Accessing Medicaid a.k.a. “Choices” to Pay for Long-Term Care

What is Medicaid?

Medicaid is a program that provides health benefits to 60 million people in the United States. Medicaid is funded with federal and state funds.

What is TennCare?

In Tennessee, our Medicaid program is named “TennCare”. TennCare encompasses all of the Medicaid based services in our state, including long-term care. Our focus is on TennCare as a resource to pay for long-term care. We will use Medicaid, TennCare and CHOICES interchangeably.

What is CHOICES?

CHOICES began with The Long Term Care Community Choices Act of 2008. For those who meet the financial and medical qualifications, they may choose to receive long-term care services at home, in a nursing home or in an assisted living facility that accepts CHOICES. There are three Groups in CHOICES:

What is CHOICES Group 1?

CHOICES Group 1 is nursing home Medicaid. Medicaid nursing home benefits are an entitlement if our client meets the medical and financial criteria. Once the client qualifies for nursing home Medicaid, Medicaid pays for the client’s care. As a general rule, our disabled client must pay his income to the nursing home each month. This is referred to as his “patient liability”. The patient liability is calculated by subtracting the cost of his health insurance, spousal support, and a personal needs allowance of $50 each month.

What is CHOICES Group 2?

If our client qualifies medically and financially for Group 1 care, he may choose to receive CHOICES benefits at home or in assisted living. If he receives services at home, TennCare will pay for a maximum of about 40 hours per week of at-home care.

If our client chooses assisted living, TennCare will pay $1100 per month toward the cost of assisted living care to an assisted living facility that accepts CHOICES. Group 2 Choices is limited to a certain number of people across the state. When receiving services at home or in assisted living, our client is able to retain all of his income.

What is CHOICES Group 3?

If a person qualifies medically and financially, CHOICES Group 3 provides assistance at home for people who do not meet the medical criteria for nursing home placement, but who are at risk of nursing home placement. Group 3 does not provide assistance in assisted living.

If I receive Medicaid benefits, do I have to spend all of my money on nursing home care?

No, you do not have to “just spend down” before qualifying for Medicaid benefits. In fact, it is a really bad idea to just spend down your assets. For example, if your health improves, you may no longer qualify medically for Medicaid. You need to set aside funds in a special needs trust in the event you need a lower level of care. Depending on where you are on the elder care continuum, and whether you are married or single, we have many creative (legal) options to help you access Medicaid benefits, preserve assets to supplement your care and for future generations.

Are you able to develop a plan to pay for long-term care?

Through our comprehensive Life Care Plan service, this is the essence of what we do. Planning for a client with dementia, whether Alzheimer’s, vascular, frontal temporal, Lewy Body, or other disability requires a holistic approach. First, we must consider where our client is on the elder care continuum. That means how far along is he in the disease process? What activities of daily living can he perform alone? What instrumental activities can he perform? What other health problems is he having? How are the caregivers holding up?

Based on that information, we, along with the medical providers, determine the level of care our client needs to maintain the highest quality of life and quality of care. Then, we consider the client’s resources, income, public benefits that may be available to him, such as Veteran’s benefits, Medicaid benefits, EEOICPA benefits, and family resources—such as spouses and/or children who are providing care. After determining the level of care needed by the client, we look at options to pay for that care using private resources and public benefits.

My father is in the nursing home and on Medicaid, but he still owns his home. Is it too late to protect the home?

As long as your father is living, it is not too late to preserve equity in the home for our client and his family. See Saving Momma’s Home in our Resource section

Our first focus is that our client receives the care he needs at the right time and in the right place. Then, we look at preserving income and assets for the well spouse, and to the extent possible for their children. It is never too late to make a plan, and there are many creative ways to accomplish the client’s and family’s goals.