Last week we defined TennCare and how it applies to our clients. This week I want to go more in-depth with how TennCare serves Tennesseans with long-term care.
Many people believe that Medicare benefits will cover nursing home care once an individual is 65 or older, but this simply isn’t true. While Medicare covers the first 100 days, it doesn’t cover long-term assisted living. Read more about Medicare here.
“ Choices” is Tennessee’s Medicaid program for long-term care services and support
Back to TennCare/Medicaid…
My Mom doesn’t have long-term healthcare insurance. What are my options?
Payout of pocket until you run out of cash – This is an unrealistic option for most families. Nursing home care is expensive. Not a lot of people have an extra $7,000-$11,000 a month in their bank accounts.
Do a reverse mortgage on her home.
Qualify for the TennCare / Medicaid program called “CHOICES”.
As you can see, options 1 and 2 are very unpleasant and leave nothing left for a loved one’s legacy. However, option 3, CHOICES, is definitely something worth looking into.
What is CHOICES?
CHOICES is the category of TennCare that provides Long-Term Services and Supports (LTSS) such as nursing home care.
What is the process for getting qualified for CHOICES?
In order to be eligible to receive benefits from TennCare/Medicaid your loved one must first qualify within these three categories:
Medical eligibility
Income threshold
Asset threshold
Being medically and financially eligible is necessary for TennCare approval
How does someone become medically eligible for TennCare CHOICES?
The state of Tennessee will determine who is medically eligible to receive TennCare Long-Term Services and Support (LTSS) by using a pre-admission evaluation (PAE). This PAE is used to determine if the applicant can do basic life skills on their own without help. The PAE will also determine if the applicant is safe in their current environment.
The PAE is a strict evaluation and it is performed on a case-by-case basis. An applicant must receive a score of 9 or higher on a 26 point scale in order to be considered medically eligible for TennCare Long-Term Support Services.
For example, a caregiver or healthcare provider may be asked about a patient’s level of ability to do things and how much assistance is needed.
The following Activities of Daily Living (ADLs) are covered in the PAE evaluation:
Transfering
Mobility
Communication
Medication
Orientation
Eating
Behavior
If you or your loved one is unlikely to get to a nine or higher on the PAE, it is always appropriate to ask for a “safety determination” evaluation as an alternative route of becoming medically eligible for Choices.
How can someone become financially eligible to receive CHOICES?
You must be able to prove that the applicant has a low income and little assets. As of January 2022, an individual applying for TennCare CHOICES cannot have an income exceeding $2,523.00 per month. Additionally, the applicant cannot have more than $2,000 in assets. This includes any money in the bank and investment accounts but also requires consideration of retirement accounts, life insurance policies, real estate, artwork, jewelry, and any other valuables. When we talk about the assets for a couple of things get a little more complex. The most important thing is that both the applicant and their family are taken care of, both medically and financially.
My Mom is over the limits for income and assets? What do we do?
If the applicant is in excess of the amounts we can plan for that! We have a tool to help people who have excess income and assets yet need to qualify for TennCare/Medicaid called the “Care and Savings Assessment”. With this Care and Savings Assessment, we work to determine the best way to structure you or your loved one’s finances, either now or in the future. We plan so that our clients have the peace of mind knowing they can qualify for TennCare if and when they need it!
In conclusion
It is often helpful to have an attorney assess your financial situation and offer recommendations on how those finances may be restructured to qualify for TennCare Long-Term Services and Support (LTSS). As an experienced TennCare planning attorney, I can help you evaluate your risk and create a plan that takes care of everyone in the family.
Are you ready for help with TennCare planning? Contact us and we can discuss your plan. Next week we will go over some examples of how we restructure an individual’s finances to meet their needs for long-term care.
Aging in place is the ability to live in your own home and community independently, regardless of age or ability. It allows you to remain in familiar surroundings while maintaining a sense of autonomy. Planning ahead for aging in place is crucial to ensure a smooth transition and a comfortable future.
By getting informed about aging in place, you can make good decisions that will positively impact your quality of life as you grow older.
Benefits of Moving Early
One of the main benefits of moving early is increased housing options. By planning ahead, you can explore different housing choices that cater to your needs and preferences.
Enhanced quality of life is another advantage. If you start early, you can create a supportive and comfortable living environment that promotes your overall well-being while reducing stress. When you plan and prepare, you can avoid the rush and uncertainty of emergency moves.
