Tennessee Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Tennessee provides long-term care resources to seniors through TennCare Division of Health Care Administration and Finance, Long-Term Services and Supports (LTSS). Additional resources on aging are available through the nationalPACE (Program for All-Inclusive Care for the Elderly) service. Finally, the Tennessee Commission on Aging and Disability provides a variety of information and services that can be accessed throughout the state, primarily through the state’s local Area Agencies on Aging.

Medicaid Waiver Programs for Assisted Living and In Home Care

Tennessee Statewide Home and Community Based Services (or “Statewide”) Medicaid Waiver (HCBS Statewide Waiver), or “CHOICES”

TennCare CHOICES in LTSS (or CHOICES for short) is TennCare’s program for adults (age 21 and older) with a physical disability and seniors (age 65 and older) administered under the Statewide Waiver. LTSS offer help doing everyday activities that you may no longer be able to do for yourself as you grow older, or if you have a physical disability, LTSS can assist you with things like bathing, dressing, getting around your home, preparing meals, or doing household chores. LTSS include care in a nursing home, as well as certain services to help a person remain at home or in the community.

Services

Services include: Personal care visits - Short visits of no more than 4 hours when someone will help you do things like get out of bed, take a bath, get dressed, fix and eat meals, or use the bathroom; Attendant care - The same kinds of help you get with personal care visits, but for longer periods of time; Home-delivered meals – Nutritious meals that can be delivered fresh each day or frozen in bulk; Personal Emergency Response System - A call button you can use to get help in an emergency; Adult day care - A place that provides supervised care and activities during the day; In-home respite care - Someone to stay with you in your home for a short time so your caregiver can get some rest; In-patient respite care - A short stay in a nursing home or assisted care living facility so your caregiver can get some rest; Assistive technology - Certain low-cost items that help you do things more easily or safely in your home like grabbers to reach things; Minor home modifications - Changes to your home that will help you get around more easily and safely like grab bars or a wheelchair ramp; Pest control - Spraying your home to take care of an infestation such as for bugs or mice; Community-Based Residential Alternatives - places to live that offer care and support for someone who can no longer live alone that include the following:

  • Assisted Care Living Facility – A place you live that helps with personal care needs, homemaker services, and taking your medicine. You must pay for your room and board.
  • Community Living Supports– A shared home or apartment where you and no more than 3 other people live. The level of support provided depends on your needs and can include hands-on assistance, supervision, transportation and other supports needed to remain in the community.
  • Community Living Supports – Family Model – A shared home or apartment where you and no more than 3 other people live with a trained host family. The level of support provided depends on your needs and can include hands-on assistance, supervision, transportation and other supports needed to remain in the community.
  • Critical Adult Care Home – A home where you and no more than 4 other people live with a health care professional that takes care of special health and long-term care needs. Under state law, this is available only for people who are ventilator dependent or who have traumatic brain injury. You must pay for your room and board.
  • Companion Care– Someone you hire who lives with you in your home to help with personal care or homemaker services whenever you need it. This is available only for people in consumer direction who need care throughout the day and night that can’t be provided by unpaid caregivers. And only when it costs no more than other kinds of home care that would meet your needs.

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care.
  2. Financial: Applicant’s must meet certain income and asset limits to be eligible for Medicaid for long-term care. To qualify for Medicaid long-term services and supports: (1) Your income can't be more than $2,205 per month (If it is, you may be able to set up a Miller Trust, also known as a Qualifying Income Trust); (2) The total value of things you own can't be more than $2,000 (The home where you live doesn't count); AND (3) You can't have given away or sold anything for less than what it's worth in the last five (5) years. In addition, the non-applicant spouse may keep up to $120,900 in assets and $3,022.50 in monthly income to cover expenses while their spouse is in the waiver program.

Practical Considerations

To enroll in CHOICES and receive home care services: (1) Your TennCare health plan (or Managed Care Organization) must be able to meet your needs safely at home; AND (2) If you qualify for nursing home care, the cost of your home care can't be more than the cost of nursing home care.

The cost of your home care includes any home health or private duty nursing care that you need. If you don’t qualify for nursing home care, but are “at risk” of needing nursing home level of care, the cost of your CHOICES home care can’t be more than $15,000 per year. That doesn’t include the cost of any minor home modifications you may need.

The CHOICES program also allows for “Consumer Direction,” which is a way of getting some of the home care you need that offers more choice and control over who gives your home care and how your care is given than receiving CHOICES services and not consumer directing. You actually employ the people who provide some of your home care services - they work for you (instead of an agency). You can hire a family member, friend, neighbor, or other person you know to provide care in Consumer Direction, but there are some limitations.

Conclusion

Tennessee’s CHOICES waiver program is a good options for assisted living and in home care long term Medicaid resources. The program is robust, and offers unique options like the Consumer Direction ability to use your own family members or relatives to provide services for you and be reimbursed by Medicaid.

Medicaid Planning may help qualify an applicant for the waiver program, especially because the state has a special income limit that allows for a special trust vehicle to help access benefits.