Long-Term Care Costs in Tennessee

Tennessee's long-term care costs are below national averages across all care settings — assisted living averages $5,845 per month, approximately 6% below the national average, while nursing home care averages $9,429 per month, near the national average of $9,581. Home care averages $5,911 per month, about 11% below the national rate. Tennessee Medicaid is called TennCare, administered by the Division of TennCare under the Tennessee Department of Finance and Administration. Long-term care services are provided through the CHOICES in Long-Term Services and Supports program. The income limit for Nursing Home Medicaid and HCBS is $2,982 per month, with applicants able to use Qualified Income Trusts (Miller Trusts) to become eligible if over the limit. Tennessee did not expand Medicaid under the ACA. This guide covers what care costs in Tennessee, how to qualify for TennCare, and what options exist for veterans and family caregivers in Nashville, Memphis, Knoxville, Chattanooga, and across the Volunteer State.

Tennessee's Aging Population: The Numbers Behind the Need

Tennessee has approximately 1.2 million residents aged 65 or older — roughly 17% of the state's total population. The senior population is concentrated in the Nashville metropolitan area (Davidson, Williamson, Rutherford, and Sumner Counties), Memphis (Shelby County), Knoxville (Knox County), and Chattanooga (Hamilton County). Growing retirement communities also exist in Murfreesboro, Franklin, Clarksville, Johnson City, Kingsport, and Hendersonville.

Tennessee's geography — from the Appalachian communities of East Tennessee to the rural counties of West Tennessee — creates distinct challenges for long-term care delivery. Many counties in the rural Cumberland Plateau and Delta regions have limited facility options, making home and community-based services essential for keeping seniors near their families and support networks.

Unpaid Caregivers in Tennessee: Scale and Impact

An estimated 1.5 million unpaid family caregivers in Tennessee provide care to aging relatives and adults with disabilities — one of the highest caregiver populations in the Southeast. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

Tennessee's CHOICES in Long-Term Services and Supports program provides support for unpaid caregivers through personal care visits, adult day services, and respite care. The program serves individuals who qualify for a nursing home level of care or who are "at risk" of needing that level of care — a unique qualification category not found in most states.

What Long-Term Care Costs in Tennessee

Tennessee's care costs vary by type of care:

• Assisted Living: $5,845 per month — approximately 6% below the national average of $6,200
• Nursing Home (semi-private room): $9,429 per month — near the national average of $9,581
• Home Care (home health aide): $5,911 per month — approximately 11% below the national average of $6,673
• Adult Day Care: $1,733 per month — approximately 16% below the national average of $2,058

At these rates, a three-year nursing home stay in Tennessee costs approximately $339,000 — while home care totals roughly $213,000 over the same period. Assisted living, at $5,845/month, represents the most affordable facility-based option at approximately $210,000 over three years. For a detailed breakdown of care costs by type and how Tennessee compares to other states, visit our Tennessee Care Costs page.

How to Qualify for TennCare Medicaid in Tennessee: Eligibility Rules for 2026

Tennessee Medicaid is called TennCare, administered by the Division of TennCare under the Tennessee Department of Finance and Administration. TennCare is a Managed Care Program — long-term care is provided through the Long-Term Services & Supports division. In addition to nursing home care, TennCare pays for assisted living, adult foster care, and non-medical supports to help frail seniors remain at home. Tennessee did not expand Medicaid under the Affordable Care Act. Consulting with a Tennessee elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $2,982/month. All of a beneficiary's monthly income, with the exception of a $70/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability). Asset limit of $2,000 (single) or $4,000 (married couple, both applying). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement — anyone who qualifies receives benefits.
• Medicaid Waivers / HCBS (CHOICES): Income limit of $2,982/month. Asset limit of $2,000 (single). Tennessee's CHOICES program has a unique "At Risk" qualification category in addition to Nursing Home Level of Care — applicants who are at risk of needing nursing home care can qualify. This is not an entitlement — slots are limited and waiting lists may exist.
• Regular Medicaid / Aged, Blind, and Disabled: Income limit of $994/month (single) or $1,491/month (couple); asset limit of $2,000 (single) or $3,000 (couple). SSI recipients are automatically approved for Medicaid in Tennessee. This is an entitlement.

Tennessee applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members and transfers by one's spouse — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. There is no look-back period for Regular Medicaid. For the full Tennessee Medicaid eligibility breakdown, see our Tennessee Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or CHOICES in Tennessee, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain up to $162,660 in countable assets. The minimum CSRA is $32,532. If the community spouse's half of the couple's assets is under $32,532, up to $32,532 can be retained.

The Minimum Monthly Maintenance Needs Allowance (MMMNA) in Tennessee is $2,643.75 per month (eff. 7/1/25 – 6/30/26). If the non-applicant spouse's income falls below this amount, income can be transferred from the applicant spouse. A non-applicant spouse can increase their allowance if housing/utility costs exceed the shelter standard of $793.13/month. The Maximum MMMNA is $4,066.50. Tennessee follows the income-first rule. For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.

Tennessee Medicaid Programs: CHOICES and PACE

Tennessee offers Medicaid-funded long-term care through its managed care system:

• CHOICES in Long-Term Services and Supports: Tennessee's primary long-term care program. Assists individuals who qualify for a nursing home level of care — or who are "at risk" of requiring it — in living at home, in a loved one's home, in adult foster care, or in assisted living. Benefits include personal care visits, adult day care, medical alert devices, transportation assistance, home modifications, and respite care.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid and Medicare benefits into one program. Additional benefits such as dental and eye care may be available. PACE is available in select Tennessee counties.

