Who Can Qualify For CHOICES?

Qualifying for Long Term Supports and Services (LTSS) through TennCare/CHOICES

When attempting to qualify for Long Term Supports and Services (LTSS) (nursing home care, some assisted living care, and in-home care) through TennCare/CHOICES, there are three (3) important categories.

1. Medical Needs:

Pre-Admission Evaluation (PAE)

An applicant’s medical needs are examined by TennCare through what’s called a Pre-Admission Evaluation (PAE).

The PAE reviews an applicant’s ability to perform certain activities of daily living (ADLs) by assigning a certain number of points based on a client’s ability within each ADL; some ADLs receive more points than others.

The PAE is the most important of the three categories, because, if an applicant does not meet the requisite PAE score (9 out of 26) when their ADLs are reviewed, then an applicant’s income totals and asset values will not matter.

Key Activities of Daily Living (ADLs)

More specifically, TennCare looks at an applicant's ability to perform the following:

i. Ability to Transfer

ii. Mobility

iii. Eating

iv. Toileting

v. Communication

vi. Administration of Medication

vii. Behaviors

viii. Orientation

2. Income:

Income Limit for LTSS Applicants

As of January 1, 2025, the new income limit for an LTSS applicant is $2,901.00.

Gross Income and Qualified Income Trust

TennCare looks at a client’s gross income total when determining eligibility, and if an applicant’s gross income is over $2,901.00, the applicant must set up a Qualified Income Trust (QIT) to qualify for benefits.

It is very important to note that an applicant’s QIT account MUST be set up within the month that the applicant applies for benefits.

3. Assets:

Asset Rules for Single Applicants

As of January 1, 2025, a single applicant’s countable assets must be less than $2,000.00 on the last day of the month of application.

Asset Rules for Married Applicants

Asset totals are treated differently for LTSS applicants depending on if the

application is single or married.

As of January 1, 2025, an applicant with a spouse may have assets between

$31,584.00 and $157,920.00.

• If an applicant and their spouse have assets totaling $22,000.00, they are under the floor of $31,584.00, and a Medicaid spend-down may not be required.

• If an applicant and their spouse have assets totaling $400,000.00, the most they are allowed to keep is $157,920.00.

• If an applicant and their spouse have assets totaling $300,000.00, they are allowed to keep one-half of the $300,000.00 because the $150,000.00 is between $31,584.00 and $157,920.00.

Other Important Considerations for LTSS Qualification

While this blog is a good overview of the three main categories an applicant must satisfy to qualify for LTSS services, there are many other important points to consider, such as:

• How certain assets are held that may make them exempt under Medicaid rules

• How certain spend-down methods may be allowed under Medicaid rules

• Estate planning documents

• Title of assets both pre and post approval

• Post approval requirements by TennCare for an applicant, along with much more.

It is always best to sit down with an Elder Law attorney to discuss how your facts align within

the law and Medicaid rules. Most people are amazed to find out that they can take more

control of a difficult situation in their life than they expected, and all the saving they’d done

to make their life better was not vain.