Understanding Long-Term Care Help for Franklin Families
Key Takeaways: TennCare CHOICES is Tennessee’s Medicaid program for long-term services and supports for seniors and adults with physical disabilities. Franklin applicants qualify by meeting both medical and financial requirements. The Bureau of TennCare uses a preadmission evaluation (PAE) to confirm nursing-home level of care, while the Department of Human Services reviews income and countable assets. Current limits generally cap monthly income at $2,982 (300% of the SSI federal benefit rate, adjusted each January) and countable assets at $2,000. A Qualifying Income Trust can help when income exceeds limits, and the primary home typically does not count. Care can be delivered in nursing homes or through Home and Community-Based Services. A "lesser level of care" pathway may help those at risk of institutional care, subject to enrollment caps. Once approved, residents meeting continued-stay criteria and remaining financially eligible generally keep their eligibility. Because these figures change and every family differs, confirming current limits with counsel is wise.
If your loved one needs nursing-home-level care in Franklin, Tennessee, they may qualify for TennCare CHOICES by meeting both medical and financial requirements. TennCare CHOICES is the state’s program that pays for long-term services and supports. To qualify, an applicant must need nursing-home-level care and qualify for Medicaid long-term services and supports. For many families, this program bridges a frightening diagnosis and a workable care plan.
If you need help navigating these rules, the team at Sawyer & Associates is here to assist. Call us at 615-570-9901 or reach out through our online consultation request to discuss your family’s situation.
What TennCare CHOICES Actually Covers
TennCare CHOICES is Tennessee’s Medicaid program for long-term care, designed for older adults and people with physical disabilities. This focus defines who the program serves in Franklin and across Williamson County.
Care can happen in multiple settings. Long-term care can be provided in nursing homes, at home, in the community, or in residential places like Assisted Care Living Facilities. Home and Community-Based Services help people stay at home. This flexibility is valuable for families wanting loved ones to remain in familiar surroundings.
The services are practical and hands-on. CHOICES offers help with bathing, dressing, mobility, meal preparation, and household chores. These daily tasks often become difficult first, and support can make the difference between staying home and moving into a facility.
TennCare CHOICES Eligibility Requirements Explained
The tenncare choices eligibility requirements break down into medical and financial components, evaluated separately. Understanding both halves early can save your family stress and delay. Tennessee law splits the qualification process across two agencies.
On the medical side, the state sets the standard for who needs long-term care. Under Tenn. Code Ann. § 71-5-1407(a), the Bureau of TennCare defines medical eligibility criteria for all long-term care services, including nursing facility and home- and community-based waiver services, with level-of-care criteria developed so the most intensive services go to persons with the highest need. In Franklin, applicants must satisfy state medical eligibility criteria before approval.
Medical eligibility is measured through a specific assessment tool. Under Tenn. Code Ann. § 71-5-1407(a), the Bureau of TennCare develops the preadmission evaluation (PAE) assessment tool and determines medical eligibility for long-term care services. All Franklin residents seeking CHOICES long-term care will be evaluated using this PAE process. Learn more on the state’s TennCare CHOICES program page.
The Financial Eligibility Piece
Financial eligibility examines both income and countable assets. The numbers are strict, and careful planning often makes the biggest difference. Franklin families are frequently surprised by how rules treat different types of property.
Current figures set clear ceilings, subject to change and attorney review. Generally, monthly income cannot exceed $2,982 (300% of the SSI federal benefit rate, updated each January). If higher, a Qualifying Income Trust may be an option. Total countable assets cannot exceed $2,000, and the primary home generally does not count. A Miller Trust can help when income exceeds the limit. Read our overview of how a Qualifying Income Trust works.
💡 Pro Tip: Because eligibility figures change annually, treat any dollar amount online as a starting point and confirm current limits before making financial decisions.
How the Application Process Moves Forward
The path to approval usually begins with prescreening and referral to two departments. Under Tenn. Code Ann. § 71-5-1418(c)(2)-(3), individuals prescreened by the area agency on aging are referred to the local health department for Medicaid eligibility determination. The health department facilitates the preadmission evaluation while the Department of Human Services begins financial eligibility determination. Understanding that medical and financial reviews travel on separate tracks helps set realistic expectations.
Tennessee also runs a front door for information and guidance. Under Tenn. Code Ann. § 71-5-1418(c)(1)-(2), a long-term care client information, referral, and assistance program operates through area agencies on aging, where individuals can obtain information and be referred to the local health department for eligibility determination. Franklin-area seniors can use their local Area Agency on Aging as a first stop.