Qualifying When Over the Limits: Miller Trusts and Asset Spend-Down

Tennessee offers several pathways for applicants who exceed the income or asset limits:

• Qualified Income Trusts (QIT / Miller Trust): For applicants over the $2,982/month income cap. Excess income is deposited into an irrevocable trust managed by a designated trustee. Funds can only be used for approved purposes such as unreimbursed medical expenses and health insurance premiums. Tennessee must be named as the remainder beneficiary. Income in the trust no longer counts toward Medicaid's income limit.
• Asset Spend-Down: Reduce countable assets by spending on exempt items — home modifications (wheelchair ramps, stair lifts, walk-in showers, first-floor bedroom additions), prepaying funeral and burial expenses (irrevocable burial trusts up to $6,000 are exempt in Tennessee), and paying off mortgage, vehicle, or credit card debt. Keep all documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Certified Medicaid Planner or Tennessee elder law attorney to employ legal strategies for eligibility and protect your home from Estate Recovery.

Asset Rules: What Counts and What Doesn't

Countable assets in Tennessee include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and non-residential real estate. In Tennessee, IRAs and 401(k)s are counted as assets — they are NOT exempt regardless of payout status. Non-countable (exempt) assets include personal belongings, household furnishings, one automobile, and generally one's primary home (subject to the home equity limit). Irrevocable burial trusts up to $6,000 are exempt in Tennessee.

All assets of a married couple are considered jointly owned regardless of the Medicaid program. The CSRA allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660. If the community spouse's share is under $32,532, up to $32,532 can be retained. Nationally, Holocaust restitution payments are not counted as income. In Tennessee, VA Aid & Attendance (above Basic VA Pension) does NOT count as income for TennCare eligibility purposes.

Veterans and Long-Term Care in Tennessee

Tennessee has a significant veteran population, with major military installations including Fort Campbell (home of the 101st Airborne Division, on the Tennessee-Kentucky border near Clarksville) and Arnold Air Force Base near Tullahoma. The Tennessee Valley Healthcare System (TVHS) operates VA medical centers in Nashville (including the Alvin C. York campus in Murfreesboro), while the Memphis VA Medical Center and the Mountain Home VA Medical Center in Johnson City serve veterans in their respective regions. Tennessee also operates four State Veterans Homes in Clarksville, Murfreesboro, Humboldt, and Knoxville.

The VA Aid & Attendance benefit provides additional monthly income to veterans and surviving spouses who require assistance with activities of daily living. In Tennessee, VA Aid & Attendance income does NOT count as income for TennCare eligibility purposes, allowing veterans to potentially qualify for both benefits simultaneously. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Tennessee

Understanding how to pay for nursing home care in Tennessee — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs near the national average at $9,429/month, a 60-month look-back period, and a $2,982/month income limit, advance planning is essential. Tennessee long-term care insurance policies, personal savings, veterans benefits, and TennCare each play a role. Key steps include:

• Understanding your current financial position relative to TennCare eligibility thresholds
• Knowing that Tennessee's income limit is $2,982/month for Nursing Home Medicaid and CHOICES — with Miller Trusts available for those over the limit
• Recognizing that in Tennessee, IRAs and 401(k)s are counted as assets — not exempt — which affects financial planning strategies
• Exploring the CHOICES program's unique "At Risk" qualification pathway for seniors not yet at nursing home level of care
• Taking advantage of the MMMNA ($2,643.75) and shelter standard ($793.13) to protect the non-applicant spouse's income
• Noting Tennessee's $6,000 irrevocable burial trust exemption — higher than many states
• Researching Tennessee long-term care insurance options while still healthy enough to qualify
• Exploring veterans benefits if the care recipient or spouse served during wartime
• Consulting with a Tennessee elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Tennessee

Tennessee operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by TennCare. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $730,000 (in 2026). Home equity is the value of the home after subtracting outstanding debt. If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. There is no home equity limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a Tennessee elder law attorney to explore legal protections including irrevocable trusts, the caretaker child exemption, and the sibling equity interest exemption.

Regional Cost Variations Across Tennessee

Long-term care costs in Tennessee vary by region. The Nashville metropolitan area (Davidson, Williamson, and Rutherford Counties) has the highest costs in the state — driven by rapid population growth, a competitive real estate market, and strong demand for senior care. Franklin and Brentwood in Williamson County tend to see premium pricing for assisted living and memory care. Memphis (Shelby County) represents a more moderate cost market. Knoxville and Chattanooga offer mid-range pricing for most care types. Rural East Tennessee (Appalachian communities), the Cumberland Plateau, and West Tennessee (Jackson, Dyersburg) generally have lower costs but significantly fewer available facilities and home care providers.

Application Timeline and Process

Tennessee Medicaid applications can be submitted through several channels:

• Apply online at TennCare Connect
• Call TennCare Connect at 855-259-0701 for questions or application assistance
• Submit a completed paper application (available on the TennCare website)
• Apply in person at a local Tennessee Department of Human Services (DHS) office
• For CHOICES: Current TennCare recipients should contact their TennCare health plan; non-recipients should contact their local Area Agency on Aging and Disability (AAAD)

It is vital that applicants are confident they meet all eligibility criteria before submitting a TennCare application. For seniors who don't meet the requirements, Medicaid Planning is recommended. Processing times vary but typically take 45–90 days. The Long-Term Services & Supports Help Desk can be reached at 877-224-0219 for additional assistance.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including Tennessee's CHOICES program — are likely targets for cuts. Tennessee did not expand Medicaid under the ACA, which means the state's Medicaid population is already more narrowly defined than expansion states. This law is still facing legal challenges. Families relying on or planning to use CHOICES should monitor developments and consider applying early.

Last updated: September 2026. Data sources: Division of TennCare, CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.