TennCare Eligibility for Adults

Replacing TennCare, Tennessee’s Medicaid program, is key for adults seeking affordable healthcare and long-term care. With stricter rules due to Tennessee not expanding Medicaid under the Affordable Care Act, careful planning is essential. Here’s what you need to know to take control of your TennCare options.

What Are the TennCare Eligibility Requirements?

TennCare eligibility is based on several categories, each with its own set of requirements. It’s not just about income – your assets, health needs, and even citizenship status are part of the equation.

Eligibility Categories

Adults may qualify for TennCare under the following categories:

• Low-Income Parents or Caretakers of Minor Children: To qualify, applicants must meet specific income thresholds and care for minor children in their household.
• Low-Income Pregnant Women: Income must be at or below 250% of the federal poverty level (FPL). Coverage includes prenatal care and delivery-related expenses.
• Individuals Aged 65 or Older: Eligibility depends on both income and resource limits, which are explained below.
• Individuals with Disabilities: TennCare provides critical support for adults with disabilities who meet income and asset guidelines.
• Long-Term Care Applicants: This includes people who require nursing home care or home and community-based services.
• Other categories include:
• Former Foster Youth: If you aged out of foster care in Tennessee, you may qualify for TennCare until you turn 26.
• Adults Diagnosed with Certain Health Conditions: Some programs assist adults with illnesses like breast or cervical cancer.

Income Limits

Your income plays a significant role in determining TennCare eligibility. The exact limits vary depending on your household size and category of eligibility. For instance, individuals aged 65 or older or those with disabilities must keep their monthly income below a certain threshold.

Here’s the part that can trip people up: TennCare looks at countable income. This includes wages, Social Security benefits, and other earnings, but not all types of income count. Foust & Foust can help you figure out what’s included and what isn’t.

Resource Limits

For individuals aged 65+ or disabled, resource limits are strict – $2,000 in countable assets for individuals and $3,000 for couples in some cases. But what exactly counts as a resource? Think savings accounts, stocks, or other liquid assets. However, certain items like your home (up to a value limit) or a vehicle may be exempt.

If your assets exceed these limits, don’t panic. There are ways to protect your hard-earned savings while qualifying for TennCare. Tools like Qualified Income Trusts (sometimes called Miller Trusts) or spousal transfers can help.

Functional Requirements for Long-Term Care

If you’re applying for TennCare to cover nursing home care or home-based services, your eligibility also depends on your health. A functional assessment evaluates whether you need assistance with basic activities like dressing, eating, or bathing.

TennCare Programs for Adults

TennCare isn’t one-size-fits-all. It offers various programs tailored to meet the needs of adults, particularly those who require ongoing or specialized care.

Standard TennCare

This program covers essential healthcare services for low-income adults who meet eligibility requirements. It’s the foundation of Tennessee’s Medicaid system.

Long-Term Care Options

For individuals who need more than standard healthcare coverage, TennCare offers:

• Nursing Home Care: Covers skilled nursing facilities for those with significant medical needs.
• Home and Community-Based Services (HCBS): This program allows eligible adults to receive care at home or in the community instead of moving to a nursing facility. HCBS waivers can help families keep loved ones close to home while managing costs.
• CHOICES Program: This program provides long-term services and support for older adults (65+) and adults with physical disabilities (21+).

Medicare Savings Programs

If you’re on Medicare and have limited income, TennCare can also help through Medicare Savings Programs. These programs assist with costs like premiums, deductibles, and co-pays.

How Foust & Foust Can Help

TennCare eligibility and planning often feel overwhelming. That’s where we come in.

Protecting Your Assets

Our estate planning services are designed to help you protect what you’ve worked hard for while preparing for potential long-term care needs. Whether it’s creating trusts, transferring assets, or crafting a financial strategy, we’ve got you covered.

Medicaid Planning

We assist with every step of the Medicaid planning process, including:

• Developing strategies to meet income and resource limits.
• Applying for TennCare benefits without unnecessary delays.
• Preparing for long-term care needs with confidence.

Simplifying the Process

Let’s face it – the TennCare application process can be complicated. We help with the paperwork, the financial calculations, and even the tricky functional assessments.

Take the First Step Toward TennCare Planning

It can be difficult to understand Tennessee’s complicated long-term care options and qualifying requirements for TennCare. Careful planning is necessary to provide care while safeguarding assets when there are income and resource limitations.  If you’re unsure whether you qualify for TennCare or need help preparing for long-term care, reach out to Foust & Foust today at (865) 203-4041. Our compassionate team is here to help you protect your assets, secure the care you need, and plan for the future. Schedule your consultation now to get started.