For someone already in or entering a facility, a different party handles the paperwork. Under Tenn. Code Ann. § 71-5-1418(c)(4), for individuals in nursing facilities or awaiting placement, the PAE application is completed by the nursing facility, hospital staff, or the individual’s physician and submitted to the division of long-term care of the Bureau of TennCare for medical criteria determination.
Here is a simplified comparison of the two qualification tracks:
| Qualification Track | What It Reviews | Who Handles It |
|---|---|---|
| Medical eligibility | Nursing-home level of care through the PAE | Bureau of TennCare, division of long-term care |
| Financial eligibility | Income and countable asset limits | Department of Human Services |
The "Lesser Level of Care" Pathway
Tennessee offers a middle option for people not yet at full nursing-facility need but still at risk. This pathway is a key planning point for clients hoping to stay home. It recognizes that care needs exist on a spectrum.
The law allows a more moderate benefit package under certain conditions. Under Tenn. Code Ann. § 71-5-1407(d), persons who meet a lesser level of care but are at risk of institutional care may qualify for a more moderate package of Medicaid-reimbursed home- and community-based waiver services, up to a specified enrollment cap. That enrollment cap is important because access can be limited even when someone qualifies on paper.
Funding realities shape available slots. Under Tenn. Code Ann. § 71-5-1417, funding for Medicaid long-term care services depends on state appropriations. This explains why some services are subject to enrollment caps and annual funding rather than unlimited entitlement.
Keeping Eligibility Once You Have It
Approval is not the end of the story, but the rules offer real stability for those who qualify. Once care is in place, families worry about whether rule changes could push a loved one out. Tennessee law provides reassurance.
Continued eligibility does not require re-qualifying under new standards. Under Tenn. Code Ann. § 71-5-1407(b), nursing facility residents who meet continued-stay criteria and remain financially eligible for Medicaid continue to be eligible and are not required to meet new nursing facility level-of-care criteria. This offers predictability for long-term care planning.
Estate planning tools work alongside these benefits. A revocable living trust helps assets pass outside probate, but it is not the same as Medicaid asset protection, and having a will alone does not avoid probate. Thoughtful estate planning in Franklin, Tennessee can align your documents so care planning and legacy goals support each other.
Common planning considerations include:
- Reviewing income against the current CHOICES limit before applying
- Confirming which assets count and which, like the primary home, generally do not
- Coordinating powers of attorney so a trusted person can act if capacity is lost
- Understanding that Medicaid rules differ significantly by state
💡 Pro Tip: If your family owns property in multiple states, flag that early, because each state applies its own Medicaid and probate rules.
Frequently Asked Questions
1. Does having a will help my parent qualify for TennCare CHOICES?
A will does not affect Medicaid eligibility and does not avoid probate. A will directs how assets pass after death through probate court. To keep assets out of probate, families use tools like revocable living trusts, beneficiary designations, or joint ownership. Medicaid qualification depends on income and asset limits described above.
2. What happens if my parent’s income is over the limit?
Being over the income limit does not automatically disqualify an applicant. If monthly income exceeds the current CHOICES limit (generally $2,982 in 2026), a Qualifying Income Trust may be an option. Whether this tool fits depends on specific facts, so confirming current figures with counsel is wise.
3. Can my parent receive CHOICES care at home instead of a nursing home?
Yes, in many cases care can be provided at home or in the community. CHOICES includes nursing home care and certain Home and Community-Based Services to help people remain at home, in the community, or in residential places like Assisted Living Facilities. Availability may be subject to enrollment caps.
4. Who decides whether my parent needs a nursing-home level of care?
The Bureau of TennCare makes that medical determination. It uses the preadmission evaluation assessment tool to decide medical eligibility. Find program details through resources like the regional Area Agency on Aging CHOICES overview.
5. Do we have to re-qualify every year?
Not under new level-of-care standards, in most cases. As long as a resident meets continued-stay criteria and remains financially eligible, eligibility generally continues. Outcomes depend on individual circumstances.
Planning Ahead With Confidence
Qualifying for TennCare CHOICES requires meeting both a nursing-home level-of-care standard and Medicaid’s financial limits, with several pathways and planning tools available. From the PAE assessment to income trusts and the lesser-level-of-care option, the rules reward families who prepare early rather than in crisis. Because these figures and rules can change and every family’s facts differ, this article is general information rather than individualized legal advice.
When you are ready to build a plan that protects your loved one and your family’s peace of mind, Sawyer & Associates is ready to guide you. Call us at 615-570-9901 or schedule your consultation today to get answers tailored to your situation. We also offer a free 30-minute consultation and a discount for veterans.
