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April Harris Jackson

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How do I qualify for Medicaid?

Long-term care is expensive

Many people have sufficient income to maintain a regular lifestyle but are unable to afford the high cost of long-term care. With the average cost of long-term care around $7,000.00 a month, it is incredibly difficult for most families to afford it, even more so after retirement. That’s why it’s a good idea to plan for qualifying for TennCare, also known as Medicaid.

Evaluate and restructure your assets to qualify for TennCare

do you know how to qualify for tenncare? Image is of a man in a long-term care facility. He is taking a walk with a nurse and his partner.
It’s worthwhile to know how to qualify for TennCare

As we discussed in our blog last week, there are certain criteria you need to meet to be eligible for TennCare. As an elder law attorney, one of my jobs is to help families get their loved ones qualified for TennCare while maintaining resources available for the rest of the household.

One of the ways that we do this is by restructuring a family’s assets. We do this by turning resources that are countable for TennCare purposes into items that TennCare does not count as part of its eligibility assessment

This process is known in the elder law community as a spend-down. The goal of the spend-down is to make you or your loved one eligible for TennCare as far as your assets are concerned. If you are overqualified for income-based criteria, we can use a special type of trust called a Qualified Income Trust, or a Miller Trust, to reduce your income. The goal of a spend-down is to maintain the quality of life for all family members including those who need long-term care. 

Image of a scooter as a mobility device. Buying a scooter is a good way to spend down your assets to qualify for tenncare
Bob might benefit from purchasing a quality mobility device

What is a “spend-down”?

For example…

Bob needs to go into long-term care. Bob is eligible based on his income. He makes $2,000.00 a month of social security retirement income. Bob also has a house, a car, and $50,000.00 in the bank. Bob is widowed and his children are adults. 

We need to do something with at least $48,000.00 from Bob’s bank account in order to make him eligible for TennCare. His house and his car are not countable for TennCare purposes in most cases. What can we do? 

  • Make improvements to his home that would improve his quality of life and access to the things that he needed in the home. This might include: 
    • Grab bars in the shower or hallway.
    • A ramp into the main entrances.
    • Paving the driveway or expanding it closer to the door 
    • Widening doors 
  • Buy some things for Bob that his Medicare did not cover, such as:
    • Hearing aids
    • Dentures
    • Eyeglasses
    • Top of the line mobility devices 

There may be other things that would improve Bob’s quality of life. There are things we can spend money on or convert into income. I am also going to suggest to everyone that they use the money to make arrangements for end-of-life needs if they have not done so already. Since at some point Bob’s children will need to make arrangements for his burial or cremation, paying for it now from his excess funds is a great way to make those funds unavailable for TennCare purposes and meet a future need. 

image of a smiling older gentleman sitting with his daughter. Do you know how to qualify for medicaid?
Bob has peace of mind because he has plans in place for long-term care

Bob might want a Care and Savings Assessment

It’s not easy getting approved for TennCare / Medicaid, and we know it! That’s why we offer help in planning your steps to qualify. It doesn’t matter what your starting point is, we’re here to help you navigate the process with one goal: get our clients the quality of care that they need. Contact us if you would like to make plans for qualifying for TennCare.

How can I plan long-term care with TennCare?

TennCare is Medicaid

What is TennCare? (A brief overview of Medicaid)

Quite simply, TennCare is Tennessee’s Medicaid program. While the name “TennCare” has the word “care” in it, it is NOT Medicare. In order to further clarify the difference between the terms “Medicaid” and “Medicare,” you need to remember that we use “Medicare” to “care” for our elders and “Medicaid” to “aid” those, of any age, in need. Essentially TennCare is Tennessee’s brand of Medicaid. Hopefully, that little trick will help you remember the differences between each program. 

Who qualifies for TennCare?

Now that you are familiar with the difference between Medicare and Medicaid, let’s discuss who qualifies for TennCare (Medicaid). 

There are three qualification criteria that you must meet in order to obtain Medicaid/TennCare. 

1. Medical qualification There is a special medical test that applicants must pass in order to qualify.  Usually, a care facility will handle this piece of the Medicaid application. 

2. Asset qualification – A TennCare applicant who is single can only have $2,000.00 in assets before they are eligible for TennCare.  Vehicles and real estate are usually exempt from the count of assets. A “Care and Savings Assessment” is a good place to start if the applicant needs help with figuring out what they have in assets and what options are available to make excess assets “non-countable” for TennCare purposes. 

3. Income qualification – A TennCare applicant can only receive $2,382.00 per month (as of 2021) in order to receive TennCare. If an applicant has more than this amount in income, an attorney can resolve it through what is called a Miller Trust or a Qualified Income Trust.

Long-term care is very expensive

Why should I be concerned about long-term care services?

Unless you are a millionaire or multi-millionaire, TennCare eligibility and designation could have a major impact on your finances and your family. While you may not need TennCare now, you will want to plan as if you will need it in the future. As you may have heard us say before “we hope for the best, and plan for the worst.” Having a plan is an effective way to ensure that you will have long-term care coverage when you need it. This isn’t to say that you won’t find yourself needing TennCare much sooner than expected. When this happens we call it “TennCare Crisis Planning”. 

Knowing your options makes all the difference

I don’t know where to start!

The biggest obstacle to TennCare planning is determining what to do with your assets and income; especially if there is excess in any category. There are a lot of rules and potential pitfalls that you need to look out for. Fortunately, we have some great financial planning and legal resources that can help our clients. If you have an immediate need for TennCare or want to plan for TennCare we can supply the client with what we call a “Care and Savings Assessment”. It’s a wonderful tool that helps people effectively navigate through their options.

How do we help our estate planning clients with TennCare planning?

For our estate planning clients, we like to take into consideration the possibility that you may need TennCare in the future. 

For example, it is our priority to set up our client estate plans to make sure that TennCare is accessible if it is ever needed.  As with many government organizations, Medicaid has lots of rules to follow and many people find that they did not know what rules they were supposed to be following until it was too late!   Fortunately for our clients, we know the rules and can help you plan in advance of ever needing to apply for TennCare to cover medical care.  Additionally, we create documents that make sure that someone can apply for Tenncare on your behalf. This is useful if you become incapacitated in the future. 

How do we help our Conservatorship clients with TennCare? 

Many of our conservatorship clients are caregivers for a loved one who requires skilled nursing to keep them safe. The average cost for this type of care is about $7,000.00 per month or more.  There is usually a large gap between monthly income and fees.  Our firm can navigate the TennCare application process and assure that the appropriate language is in the conservatorship order paperwork with the court so that the client may obtain the appropriate benefits for their loved one.  

How do we help clients with TennCare Crisis planning? 

For those who have never considered the cost of long-term care until they or a loved one need to enter a nursing facility, the cost of care is likely to come as a shock- and an unaffordable, but necessary, expense.  This is when we can step in with what we call “crisis planning,” meaning that you need a plan and you need a plan now

In these cases, we are able to look at the household financial situation of the person needing skilled care, as well as the family situation overall, and come up with a plan for how to best use existing resources and get them qualified for TennCare benefits to pay for the nursing home bills. This process called our “Care and Savings Assessment”,  is one of the most rewarding things that we do!  It allows us to help people get the care that they need while still providing a quality of life for themselves and their families. 

If you are concerned about accessing TennCare benefits for long-term care, contact our office for a complimentary initial call using our online calendar here

Read our article about Medicare planning.

Have you thought about qualifying for TennCare in the future?