Improved safety is important, too. Adapting the living space to accommodate changing needs can prevent accidents and injuries, meaning you’ll be healthier and happier.
Assessing Your Needs
When planning to age in place, it is important to assess and address specific needs. Here are some things you can do:
Make simple home modifications like grab bars and clear plenty of space to walk or move with mobility aids.
Invest in medical equipment or technology like stairlifts, home monitoring systems, etc., for added peace of mind.
Check into community support services, like meal delivery programs and in-home care providers, to stay socially engaged.
Secure accessible transportation so you can get where you need to go, even if your situation changes.
Our area has awesome resources for those who want to stay independent without personal vehicles. Check out WeGo, Senior Ride Nashville, or Wilson County Rides in addition to rideshare programs. If you need transportation to a medical appointment and have a Medicare Advantage plan, you may have transportation benefits!
Exploring Housing Options
Independent living communities provide a range of housing options that cater to those who want an active and social lifestyle. These communities usually offer amenities and services designed to enhance well-being and promote socialization.
Assisted living facilities are suitable for individuals who require some assistance with daily activities. Trained professionals are available to provide support while still allowing residents to maintain their independence.
Nursing homes provide comprehensive 24/7 care for individuals with complex medical needs. These facilities offer skilled nursing services and rehabilitation programs.
Our personal favorites, though, are continuing-care retirement communities. They provide a continuum of care, helping people transition seamlessly between independent living, assisted living, and nursing care as their needs change. While you may never need anything more than independent living, it’s comforting to know that you won’t have to plan another big move or relocate further from friends and family.
Financial Planning
Most people ages 65 and up are eligible for Social Security retirement benefits. Additional government assistance programs, such as Supplemental Security Income (SSI) and Veterans Affairs (VA) benefits, may be available to eligible older adults. Exploring these options can provide extra financial support.
Consistently saving for retirement ensures you’ll have the necessary funds to support your desired lifestyle. Retirement savings, such as 401(k)s and IRAs, can help you live comfortably in retirement. If you are fortunate enough to have a pension, it will be a great resource to help your quality of life in your golden years.
For these types of accounts, you’ll want to make sure that you name a beneficiary with your financial institution. If you have a pension, you will need to designate whether you want your spouse to continue receiving income in the event that you predecease them.
Medicare and Medicaid are government programs that provide healthcare coverage for seniors. Understanding the eligibility criteria, available benefits, and how (or whether) they can be combined with other plans is essential for effective financial planning.
Your Medicare coverage may assist with certain improvements to your home and home health care under limited conditions. Medicaid (also called TennCare) is frequently used by individuals in nursing homes to supplement their income to pay for care.
Long-term care insurance can help cover the costs of assisted living, nursing homes, and in-home care. It provides financial security and peace of mind for individuals planning their futures and provides more robust and flexible solutions than relying on Medicare or Medicaid alone.
Long-term care insurance can be expensive, but there are newer options to make it a better value overall, such as hybrid policies that provide a death benefit and deduct the amount spent on long-term care needs. Your insurance agent is a great resource to talk through these options.
Building a Support Network
Family and friends play a vital role in supporting those who wish to age in place. Reliable support systems can provide emotional support and practical assistance, ensuring that loneliness is never an issue.
Community organizations like FiftyForward and other local non-profits offer various activities and services to help seniors stay connected. Support groups for older adults can offer a space to share experiences, find understanding, and receive advice from others facing similar challenges. These groups foster a sense of community and provide emotional support.
Professional caregivers can provide specialized assistance and care for individuals who require additional support. Hiring trained professionals can ensure individuals receive the help they need while remaining in their own homes.
Maintaining Independence
Physical exercise and wellness are essential for maintaining independence and overall well-being. Engaging in regular exercise like walking or fitness classes can improve strength, balance, and flexibility.
Mental stimulation and cognitive health are also important. Doing puzzles, reading, and socializing can help keep your mind sharp and promote cognitive function. A little daily Wordle competition is a favorite in April’s house.
Nutrition will help you maintain good health. A balanced diet of fruits, vegetables, and whole grains can support overall well-being and energy levels.
Keep appointments with doctors and specialists to manage existing health conditions and address new concerns. Regular check-ups, screenings, and preventive care can help individuals stay healthy and catch any potential issues early.
Want More Info on Aging Gracefully?
Taking these steps will help increase your chances of having a comfortable and fulfilling future.
Remember, it’s never too early to start thinking and planning for your golden years.
