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.
Aging often comes with increased healthcare costs and healthcare costs impact everyone—regardless of income level. Miller Trusts are a legal tool that helps individuals with high income qualify for Medicaid long-term care benefits. With a Miller Trust in Tennesee, you can become eligible for TennCare even if you are over the “income cap” set by the state.
What is a Miller Trust?
The Medicaid program (called TennCare here in Tennessee) typically requires limited income to qualify. A Miller Trust is a legal arrangement designed to help those with high income qualify for Medicaid long-term care benefits. By establishing a Miller Trust, also known as a Qualified Income Trust, you can redirect your income into the trust, your income then becomes exempt from Medicaid income calculations.
Why are Miller Trusts Used in Tennessee?
Tennessee is an “income cap” state for Medicaid. That means that those who have income above the cap will not qualify for TennCare. Miller Trusts are used primarily as a tool to create eligibility for Medicaid/TennCare even when you might have too much income. There are times when assets may fall within Medicaid eligibility requirements while income exceeds eligibility limits. In this case, a Miller Trust can help.
Without a Miller Trust even when assets meet eligibility requirements, income may exceed the limits for Medicaid eligibility. By redirecting income into a Miller Trust, you can effectively reduce your income for Medicaid eligibility purposes, ensuring you can receive necessary long-term care benefits.
The Benefits of Miller Trusts
There are several key benefits associated with establishing a Miller Trust.
Qualifying for Medicaid
The primary benefit of a Miller Trust is that it allows individuals with middle to high income to qualify for Medicaid long-term care benefits. A Miller Trust provides a way to legally redirect income into the trust effectively lowering income for Medicaid eligibility purposes.
Preserving Income
Miller Trusts also provide a means to preserve income. Instead of having to find a way to reduce your income to meet Medicaid’s income requirements, you can redirect your income into the trust. This ensures you can continue to receive your income while still qualifying for Medicaid long-term care benefits. It provides a way to maintain some financial flexibility while accessing the necessary healthcare coverage.
The Process of Setting Up a Miller Trust
The process of setting up a Miller Trust involves several key steps.
Gathering Financial Information
The first step in setting up a Miller Trust is gathering all relevant financial information. Financial information must be thorough including all income sources and other financial details to create a comprehensive financial report. An effective Miller Trust helps you meet income qualifications for Medicaid. In order for a Miller Trust to work for you it is critical to have an accurate understanding of your current financial situation.
Selecting a Trustee
The next step, in setting up a Miller Trust is to select a trustee. It is important to choose someone who possesses good organizational skills, excellent financial management, and will always prioritize your best interests. Opting for a trustee (typically a family member) who works with a lawyer who has a focus on Medicaid planning to set up the trust ensures they can adeptly navigate the intricacies involved in establishing a Miller Trust. Once the trust is established, it’s usually not too difficult to care for the account.
Creating the Trust Agreement
Once a trustee has been selected the next step is to create the trust agreement outlining the terms and conditions of the trust, including how income will be deposited into the trust and how it will be used for qualified expenses. Consulting an attorney experienced in Medicaid planning is crucial to ensure that the trust agreement is drafted correctly and in compliance with all applicable regulations.
Funding the Trust
After the trust agreement has been created and signed, the next step is to fund the trust. This involves transferring income into the trust, which will then become exempt from Medicaid’s income calculations. This typically involves setting up your Social Security to be direct-deposited to the trust account. You can likely do this online if you have an online account with the Social Security Administration.
It is essential to follow all necessary procedures and guidelines when funding the trust to ensure that it is done correctly and in compliance with Medicaid regulations. Make sure you work with a banker who is familiar with Miller Trusts to be sure that all regulations are followed and ensure that all necessary documentation is provided. Your attorney should be able to provide recommendations for banks they have successfully worked with in the past.
Meeting Medicaid Requirements
Finally, meeting all Medicaid requirements is essential. Income limits, reporting, documentation and any other Medicaid requirements must be met for a Miller trust to be effective. Consulting with an attorney with experience in Medicaid planning can help ensure all requirements are met.
Managing a Miller Trust
Once a Miller Trust has been established, proper management is essential. Here are a few key considerations.
