TennCare income limits determine eligibility for Tennessee’s Medicaid program, and at income-partners.net, we help you understand these financial requirements to navigate the system successfully and maximize your chances of qualifying. Understanding TennCare’s income eligibility, asset limits, and long-term care options is crucial, so explore opportunities for strategic financial planning, asset protection, and maximizing your income potential for future financial security with our partnership programs.
1. Understanding Tennessee Medicaid (TennCare) and Long-Term Care
TennCare, Tennessee’s Medicaid program, offers healthcare coverage to low-income individuals of all ages. According to the Tennessee government, it is a vital resource for elderly residents aged 65 and over, especially those needing long-term care. This coverage extends beyond traditional medical services, encompassing nursing home care, assisted living, and vital non-medical support to enable seniors to live comfortably at home.
There are three primary categories of Medicaid long-term care programs in Tennessee:
- Institutional / Nursing Home Medicaid: This entitlement program ensures that anyone who meets the eligibility criteria receives assistance exclusively within nursing home facilities.
- Medicaid Waivers / Home and Community Based Services (HCBS): These waivers are not an entitlement and have limited participant slots with potential waiting lists. According to the American Council on Aging, the goal is to prevent or delay nursing home admissions by providing services in various settings, including homes, adult daycares, adult foster care, and assisted living facilities.
- Regular Medicaid / Aged, Blind, and Disabled: This entitlement program guarantees benefits to all eligible individuals, offering various long-term care services like personal care assistance and adult daycare.
TennCare operates as a Managed Care Program, with the Long-Term Services & Supports division overseeing long-term care assistance for the elderly. It’s jointly funded by the state and federal government but administered by the state within federal guidelines.
2. What Are The Income and Asset Limits for TennCare Eligibility in 2025?
Eligibility for TennCare’s long-term care programs depends on meeting specific financial and medical criteria, which vary annually and based on marital status. Tennessee offers multiple pathways to qualify for Medicaid.
For a single applicant seeking nursing home care in 2025, the simplified eligibility criteria include:
- Income Limit: Below $2,901 per month.
- Asset Limit: Below $2,000.
- Level of Care: Requiring a Nursing Home Level of Care.
Overview of 2025 TennCare Long-Term Care Eligibility for Seniors
| Single | Married (Both Applying) | Married (One Applying) | |
|---|---|---|---|
| Type of Medicaid | Income Limit / Asset Limit | Income Limit / Asset Limit | Income Limit / Asset Limit |
| Institutional / Nursing Home Medicaid | $2,901 / $2,000 | $5,802 / $4,000 | $2,901 / $2,000 (Applicant) & $157,920 (Non-Applicant) |
| Medicaid Waivers / HCBS | $2,901 / $2,000 | $5,802 / $4,000 | $2,901 / $2,000 (Applicant) & $157,920 (Non-Applicant) |
| Regular Medicaid / Aged, Blind, & Disabled | $967 / $2,000 | $1,450 / $3,000 | $1,450 / $3,000 |
- For Nursing Home Medicaid, most of the beneficiary’s income goes towards nursing home costs, except for a Personal Needs Allowance of $70/month, Medicare premiums, and potential Needs Allowance for a non-applicant spouse.
- Income limits for Medicaid Waivers may vary depending on the living situation.
- Persons eligible for SSI are automatically approved for Medicaid in Tennessee.
Even if you don’t meet these criteria, you may still qualify for TennCare with strategic planning.
3. How Is Income Defined Under TennCare Guidelines?
Almost all income received by a Medicaid applicant counts towards the income limit, including wages, alimony, pensions, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. According to the Tennessee government, certain payments like Holocaust restitution and VA Aid & Attendance (above the Basic VA Pension) are exempt.
3.1 How Does TennCare Treat Income for Married Couples?
When only one spouse applies for Nursing Home Medicaid or a Medicaid Waiver, only the applicant’s income counts. The non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) to avoid poverty.
- In Tennessee, the MMMNA is $2,643.75 (effective 7/1/25 – 6/30/26).
- If the non-applicant’s income is below this amount, income can be transferred from the applicant spouse to reach the MMMNA.
- The Spousal Income Allowance can increase if housing and utility costs exceed $793.13/month (eff. 7/1/25 – 6/30/26), but cannot exceed a total income of $3,948/month.
For Regular Medicaid, both spouses’ incomes are counted, and there is no Monthly Maintenance Needs Allowance for the non-applicant spouse.
4. What Assets Are Considered When Determining TennCare Eligibility?
Countable assets include cash, stocks, bonds, investments, bank accounts, and non-primary residence real estate. IRA’s and 401K’s are also counted in Tennessee. Exempt assets include personal belongings, household furnishings, an automobile, irrevocable burial trusts (up to $6,000), and typically the primary home.
4.1 How Does TennCare Treat Assets for Married Couples?
Assets of a married couple are considered jointly owned, regardless of which spouse applies for Medicaid. A Community Spouse Resource Allowance (CSRA) protects a portion of the assets for the non-applicant spouse when one spouse applies for Nursing Home Medicaid or a Medicaid Waiver.
- In 2025, the community spouse can retain 50% of the couple’s assets, up to a maximum of $157,920.
- If the community spouse’s share is under $31,584, they can retain 100% of the assets, up to $31,584.
4.2 What Is The Medicaid Look-Back Period?
Tennessee has a 60-month (5-year) Look-Back Period before applying for Nursing Home Medicaid or a Medicaid Waiver. During this time, Medicaid reviews asset transfers to ensure no gifting or sales occurred below fair market value. Violations result in a period of Medicaid ineligibility.
While the U.S. Federal Gift Tax Rule allows gifting up to $19,000 per recipient in 2025 without filing a Gift Tax Return, such gifting still violates Medicaid’s Look-Back Period.
