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
WHAT ARE THE INCOME-ELIGIBILITY GUIDELINES?
Your countable income must be less than the total of
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.
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:
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.