By the way, there’s a FiftyForward event coming up on 1/16 to discuss housing. We’ll be there – will you?
Navigating TennCare/Medicaid: What You Need to Know
What is TennCare? What’s the difference between that and Medicaid? How do you know if you’re eligible for it, and what can you do about it if you aren’t?
Fear not, dear reader, we’ll answer all of those questions and more as we dive into what you need to know about TennCare/Medicaid!
What is TennCare/Medicaid?
Simply put, each state has a name for its own Medicaid program. TennCare is the state of Tennessee’s Medicaid program. It’s a way of saying “Tennessee Medicaid” in fewer syllables.
In terms of what TennCare actually does, it’s a healthcare program that provides medical assistance to low-income individuals, pregnant women, children, and individuals with disabilities. It is funded by both the Tennessee and federal governments, and the primary goal is to ensure that everyone has access to essential healthcare services.
Who is eligible for TennCare?
To be eligible for TennCare, you have to meet specific income requirements and fall into a certain category. If you’re a low-income adult, a child, a pregnant woman, an elderly individual, or an individual with a disability, you’re in an eligible category. However, you still need to qualify based on your specific circumstances and resources available within the program.
Why is it important to understand TennCare?
Understanding TennCare (Medicaid) is crucial because it can provide you and your family with affordable access to healthcare services.
Most seniors are on a fixed income. The median retirement income for Tennesseans is just under $2,000.00-but the cost of a nursing home averages around $7,500 a month. Even if your loved one has savings that can be allocated toward their care, those savings can be depleted quickly. Knowing the eligibility criteria, application process, and coverage options can help ensure that those in need can receive the necessary medical care.
At Graceful Aging Legal Services, we have experience with TennCare applications. We’d be happy to discuss how you can protect your savings and your spouse while still qualifying for TennCare. Another good resource is Tennesse Justice Center, if you’ve got any questions.
What’s Covered?
The purpose of TennCare is to make sure that you have access to essential healthcare services that help you to maintain your well-being. With that in mind, there are a wide range of medical services covered under TennCare. However, some services, like nursing home care, require further application.
Services include:
Doctor visits, hospital stays, preventative care, and emergency services
Prescription drugs for managing health conditions
Counseling, therapy, and other treatments for mental health conditions
Dental and vision care
Applying for TennCare/Medicaid
Find out about the application process and what documents and identification information you’ll need to apply – and what not to do, so you can avoid delays.
Application Process
Applications are no one’s idea of a good time, but they are unfortunately necessary for TennCare. Luckily, the process isn’t as grueling as it used to be. You can do it online, by mail, over the phone, or in person, so pick whatever is easiest for you. If you have questions about the process or want someone to help you through it, that’s what we do for some of our clients!
To make the process easier, prepare all of the documents and information that will be needed for your application ahead of time. That will make filling out the actual paperwork go by much faster!
Required documents and information
Documents to prepare:
Identification documents
Medical history
Proof of income
Health insurance information
Information to have on hand:
Social security numbers of everyone applying
Dates of birth for everyone applying
Current income
Current address
Contact information
Citizenship and immigration status
Car and property value
Bank and financial statements (3 months)
Vehicle title (Kelley Blue book value)
Life insurance policy information
Common mistakes to avoid
Mistakes mean delays or denials of coverage, so here are major mistakes to avoid:
Providing incorrect or incomplete information
Failing to include required documents
Not reporting changes in income or household size
Transferring property or making large gifts
Sharing bank accounts and funds with someone other than a spouse
Renewing and Managing TennCare/Medicaid
Here are the key steps to renew and manage your TennCare plan.
Renewal process
TennCare coverage is not permanent and needs to be renewed periodically. TennCare will try to renew your coverage using the information they already have on file, but they may need further information. Keep an eye out for a renewal packet, and fill out the required information as soon as possible.
Reporting changes in income or household
It is essential to report any changes in income or household size to TennCare. These changes can impact eligibility and may require you to update your information or submit additional documents. Failing to report changes promptly can lead to complications in coverage.
Appealing decisions
If your TennCare application or renewal is denied, there is an appeals process in place. This allows you to challenge the decision and provide further information or evidence to support your eligibility. If you get to this point we recommend working with an advocate, such as a lawyer or non-profit agency like the Tennessee Justice Center.
Want to Know How We Can Help You Qualify for TennCare?
