TennCare CHOICES in Long-Term Care: Cash & Counseling

Program Description

TennCare CHOICES is a Medicaid program for elderly and / or disabled Tennessee residents that require the level of care typically provided in a nursing home or who are “at risk” of moving into a nursing home. While CHOICES does cover nursing home care, more interesting to most families is the care offered outside of nursing homes. Participants can receive care and support services either in their home, the home of a caregiver or family member, in an adult foster care home, or in an assisted living community. A wide range of personal care assistance and support services are covered, supporting both the person in need of assistance, as well as the primary caregivers of those who remain living in the community.

Personal care services are provided to assist eligible individuals with activities of daily living (ADLs), as well as instrumental activities of daily living (IADLs), such as bathing, dressing, using the bathroom, eating, grocery shopping, and preparing meals. Also, of great interest is the support of assistive technology, personal emergency response services, and minor home modifications to make homes safer and more accessible.

The word CHOICES in the program’s name stems from the fact that some of the services can be “consumer directed.” This means they are offered based on the Medicaid Cash and Counseling model in which participants are provided with the flexibility and choice to self-select their care providers. One option that is very popular for self-direction allows the care recipient to employ friends, neighbors and certain family members as caregivers. Spouses and legal guardians or individuals who have a Power of Attorney for the elder are not eligible to become paid caregivers through this program.

Eligibility Guidelines

This program has qualification criteria regarding the applicant’s age, functional ability, and financial situation.

Age and Functional Ability
Applicants must be disabled and at least 21 years of age. If they are 65 or older, full disability is not required. Instead, they should require the level of care typically provided in nursing homes and / or be “at risk” of moving to a nursing home if they don’t receive care.

Financial
There are limits on both an applicant’s income and assets. The 2022 income limit for an individual applicant is gross monthly income of $2,523. This figure is adjusted annually per the federal Cost of Living Adjustment (CoLA). If an applicant is married and his/her spouse is not applying for Medicaid, some of the applicant spouse’s income might be allocated to the non-applicant spouse. This can help the applicant in meeting the income limit and also give the non-applicant spouse sufficient income to support oneself. As of 2022, as much as $3,435 / month might be able to be allocated to the non-applicant spouse. Another alternative is to distribute excess income into a Qualified Income Trust or Miller Trust. Both spousal and trust distribution of income are complicated processes and may require the assistance of a Medicaid planning professional.

The individual asset limit is $2,000 in countable assets. This excludes certain resources like pre-paid burial plans, wedding rings, and one’s home, if the equity value is under $636,000 and the applicant lives in the home, and one vehicle. Assets that must be included in one’s application include the value of any checking, savings, or investment accounts, and the cash surrender values of any life insurance policies. Applicants over the asset limits may still qualify if they are married and their spouse is not also applying for benefits. Under these circumstances, the non-applicant spouse can retain half of the couple’s total joint resources, up to $137,400 in funds. Alternatively, some “counted assets” might be converted into “exempt assets” in order to meet the asset limit. Again, these are complicated processes. Note that it is very important that one not give away cash and other valuables to reach the asset limit. Doing so violates Medicaid’s look-back rule and can lead to a period of ineligibility. If one is over the asset limit, a professional Medicaid planning consult is recommended. One can learn more here. 

Benefits and Services

This program provides services that help individuals remain living outside of nursing homes, as well as provides some services in nursing home facilities. Some of these services may be self-directed.

• Adult day care
• Adult care homes – adult foster care
• Assisted living – homemaker services, medication management, and assistance with personal care
• Assistive technology and home modifications to make one’s residence more accessible – grabbers, walk-in tub, ramp, widening of doors, etc. 
• Benefit planning
• Home-delivered meals – fresh or frozen
• Homemaker services – assistance with the instrumental activities of daily living, such as laundry, grocery shopping, and meal preparation
• Personal care assistance with the activities of daily living, sometimes also called attendant care
• Personal Emergency Response Services (PERS). Read more about top medical alert systems.
• Respite care to relieve the primary caregiver – in-home and in-patient
• Rodent and insect control
• Transportation

Under certain circumstances, TennCare will limit the value of the home care services that the participant receives to $18,000 per year.

How to Apply / Learn More

Interested individuals should contact their local Area Agency on Aging or visit the TennCare Choices website to learn more about the program. Alternatively, one can call their toll-free number at 1-866-836-6678.  

The CHOICES program is available statewide. However, a waiting list for services may exist and prioritization is not necessarily first-come, first-serve. Persons who are currently residing in a nursing home and wish to return home receive higher priority.