Medicaid Long-Term Care Guide in Tennessee
Long-term care eligibility, benefits, and how to apply through the Division of TennCare.
What makes Tennessee Medicaid different
Tennessee Medicaid, also called TennCare, is a Managed Care Program providing long-term care assistance through the Long-Term Services & Supports division. The state offers nursing home care, assisted living services, and adult foster care, along with non-medical support services to help seniors remain at home. Tennessee uses Qualified Income Trusts for applicants over the income cap and has an 'At Risk' qualification category for Medicaid Waivers. Tennessee did not expand Medicaid under the Affordable Care Act.
Administered by the Division of TennCare.
Program Types
Institutional / Nursing Home Medicaid
An entitlement program providing care in Medicaid-certified nursing home facilities
Level of care: Nursing Facility Level of Care (NFLOC)
Medicaid Waivers / HCBS
Home and Community Based Services with limited participant slots and potential waiting lists
Level of care: Nursing Home Level of Care (NFLOC) or 'At Risk'
Regular Medicaid / Aged, Blind, and Disabled
Aged, Blind, and Disabled Medicaid with various long-term care benefits like personal care assistance
Level of care: Help with ADLs (not NFLOC)
2026 Tennessee Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid
Medicaid Waivers / HCBS
Regular Medicaid / Aged, Blind, and Disabled
*All of a beneficiary's monthly income with the exception of a Personal Needs Allowance of $70/month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability).
†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
Explore Tennessee Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Tennessee.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Compare Medicaid Programs — Tennessee
How the main LTC programs available in Tennessee compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $14–16/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in Tennessee | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Tennessee Medicaid programs
CHOICES Waiver
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Tennessee
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in TennesseeHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: TennCare · tn.gov/tenncare
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Tennessee
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Tennessee. The process typically takes 45–90 days from application to first paycheck.
Apply in Tennessee: TennCare · tn.gov/tenncare
Medicaid Eligibility Screener — Tennessee
Answer 7 quick questions — we'll check the financial and care requirements for Tennessee and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Choose one to continue — tap a button below.
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
See how Medicaid fits into your long-term care plan
Our free Affordability Calculator shows how Medicaid works alongside your savings, income, and care costs.
Key Rules at a Glance
- Nearly all income counts: employment wages, alimony, pensions, Social Security (including SSDI), IRA withdrawals, and stock dividends
- Nationally, Holocaust restitution payments are NOT counted
- Tennessee: VA Aid & Attendance (above Basic VA Pension) does NOT count as income
- Married couples (Nursing Home/Waiver): Only applicant's income is counted; non-applicant spouse income is disregarded
- Married couples (Regular Medicaid): Both spouses' income is counted toward eligibility limit
- SSI eligibility: Persons eligible for SSI are automatically approved for Medicaid, including long-term services if functional criteria are met
- Countable assets: cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate
- Exempt assets: personal belongings, household furnishings, one automobile, primary home (with conditions)
- Burial funds: Irrevocable burial trusts up to $6,000 are exempt
- IRAs/401Ks: Counted as assets (NOT exempt)
- Married couples: All assets considered jointly owned regardless of which spouse applies
- Home automatically exempt if applicant's spouse, child under 21, or blind/disabled child (any age) lives in it
- Home equity interest limit: $752,000 (2026)
- If above family members don't live in home, applicant must have 'Intent to Return'
- Regular Medicaid: No home equity interest limit applies
- Home equity = home value minus outstanding debt; equity interest = portion of equity owned by applicant
- Estate Recovery: Home is NOT exempt from Medicaid's Estate Recovery Program (MERP)—state may seek reimbursement from deceased's estate
- Tennessee has a 60-month (5-year) Look-Back Period for Nursing Home Medicaid and Medicaid Waivers
- Medicaid reviews all asset transfers during the 60 months immediately before application date
- Gifting assets or selling for under fair market value triggers a Penalty Period of ineligibility
- Transfers by non-applicant spouses are also reviewed and can trigger penalties
- U.S. Federal Gift Tax Rule (up to $19,000/recipient in 2026) does NOT protect transfers from Medicaid's Look-Back
- Regular Medicaid: No Look-Back Period applies
- Keep documentation of all asset transfers and expenditures to prove compliance
- MMMNA: $2,705/mo · CSRA: $162,660 · CSRA Min: $32,532
- Minimum Monthly Maintenance Needs Allowance (MMMNA): Non-applicant spouse can receive income from applicant spouse up to $2,705/month (eff. 7/1/26 – 6/30/27)
- If non-applicant's housing and utility costs exceed 'shelter standard' of $811.50/month, Spousal Income Allowance can be increased
- Maximum MMMNA: Spousal Income Allowance cannot push non-applicant's total income over $4,066.50/month
- Community Spouse Resource Allowance (CSRA): Non-applicant spouse can retain 50% of couple's assets, up to $162,660 (2026)
- CSRA minimum: If non-applicant's share of assets is under $32,532, they can keep 100% of assets up to $32,532
- Spousal protections apply only to Nursing Home Medicaid and Medicaid Waivers, NOT Regular Medicaid
- Qualified Income Trusts (QITs) / Miller Trusts: For applicants over the $2,982/month income cap—excess income is deposited into an irrevocable trust that doesn't count toward income limit
- QIT requirements: Income deposited into irrevocable trust (cannot be changed or canceled), designated trustee manages account, funds only for approved purposes (unreimbursed medical expenses, health insurance premiums), Tennessee must be named as beneficiary
- Asset Spend-Down: Reduce countable assets by spending on exempt items—home modifications (first floor bedroom additions, wheelchair-accessible bathroom remodels, chair lifts)
- Additional spend-down options: Prepay funeral/burial expenses, pay off mortgage/vehicle/credit card debt
- CRITICAL: Never gift assets or sell below fair market value within 60-month Look-Back Period—always keep receipts
- Medicaid Planning: Work with a Certified Medicaid Planner to employ legal strategies for eligibility and home protection from Estate Recovery
Tennessee Medicaid Programs
CHOICES in Long-Term Services and Supports Program
Assists nursing home qualified individuals and those 'at risk' of requiring this level of care in living at home, in a loved one's home, adult foster care, or assisted living. Benefits include adult day care, personal care, medical alert devices, transportation assistance, and more.
Program of All-Inclusive Care for the Elderly (PACE)
Combines Medicaid long-term care services and Medicare benefits into one program. Additional benefits like dental and eye care may be available.
How to Apply
- Online at TennCare Connect
- Phone: TennCare Connect at 855-259-0701
- Submit completed paper application (available on TennCare website)
- In-person assistance: Contact local Department of Health (DOH) office
- For CHOICES program: Current TennCare recipients should contact their TennCare health plan; non-recipients should contact local AAAD (Area Agency on Aging and Disability) office
Application process varies by program. Long-Term Services & Supports Help Desk: 877-224-0219 for questions and assistance. Ensure all eligibility requirements are met before applying—consider Medicaid Planning if over income/asset limits.
More Tennessee Long-Term Care Resources
Sources & references
Verified October 2026- Centers for Medicare & Medicaid Services: Long-Term Services & Supports
- Administration for Community Living: State Medicaid Agencies
- Centers for Medicare & Medicaid Services: Medicaid Eligibility
- American Council on Aging: About Medicaid Planning Assistance
- Division of TennCare: Tennessee Medicaid — Official site