Graceful Aging Legal Services is here to help! Contact us today to set up an appointment to talk about TennCare and estate planning, or caring for someone who needs advanced care without the resources to pay for it.
Trusts are a legal tool that can be used for many purposes including estate planning, asset protection, and income tax minimization. Trusts are a way of managing property with the intention of protecting it so that it can be passed on via inheritance to future generations.
Trusts establish a fiduciary relationship that allows a third party to hold a person’s assets on behalf of that person’s beneficiary or beneficiaries. The person establishing the trust and designating the beneficiaries is known as the “settlor” or “trustor,” and the third party who holds the assets on behalf of the beneficiaries is the “trustee.”
Why do people create trusts?
Why do people create trusts in the first place? How do you know if you need a trust? First, people create trusts to control and protect their assets, especially for after they pass away. Trusts provide legal protection for the trustor’s real and personal property, and can also provide protection from creditors. Second, people create trusts because they are concerned about their money being spent on someone other than who it was intended for. Trusts are established to make sure that the trustor’s assets are distributed according to their wishes. If you have significant assets, especially a significant amount of real estate assets, or you have very specific wishes about how and when you want your assets distributed after you pass away, a trust might be for you. The best thing to do is talk to your attorney, who will help you determine whether a trust is the best way to protect your assets.
A beneficiary cannot just “take” an inheritance out of a trust
Since the purpose of a trust is to protect your assets, beneficiaries cannot just take their inheritance out of the trust as they please. The trustee must follow the terms of the trust established by the trustor.
Minors & age clauses within trusts
People under the age of 18 legally cannot control their own money. A trust may be established for a minor beneficiary in order for them to have financial resources during their minority, but these resources are managed by the trustee according to the terms established by the trustor. For example, a trustor may include that their beneficiary receives a regular allowance from the trust.
However, turning 18 does not necessarily mean that the beneficiary will automatically have unlimited access to the trust. Many trustors include payout clauses that extend the trust for a certain amount of time after the beneficiary turns 18. The policy behind this is that, while an 18-year-old may legally be able to control money and property and enter into contracts, the late teenage and early adult years are still a very developmental stage of life. An 18-year-old very well may not have the maturity and money management skills required to handle a significant amount of assets. Age clauses allow for the beneficiary to continue receiving periodic funds from the trust, but provide another level of protection of the trustor’s assets until the beneficiary reaches an age of presumed maturity, usually when the beneficiary reaches their mid-20s.
Trusts for beneficiaries with special needs
These types of trusts are intended to provide for individuals with special needs while also allowing them to retain government benefits like social security or Medicaid. The Trustee will distribute funds from the trust as needed, or on a regular schedule, to take care of the special needs beneficiary’s living expenses and health care needs.
Do you have assets that need to be directed to a beneficiary in a specific manner?
The terms for receiving an inheritance are set when the trust is created
Overall, money moves from a trust only according to the terms set forth at the creation of the trust. This may mean a periodic payment to the beneficiary distributed by the trustee, lump-sum payment to the beneficiary at a certain age, or both. Assets cannot be removed from the trust unless the terms provide for it. To obtain assets from the trust that are not provided for within the terms of the trust, you likely will have to go to court.
In conclusion
When it comes to estate planning, there are many ways that you can distribute your assets according to your wishes. One of the most popular ways is to create a trust.
There are many types of trusts out there. A trust can be either revocable or irrevocable and it can have unique clauses for receiving an inheritance. Trusts are in many ways the opposite of a will. A will is used to distribute property after someone dies, while a trust is set up while someone is alive and involves giving up control over the assets.
Not sure if a trust is right for you? Discuss your financial and family situation with a qualified attorney first.
Many of our Nashville elder law clients wish to remain in their own homes for as long as possible. With the advances in medications, treatments, and home healthcare options, more people are able to stay in their own homes. Whether you are looking for a home healthcare provider in Middle Tennessee for yourself or a loved one, here are some great guidelines to follow:
1. Determine what level of care is needed.
The level of care that you need is the most important determination when you want to hire a home healthcare provider. This factor will affect many other decisions. For example, are you or your loved one dealing with a specific ailment? If so, it may be preferable to choose a provider or agency with experience in that field. Additionally, do you need round-the-clock care, someone to come a few hours a day, or something else entirely? There are adult day programs that can provide an outlet for social activities and certain therapies. Adult day programs can be used on their own or in conjunction with a home healthcare provider. You may wish to ask your elder lawyer for a list of possible facilities in the greater Nashville area or you can access statewide resources on the Tennessee Department of Human Services website.
