Tennessee Medicaid for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex
TennCare CHOICES waiver provides home and community-based care — apply early, as enrollment has capped capacity
What TennCare CHOICES covers
TennCare CHOICES (Community Health through Optimizing Innovation, Care and Efficiency for Seniors) provides long-term services and supports through Tennessee's three TennCare MCOs — BlueCare Tennessee, UnitedHealthcare Community Plan, and Wellpoint. Services are coordinated by the MCO's care coordinator assigned to each member.
- Nursing facility (nursing home) care — 24-hour skilled nursing
- Personal care at home (assistance with bathing, dressing, personal hygiene)
- Home health aide services
- Adult Day Health Center services
- Respite care for family caregivers (including temporary nursing home stays)
- Home delivered meals (for some CHOICES members)
- Assistive technology and home modifications
- Hospice care
- Transportation to medical appointments
Source: Bureau of TennCare CHOICES program description; TennCare CHOICES member information (tn.gov/tenncare).
TennCare financial eligibility for long-term care (2026)
TennCare long-term care uses non-MAGI financial eligibility rules — an income test and an asset test both apply. The income limit for nursing facility TennCare is 300% of the Social Security Federal Benefit Rate (FBR). For 2026, that is approximately $2,829 per month (the FBR for 2026 is $943/month; 300% = $2,829). Income above this limit is applied toward the cost of nursing home care; TennCare covers the remainder.
| Financial figure | 2026 amount (approx.) |
|---|---|
| Income limit for nursing facility (300% FBR) | ~$2,829/mo |
| Individual asset limit | $2,000 |
| Community spouse minimum resource protection (CSRA) | $32,532 |
| Community spouse maximum resource protection (CSRA) | $162,660 |
Source: Bureau of TennCare CHOICES eligibility standards; 42 U.S.C. § 1396r-5 (federal spousal impoverishment rules). The federal spousal impoverishment CSRA figures are set annually. Verify exact Tennessee figures with your TennCare MCO or an elder law attorney.
CHOICES Group 1 vs. Group 2
TennCare CHOICES divides long-term care into two groups based on care setting:
CHOICES Group 1 — nursing facility residents
Covers all TennCare-eligible seniors and adults residing in a nursing facility. This group is an entitlement — no enrollment cap. If you are in a nursing home and meet financial and clinical criteria, you cannot be waitlisted.
CHOICES Group 2 — home and community-based services
Provides home-based alternatives to nursing home care for members who meet nursing facility level of care but prefer to remain at home. Enrollment has historically been capped. A waitlist may apply — call 1-866-836-6678 to be assessed and placed on the list if needed.
Tennessee Medicaid estate recovery
Tennessee participates in Medicaid estate recovery. TennCare may seek reimbursement from the estate of a member who received long-term care services after age 55, or who was institutionalized (nursing home, ICF, or hospital). The family home is generally exempt while a surviving spouse, a child under 21, or a blind or disabled child lives there. Tennessee applies a 5-year (60-month) look-back period for asset transfers. Consult a Tennessee-licensed elder law attorney before making gifts or transferring assets if nursing home care may be needed.
Medicaid as the primary payer for long-term care
Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.
Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Tennessee's share of that population is administered through TennCare (Tennessee Medicaid). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.
Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.
Nursing facility coverage
TennCare (Tennessee Medicaid) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.
Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.
If income exceeds the institutional Medicaid limit, Tennessee may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Tennessee uses this approach with TennCare (Tennessee Medicaid).
Home and community-based services (HCBS)
HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through TennCare (Tennessee Medicaid) differs from what's available in neighboring states.
Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.
Contact TennCare (Tennessee Medicaid) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.
Asset limits for long-term care Medicaid
Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.
Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.
Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult TennCare (Tennessee Medicaid) or a Medicaid planning attorney before transferring assets.
Spousal protections
When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.
The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Tennessee's current CSRA is set by TennCare (Tennessee Medicaid) and published on their website.
The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).
Estate recovery applies to long-term care recipients age 55 and older
What long-term care Medicaid typically covers
- Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
- Physical, occupational, and speech therapy provided in a nursing home
- Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
- Home health aide visits for those receiving care at home
- Adult day health care programs
- Respite care to give family caregivers temporary relief
- Durable medical equipment prescribed by a physician
- Transportation to and from medical appointments