Elder Care Index

What TennCare Actually Covers for Senior Care

Navigating senior care can feel overwhelming, but TennCare, Tennessee's Medicaid program, offers crucial support through its CHOICES in Long-Term Services and Supports program. CHOICES is designed to help older adults (age 65 and older) and adults with physical disabilities (age 21 and older) receive the care they need.

The program has different groups based on your loved one's needs. CHOICES Group 1 is for those receiving nursing home care and is an entitlement, meaning if your parent qualifies, they will receive benefits. It covers comprehensive care, including room and board, personal care, skilled nursing, doctor visits, and prescriptions within a Medicaid-certified nursing home. However, it won't pay for private rooms or comfort items not deemed medically necessary.

For those wishing to stay at home or in the community, CHOICES Group 2 supports individuals who medically qualify for nursing home care but choose home and community-based services (HCBS) instead. These services can include personal care, adult day care, home-delivered meals, minor home repairs, and even personal emergency response systems. There's an annual cost cap of $55,000 for Group 2 services. CHOICES Group 3 is for seniors who don't currently need nursing home care but are at risk of needing it without support. This group also offers HCBS like personal care and home modifications, with an annual cost cap of $15,000, excluding certain home modifications and care in alternative residential settings. It's important to know that unlike Group 1, Groups 2 and 3 are not entitlements, meaning there are limited spots, and waitlists can occur. While these waivers cover many services, they generally do not fully cover room and board costs in assisted living facilities.

Do You Qualify?

For 2026, a single applicant for TennCare's long-term care programs (including CHOICES) must meet both income and asset limits. The monthly income limit is $2,982. If your parent's income is higher, a Qualified Income Trust (QIT), also known as a Miller Trust, may help them qualify by redirecting excess income. The asset limit for a single applicant is $2,000 in countable assets.

If your parent owns a house, the primary residence is typically an exempt asset and won't count against the limit, provided they intend to return home or a spouse or dependent relative lives there. This exemption applies up to an equity value of $603,000. Be cautious about selling the home, as the proceeds could become countable assets. For married couples where only one spouse is applying, the applicant still has a $2,000 asset limit, but the non-applicant spouse can keep up to $162,660 in assets, known as the Community Spouse Resource Allowance. Pensions are generally considered income. If assets exceed the limit, a "spend-down" process is required, where funds are used for medical expenses or exempt items like home repairs, new appliances, or prepaid funeral plans. Keep in mind TennCare has a 60-month (five-year) "look-back" period for asset transfers, and gifts or sales for less than fair market value during this time can result in a penalty period.

Waitlists & How to Apply

While CHOICES Group 1 (nursing home care) is an entitlement, meaning no waitlist once eligible, the Home and Community Based Services offered through Groups 2 and 3 are not. This means there are limited enrollment spots, and waitlists can occur, potentially lasting months to years. The Employment and Community First CHOICES program for individuals with disabilities has recently seen a significant reduction in its waitlist.

To apply for TennCare's long-term care services, if your parent doesn't currently have TennCare, the best first step is to contact your local Area Agency on Aging and Disability (AAAD) at 1-866-836-6678. They can help with the application and conduct the necessary medical assessment. If your parent already has TennCare, you should contact their specific managed care organization (MCO) directly; numbers like BlueCare at 888-747-8955, United Healthcare Community Plan at 800-690-1606, or Wellpoint at 833-731-2153 can connect you. Applications can be submitted online via TennCare Connect (tenncareconnect.tn.gov), by calling TennCare Connect at 855-259-0701, or by visiting a local Department of Human Services (DHS) office. Be prepared with extensive documentation, including bank statements, property deeds, and identification. TennCare typically takes up to 90 days to process a CHOICES application.

Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.