Using Trust Funds for Qualified Expenses
The funds in a Miller Trust should be used exclusively for qualified expenses. This includes medical and long-term care costs that are not covered by Medicaid/TennCare. For example, if Medicaid covers one set of dentures every two years but you lose yours before it’s time to get a new set, you can use it to cover another set of dentures. It is important to keep accurate records of all expenses paid from the trust to ensure compliance with Medicaid regulations.
A trust can also be used for professional expenses. For example, a Miller Trust can be used to pay for legal fees.
Keeping Accurate Records
Record keeping is a vital aspect of managing a Miller Trust. Accurate records of all income deposits, expenses paid and other trust related financial transactions are necessary for proper trust management. The records are required for ongoing compliance as well as the TennCare redetermination period when you will need to submit proof that you still financially qualify for TennCare/Medicaid.
Reporting to TennCare/Medicaid
As a Miller Trust beneficiary it is important to report any changes in income or financial circumstances to TennCare/Medicaid if there is a significant increase. This includes significant increases in income sources, the amount of income deposited into the trust, and any other relevant financial changes. By keeping Medicaid informed – and by getting in touch with an experienced Medicaid attorney – beneficiaries can maintain their eligibility and continue to receive the necessary healthcare coverage.
For example, if you get a Miller Trust and then get an inheritance, you may no longer be eligible for TennCare/Medicaid. However, at that point, it would be wise to talk to an experienced Medicaid attorney, because they may be able to help you if you notify them quickly and before the inheritance is received.
Potential Challenges and Considerations
While Miller Trusts can be a valuable tool for Medicaid planning, there are some challenges and considerations to keep in mind.
Legal and Financial Implications
When establishing a Miller Trust there are serious legal and financial considerations making it vital to consult with an attorney who has Medicaid planning experience. An experienced attorney will help ensure all legal requirements are met and help you fully understand the implications of a Miller Trust.
Estate Recovery
In all cases, Medicaid will seek to recover expenses paid on behalf of a Miller Trust beneficiary from the beneficiary’s estate after their passing. In other words, anything in the Miller Trust at the end of life will go to the TennCare/Medicaid office This is known as estate recovery. It is important to understand the potential implications of estate recovery and to plan accordingly when establishing a Miller Trust.
Monitoring Eligibility Requirements
Medicaid eligibility requirements can change over time and it is important to monitor these changes to ensure ongoing eligibility. It’s in your best interest to stay informed about updates and changes to Medicaid requirements.
Consult Graceful Aging Legal Services for Your Miller Trust
Miller Trusts provide an option for individuals who have significant income and want to qualify for Medicaid long term care benefits. If you or someone you love falls into this category, a Miller Trust is an option to divert your income.
In addition to the oftendifficult conversations surrounding estate planning, establishing and managing a Miller Trust can be quite complex and challenging. It is advisable to seek assistance from a lawyer who focuses on Medicaid planning to navigate the process of establishing and managing a Miller Trust.
If you have more questions about Miller Trusts and would like to know if it’s a good option for you or your family, click here to schedule an initial call with our office. We’d love to work with you!
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.
At the end of 2020, Congress approved new stimulus payments for most Americans. Stimulus payments by direct deposit are already going out. The Treasury Department is sending others by check or debit cards in the mail. Under President Biden, we may see more stimulus payments coming as well.
With that in mind, let’s consider those who may have limited income and receive means-tested assistance, such as TennCare or Supplemental Security Income (SSI). Those individuals or their loved ones may be concerned that the additional funds contributed to their bank account may disqualify them from benefits. However, the Social Security Administration has clearly said that stimulus payments do not count as income for means-tested assistance- at least not in the year it is received. For those receiving TennCare, you have twelve months to spend your stimulus payment.
If you care for someone in a facility, the facility may try to claim the stimulus payment on behalf of the patient. This is especially true if the facility is the Representative Payee for the patient’s Social Security check. However, the stimulus payment belongs to the patient, not the facility. It is not part of the patient liability payment for TennCare.
While a facility may request payment for debts owed before a patient received TennCare, they cannot hold stimulus payments hostage. A patient or their legal representative may agree to have the funds held in a patient trust account at the facility.
No matter who holds a stimulus payment, it must be used for the benefit of the recipient. If you care for someone who received one, consider what these funds might be used for to improve their quality of life for the year ahead.
If you have any questions about a nursing home trying to keep your loved one’s stimulus payment, book a call with us now.
Disclaimer
This website is an attorney advertisement. It is not legal advice and does not create an attorney-client relationship with the viewer.
