Seniors

SOUTHEAST TENNESSEE LEGAL SERVICES

 

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HOW ARE NURSING HOMES COSTS PAID?

The TennCare Bureau pays for 70% of eligible nursing home costs. If it decides you are eligible, the state will pay the difference between your income and the nursing home costs. If you are not eligible for TennCare, then you will pay for your own care with your assets or a long term care insurance policy. Medicare pays only 2% of Tennessee nursing home costs.

HOW DO I APPLY FOR NURSING HOME MEDICAID?

You apply at your local county department of human services. who determine if you are financially and asset eligible. The hospital or doctor will file a form with the state who will determine if you need intermediate or skilled nursing services.

WHEN WOULD I BECOME ELIGIBLE FOR NURSING HOME MEDICAID

To be eligible for nursing home Medicaid you must be

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income eligible

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asset eligible

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medically eligible

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have received 30 continual days of nursing home care and

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living in or expect to enter a nursing home that accepts TennCare payments.

WHAT ARE THE INCOME-ELIGIBILITY GUIDELINES?

Your countable income must be less than the total of

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the amount TennCare will pay for nursing home care, plus

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your regular monthly medical expenses that are not paid by insurance or other payment source.

DO I HAVE TO SELL MY HOME IN ORDER FOR THE STATE TO PAY FOR MY CARE IN A NURSING HOME?

The home is not considered an asset and will not have to be sold. However, if there is a mortgage on the home you will not be able to pay it because all your income will be used to pay for your care in the nursing home. Once the home is unoccupied, be sure to change your insurance to unoccupied dwelling insurance. The insurance company will not pay for a loss if it is insured by a homeowner's policy. It would only refund your premiums.

WHAT HAPPENS TO MY HOUSE AFTER I DIE?

If your name is the only name on the deed to your house, the state will file a claim for the expenses it paid for you while you were in the nursing home.

WHAT ARE THE ASSET-ELIGIBILITY GUIDELINES?

At this writing, a single person can have no more than $2,000 in COUNTABLE ASSETS.

WHAT ASSETS ARE NOT COUNTED?

THE MOST COMMON ASSET THAT DOES NOT COUNT IS THE HOME. READ ON TO FIND OUT WHAT COUNTS IN YOUR SITUATION.

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Your home does  not count if your spouse, dependent child or disabled relative still lives there.

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If you are single the home is not considered an asset as long as you express and intent to return even if this intent is not realistic. A family member or other person can express this intent even when you cannot.

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If you own other real property it may be considered an asset unless you can show it is income-producing property. The property may not be considered an asset if it cannot be sold for several months. If you are incompetent and you do not have not have a legal representative  to sign for you, your family cannot be forced into filing a conservatorship petition in order for you to be eligible for the nursing home Medicaid.

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Jointly held real estate will not be considered and asset if it cannot be easily divided or if the other owner needs it for a home.

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One car is not counted as an asset.

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A personal possession is usually not counted unless it is an item of great value like a coin collection.

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Assets to be used for funerals and burials are not counted, subjectto these limitations. A burial fund of $1,500 is exempt as a asset if it is set aside in a clearly designateD account to cover burial expense. A burial plot and headstone are not counted. An irrevocable burial trust may be created for burial and funeral expenses. This amount will not be considered if it is a reasonable amount.

WILL MY SPOUSE BE ABLE TO LIVE FINANCIALLY WHEN I GO INTO THE NURSING HOME UNDER THE MEDICAID PROGRAM?

THE STATE ELIGIBILITY WORKER MUST FIRST DETERMINE THE TOTAL VALUE OF ALL THE COUNTABLE ASSETS OWNED BY BOTH SPOUSES at the date one spouse entered the nursing home. (The dollars expressed below may be changed from time to time. Be sure to check for the latest limits.)

The assessment is always based of the total assets of both husband and wife as of the first day of nursing home admittance. This assessment is called a resource assessment.

All countable assets of both spouses will be counted together to determine eligibility. It does not matter which spouse owns what asset or whether an asset is community or separate property.

The spouse at home can keep one-half of the total assets in the resource assessment. However, the spouse's half can have a value of not more than $70,740. Also, the spouse left at home can always keep resources valued at $14,148 even if the spouse’s share is less than that.

When the spouse in the nursing home spends down his share of the countable assets to $2,000, then Medicaid eligibility may begin.

HOW MUCH INCOME MAY THE SPOUSE WHO STAYS AT HOME KEEP?

When one spouse goes into a nursing home, Medicaid allows the spouse who remains at home to keep income which is the greater of either:

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all income paid in her name, or

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all income paid in her name plus as much of the institutionalized spouse's income as is necessary to bring her income up to $1,179 per month. (If her housing costs exceed $345 per month, the income level can be increased by the amount in excess, up to $1,769. In calculating housing costs, the actual costs for rent mortgage, taxes and insurance are used. For utilities, a standard amount is used. A nursing home resident who has Medicaid may also get an additional allowance paid to a dependent other than the spouse.)

WHAT ARE THE MEDICAL ELIGIBILITY GUIDELINES?

The Medical application called a PRE-ADMISSION EVALUATION (PAE) IS USUALLY FILLED OUT BY THE MEDICAL PROVIDER. This application is then sent by the medical provider to the TennCare Bureau. The state looks at the application and determines if you need nursing -level care on a daily basis. Another part of the medical application is called the PASARR. It prevents someone who needs mental health services from being placed in a nursing home.

WHAT CAN I DO IF THE STATE OF TENNESSEE DECIDES I AM NOT ELIGIBLE?

APPEAL! If you are turned down for financial or medical reasons you will be given a right to appeal in the notice. Be sure to read the notice carefully for the number of days you have to appeal If you miss the appeal deadline, you may lose the right to appeal.

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