Waiver Description
This Medicaid waiver was created to help elderly and / or disabled individuals to continue living in the community. Tennessee residents that are medically qualified to receive care in nursing homes are given the option to receive that level of care at home, in the homes of their caregivers or family members or in assisted living residences. This program is considered a win-win in that families prefer to receive care outside of nursing homes and the state saves money because the cost providing care at home or in assisted living is less expensive than in a nursing home.
State residents may also be interested in the TennHealth CHOICES in Long-Term Care program which offers participants even more flexibility by allowing for consumer direction of care services.
Eligibility Guidelines
There are four types of eligibility requirements for participation in this waiver.
1) Age – Participants must be over the age of 20.
2) Residency – Participants must be residents of the state of Tennessee and they must be willing and able to receive care services at home or in assisted living.
3) Functional Ability – Applicants must be assessed by a medical team and found to be in need of the level of care usually provided in nursing homes.
4) Financial – Persons must meet the income and asset limits set forth for Tenn. Medicaid
Tennessee Medicaid Financial Limits for 2013
Blind, disabled or elderly individuals can have a maximum monthly income of $2,130 and total countable resources valued at no greater than $2,000. The home is exempt when calculating the value of their resources as are certain other personal assets.
Exceptions for Individuals Over the Limits
The most common exception occurs with married couples when only one spouse is seeking to qualify for Medicaid. Joint income and assets over the limit can be allocated to the non-applicant spouse as a living allowance. In this situation, the non-applicant can retain up to $115,920.
A second option is “Medically Needy” Medicaid, which is offered by the state to individuals with exceptionally high medical expenses. These persons are conditionally accepted into Medicaid, provided they spenddown their excess resources on their care costs.
A third option is to re-allocate one’s finances by putting income and assets over the limits into income trusts, annuities and non-countable assets. This process is referred to as Medicaid planning and can be complicated. It is recommended that persons wishing to become Medicaid complaint in the manner, retain the services of a Medicaid planner.
Benefits and Services
Applicants are approved for services on an as-needed basis. While all individuals receive case management and personal care services, waiver participants can also receive the following benefits to help them continue living outside of nursing homes.
- Adult Day Care
- Assistive Technology
- Home Modifications
- Homemaker
- Personal Care Attendant
- Personal Emergency Response System (PERS)
- Pest Control
- Respite Care
How to Apply / Learn More
This program is open to residents across Tennessee although a limited number of slots are available at any one time. The total number of participants is restricted to 3,700 therefore waiting lists may exist. To learn more or apply for the program, call 1-866-836-6678 or contact your local Tennessee Area Agency on Aging.
