Medicaid for nursing home and home care in Tennessee

What CHOICES pays for

CHOICES is TennCare's long-term care program for people 65 and over and adults 21 and over with a physical disability. It has three groups:

• Group 1: People of any age who live in a nursing home and need that level of care.
• Group 2: People who need nursing home level care but choose to get care at home or in the community instead.
• Group 3: People who do not yet need nursing home care but need some help to delay or prevent it. Group 3 has a limited number of spots for people who do not get SSI.

With Consumer Direction, you can become the employer of the people who give your home care. This can include some family members or friends.

Who qualifies

You must meet three tests: medical need, income and assets.

Medical need. A Pre-Admission Evaluation (PAE) checks whether you need help with daily living. Your Area Agency on Aging and Disability, a hospital, your health plan or a nursing home can complete it. TennCare reviews it.

Income above the cap? You may still qualify by setting up a Qualified Income Trust (QIT), sometimes called a Miller trust. See below.

No spend-down for adults. Tennessee's medically needy spend-down groups are only for children and pregnant women. Adults 65 and over who need long-term care use the income cap or a QIT.

Gifts and sales. TennCare looks back five years. If you gave away money or property, or sold it for less than it was worth, you may have to wait for coverage.

What counts and what does not

Income. TennCare compares your gross monthly income, before any deductions, to the cap.

Assets that do not count include:

• Your home, if your equity is under $752,000. The equity limit does not apply if your spouse, a child under 21, or a blind or disabled child lives there. If you are in a nursing home and plan to go home, the home can still be excluded. TennCare checks your plan to return at each renewal.
• Household goods and personal items.
• One burial space for each close family member.
• Up to $1,500 each for you and your spouse set aside for burial, and irrevocable prepaid burial contracts that meet the rules.
• Term life insurance, and the cash value of life insurance if the total face value is $1,500 or less.

Bank accounts, cash, stocks and most other property do count.

The Qualified Income Trust

A QIT is a special trust used only to qualify for TennCare long-term care. Here is how it works:

• Each month, some of your income (often Social Security or a pension) goes into the trust. The income left outside the trust must be at or under the cap.
• The trust must be irrevocable.
• Each month the trustee must pay out everything that came in. It can keep up to $20 for bank costs.
• The trust can pay your personal needs allowance, an allowance for a spouse at home, health insurance premiums, and your share of the nursing home bill.
• It cannot pay lawyer or trustee fees, funeral costs or old debts.
• When you die, the State of Tennessee gets what is left, up to what TennCare paid for your care.

If you are married

Your spouse at home does not have to become poor.

• Assets: TennCare takes a snapshot of everything you and your spouse own on the first day of a continuous stay in a nursing home, or the date your home care PAE is approved. Your spouse can keep half, but not less than $32,532 and not more than $162,660 in 2026. The rest must be at or under the limit for you. You can ask for this assessment before you apply.
• Income: Part of your income can go to your spouse each month as an income allowance. Ask your caseworker how much.

What you keep each month

• In a nursing home: You keep a personal needs allowance of $50 a month. Most of the rest of your income goes to the nursing home. This is called patient liability.
• At home (CHOICES Groups 2 and 3): You can keep income up to the income cap to pay your living costs.
• People on SSI who live in a nursing home have no patient liability.

How to apply

1. Call your Area Agency on Aging and Disability (AAAD) at 1-866-836-6678. It is the main front door for older adults. It can send in your TennCare application and do your PAE.
2. If you already have TennCare, call the health plan on your TennCare card instead.
3. Or apply yourself through TennCare Connect online at tenncareconnect.tn.gov, or by phone at 855-259-0701. Paper applications go to TennCare Connect, P.O. Box 305240, Nashville, TN 37230-5240, or fax 1-855-315-0669.
4. Have ready: Social Security numbers and birth dates, income for you and your spouse, bank and other account values, car and property values, other health insurance, and citizenship or immigration papers.
5. Send any proof TennCare asks for quickly. Missing papers are a common reason for denial.

TennCare should decide your application or give you a hearing within 90 days for CHOICES applications.

After you apply

• Renewals: TennCare checks eligibility once a year. If it needs more from you, you get a renewal packet by mail with a due date. Return it on time. If you miss it, you can send it within 90 days after your coverage ends to get coverage back.
• Report changes such as new income or a move through TennCare Connect or at 855-259-0701.
• Appeals: You can appeal a denial or ending of coverage. File within 40 days of the date on your notice. To keep coverage during the appeal, file within 20 days or before the coverage end date. File online in TennCare Connect, by phone at 855-259-0701, by mail to Eligibility Appeals, P.O. Box 23650, Nashville, TN 37202-3650, or by fax to 844-563-1728. Keep a copy.

Things people miss

• Applying for help at home does not mean you need to be in a nursing home first.
• A spouse can ask for the asset assessment early, so you know what your spouse can keep.
• Estate recovery: If you were 55 or older and got CHOICES care, TennCare may ask your estate to repay costs after you die. It waits while a spouse, a child under 21, or a blind or disabled child survives you.

Free help

• Area Agency on Aging and Disability: 1-866-836-6678
• TennCare LTSS Help Desk: 1-877-224-0219
• TennCare Connect: 855-259-0701

See also paying for a nursing home, Medicare and all benefits in Tennessee.

Phone numbers: Free help lines for Tennessee agencies

Check what you may qualify for