By Barbara Boone McGinnis, CELA
Who can get CHOICES?
In order to qualify for CHOICES, a person must demonstrate two types of need.
First, there must be a medical need. To get CHOICES, your medical needs must be so serious that you need help with you daily tasks, called “activities of daily living.” TennCare will give you a score on their “Acuity Scale.” Acuity means how bad your health problems are manifested. The particular tasks that will be reviewed include transfers, mobility, eating, toileting, communication, orientation, medication administration, and behaviors.
Second, there must be a financial need. To get CHOICES, you must also show that your income and financial resources are low enough. You will fill out a document that asks about what money you get each month and how much you have in the bank. In 2017, the income limit is $2,205/month. The resource limit, excluding the house and a car, is $2,000 for a single applicant.
I was told I make too much money to get CHOICES, but I still can’t afford the cost of nursing home care. What can I do?
The rules for financial need for CHOICES are confusing. If you are told you can’t get CHOICES because you make too much money, you may still be able to get CHOICES. You may be able to set up a Qualified Income Trust (QIT). To get help doing this, you can call an elder law attorney or you can call the Tennessee Justice Center.
How does a QIT work?
Each month a trustee (typically a family member) deposits into the QIT the amount of income that exceed the limit. Then, at the end of the month the trustee writes a check out of the QIT for that amount. This check is made payable to the nursing facility to go towards the patients liability. An applicant is only eligible during the month in which a QIT is completed.
I’ve heard that I have to apply for my TennCare benefit each year. Is that right?
Sort of. TennCare has resumed processing of the “redetermination” packets that the Bureau sends out annually to verify that someone receiving benefits remains eligible for program coverage.
What if my TennCare CHOICES was cut off because TennCare said I didn’t send in the renewal packet?
If you didn’t receive the renewal packet, call Tennessee Health Connection (THC) at 855-259-0701 and tell them. Find out what address they sent the papers to. If it is the wrong address tell them so and give them the correct one. Ask them to send you the documents at that address.
My mother is in the nursing home on TennCare and now needs a new pair of glasses. The trouble is, she can’t afford them. Will TennCare pay for new glasses?
TennCare does not pay for prescription eye glasses but there is a work-around for certain medically necessary expenses. TennCare’ s process for this is referred to as Item D expenses, which is those expenses not covered by TennCare or a third party such as Medicare. New prescription eye glasses are an example of an item you may submit as Item D deductions request. If you have questions, you can ask the billing office at the nursing home.
For more information, contact Takacs McGinnis Elder Care Law at 615.824.2571 or www.tn-elderlaw.com.