eligibility reference guide: https://www.tn.gov/content/dam/tn/tenncare/documents/eligibilityrefguide.pdf