2. Understand the difference between Home Healthcare and In-Home Care.
Home healthcare is provided to those recovering from surgery or hospitalization, or those needing continuous medical care. These services include skilled nursing care, physical therapy, occupational therapy, speech therapy, and administration of medication. In-home care on the other hand provides ongoing non-medical assistance following illness or surgery or for chronic disease or disability.
3. Decide if you want to hire someone on your own or if you want to go through an agency.
There are advantages and disadvantages to both options. If you choose to do it on your own, you will likely have more say in who will be providing the direct care, as well as what services he or she will provide, but you will be responsible for handling payroll and taxes. On the other hand, an agency will be able to screen applicants thoroughly and can handle payroll and other paperwork for you.
4. Ascertain how you will pay for the home healthcare services.
An experienced elder attorney can point you toward various resources, depending on your needs. You or your loved one may have long-term care insurance set up for just this situation, or you may be looking to Medicare, Veterans Administration, and/or TennCare/Medicaid to assist with the costs. Medicare will only pay for home healthcare, but not in-home care.
One step at a time
Deciding to hire a home healthcare provider in Middle Tennessee is a big job. Break things down into manageable objectives and avoid becoming overwhelmed. At any point in the process, an experienced estate planning and elder law attorney in the Nashville area will be able to offer practical advice and suggestions. If you are unsure about what to do consider scheduling an hour-long Strategy Session and get legal advice from our attorney. We also have a planning tool called the “Care and Savings Assessment”. We use this tool to help our clients qualify for TennCare.
TennCare will use estate recovery on TennCare payments for long-term care.
Long-term medical care is expensive – but where does the money come from?
This week I want to talk about TennCare Estate Recovery. Over the last few blog posts, we have gone over the benefits available to those who qualify medically and financially for TennCare Choices, Tennessee’s long-term care Medicaid program. We have also discussed how we can help our clients adjust their finances so that they can qualify. This week we want to discuss how TennCare recoups the cost of providing long-term care services.
TennCare rules can be confusing
A long time ago, my friend told me that her grandmother had to give away her house because she could not afford to pay for medical care and needed to qualify for Medicaid. This is really unfortunate! Her grandmother clearly didn’t understand the rules of Medicaid. Unfortunately, people like my friend’s grandmother get bad information about Medicaid, the services that are available, and the requirements to become eligible. I wish I could have told my friend’s Grandmother that she could have kept her house. This leads me to my main point…
TennCare will not take your house while you are living in it.
However, TennCare estate recovery allows TennCare to get reimbursed for any funds that they spent on behalf of someone after that person dies. In other words, the state will eventually try to get reimbursed for the money they spent on your long-term care.
According to current TennCare rules, a single person can own a house that is worth up to $603,000, or land with a house worth over $603,000, without any concern about being ineligible for TennCare due to their home. However, you will want to talk to your attorney and financial advisor about how you may be able to continue to pay the costs of maintaining a home if you are in skilled nursing care.
How and when does TennCare get reimbursed for your long-term care?
For most of us, TennCare is not going to take your home even if you are living in a facility. Concern about your real estate should arise if you were hoping to pass your real estate to your family when you die. While TennCare will not try to get repaid for their expenditures during your lifetime, they will seek reimbursement after you pass away.
For example…
Roberta has a home worth $250,000 and no other assets. She was in a skilled nursing facility for two years and received TennCare services for which they paid $125,000. After Roberta passes away, her estate will be expected to pay $125,000 back to TennCare before the family receives any money. Since there is a house worth $250,000, the family would be expected to sell that house and give half the proceeds to the state. This process is called estate recovery.
Work with a probate attorney to resolve an estate recovery claim.
Is there any way we can keep the house in the family?
Estate recovery is something that TennCare takes seriously, and will go to great lengths to make sure that they are properly reimbursed. However, they will not take your home while you are living in it.
I want to be clear: A loved one receiving TennCare benefits while alive does not mean that Tennessee will later attempt to collect the money from YOU. The debt is not yours. If you have a loved one who passes away while on TennCare, your probate attorney will work with you to resolve that estate recovery claim so that TennCare can get reimbursed for any funds they spent on behalf of the deceased.
You can find more information through the Estate Recovery division here.
If you have a family member that was on TennCare or needs to get on TennCare, contact us at 615-846-6201. We’re here to help!