5. What Are The Home Exemption Rules for TennCare?
To be exempt, the Medicaid applicant or their spouse must live in the home. If there’s no spouse, the home equity interest limit is $730,000 in 2025. The applicant must also have Intent to Return if neither the applicant nor their spouse lives in the home.
5.1 Medicaid Estate Recovery Program (MERP)
While the home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program (MERP). Tennessee’s Medicaid agency may seek reimbursement for care costs from the deceased’s estate, often including the home. Planning strategies are essential to protect the home from MERP and ensure it passes to family as inheritance.
6. What Medical or Functional Needs Must Be Met to Qualify for TennCare?
Applicants must demonstrate a medical need for long-term care Medicaid. Nursing Home Medicaid and Medicaid Waivers require a Nursing Facility Level of Care (NFLOC). Regular Medicaid requires a functional need with Activities of Daily Living, but not necessarily an NFLOC.
7. How Can One Qualify for TennCare When Over The Income or Asset Limits?
Even if you exceed the income or asset limits, there are strategies to qualify for long-term care Medicaid:
- Qualified Income Trusts (QITs): Also known as Miller Trusts, QITs allow individuals over the income limit to become income-eligible for Medicaid nursing home care or a Medicaid Waiver. Excess income is deposited into the trust and managed by a trustee for specific purposes like medical expenses and health insurance premiums. The state of Tennessee must be named as a beneficiary.
- Asset Spend Down: Individuals over the asset limit can spend down excess assets on non-countable ones, such as home modifications, prepaid funeral expenses, and debt repayment. Careful documentation is crucial to avoid violating the Look-Back Rule.
- Medicaid Planning: Working with a Medicaid Planning Professional can help families employ various strategies to become Medicaid-eligible and protect their home from the Estate Recovery Program.
8. What Specific Tennessee Medicaid Programs Are Available?
In addition to nursing home care, Tennessee Medicaid offers programs that help the elderly live independently:
- CHOICES in Long-Term Services and Supports Program: This assists individuals who qualify for nursing homes or are at risk of needing this level of care to live at home, with loved ones, in adult foster care, or in assisted living. Benefits include adult day care, personal care, medical alert devices, and transportation.
- Program of All-Inclusive Care for the Elderly (PACE): This combines Medicaid and Medicare benefits into a single program, with additional benefits like dental and eye care.
9. How Do I Apply for Tennessee Medicaid (TennCare)?
You can apply for TennCare online, by phone, in person at a local DHS office, or by submitting a paper application. Current TennCare recipients seeking long-term services via CHOICES should contact their TennCare health plan. Non-recipients should contact their local Area Agency on Aging and Disability (AAAD) office.
9.1 What Steps Should I Take Before Applying?
Before applying, ensure that you meet all eligibility requirements. If you have excess income or assets, consider Medicaid Planning for the best chance of acceptance into a Medicaid program.
10. What Are The Most Common Questions About TennCare Income Limits?
1. What happens if my income is slightly over the TennCare limit?
You may still qualify for TennCare by using a Qualified Income Trust (QIT), also known as a Miller Trust, which allows excess income to be deposited into the trust and used for specific medical expenses, thus reducing your countable income.
2. Can I give away assets to qualify for TennCare?
Gifting assets can trigger the Medicaid Look-Back Period, potentially leading to a period of ineligibility. Consult with a Medicaid planning professional before transferring assets.
3. Will TennCare take my home if I need long-term care?
While your home is generally exempt from the asset limit, it may be subject to Medicaid’s Estate Recovery Program (MERP) after your death. Proper planning can help protect your home.
4. What if my spouse’s income is too high for me to qualify for TennCare?
If only one spouse is applying for Nursing Home Medicaid or a Medicaid Waiver, only the applicant’s income is counted. The non-applicant spouse may also be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA).
5. Are there any assets that TennCare doesn’t count?
Yes, exempt assets include personal belongings, household furnishings, one automobile, irrevocable burial trusts (up to $6,000), and typically your primary home.
6. How often do TennCare income and asset limits change?
TennCare income and asset limits are typically updated annually. Check the latest guidelines to ensure accurate eligibility assessment.
7. What is the difference between Medicaid Waivers and Regular Medicaid in Tennessee?
Medicaid Waivers (HCBS) are not an entitlement and have limited participant slots, while Regular Medicaid guarantees benefits to all eligible individuals. Waivers often provide services in home or community-based settings, whereas Regular Medicaid may offer a broader range of services.
8. How does TennCare define “nursing home level of care”?
Nursing home level of care (NFLOC) refers to the level of medical and functional assistance required by an individual, typically involving significant help with Activities of Daily Living (ADLs) and medical needs that can be met in a nursing facility.
9. Can I use a Medicaid planner to help me qualify for TennCare?
Yes, working with a Medicaid Planning Professional can provide valuable assistance in navigating complex eligibility rules, employing strategies to become Medicaid-eligible, and protecting assets.
10. Where can I find the most up-to-date information on TennCare eligibility requirements?
You can find the most current information on the official TennCare website or by contacting your local Area Agency on Aging and Disability (AAAD) office.
Navigating TennCare eligibility can be complex, but understanding the income and asset limits is the first step. By utilizing available resources and seeking professional guidance, you can confidently navigate the system and secure the care you need.
At income-partners.net, we understand the challenges of navigating TennCare eligibility. We offer insights into various partnership programs designed to help you maximize your income potential, protect your assets, and secure your financial future.
Ready to explore strategic partnership opportunities and unlock your income potential? Visit income-partners.net today to discover how we can help you navigate TennCare eligibility and achieve your financial goals. Contact us at Address: 1 University Station, Austin, TX 78712, United States. Phone: +1 (512) 471-3434 to learn more and get started on your path to financial success!
