Tennessee nursing home care costs about $9,400 a month. TennCare’s rules protect more than most families expect.
In Tennessee, Medicaid is TennCare, and long-term care comes through a program called CHOICES. When a parent or spouse suddenly needs a nursing home, families are often told to “get the finances in order” with no idea what that means. This guide explains it in plain English. (Monthly cost: CareScout 2025 median, semi-private room.[11])
Watch: What Tennessee Law Lets Your Family Keep · about 2 minutes, plain English. Frank is our AI guide.
Reviewed September 2026 against official sources. Figures are for 2026 unless noted.
Medicare does not pay for long-term nursing home care — most families learn this in the worst week of their lives. See Medicare.gov.
How Tennessee pays for long-term care
Medicare doesn’t cover custodial care if that’s the only care someone needs.[12] TennCare pays for long-term care through TennCare CHOICES in Long-Term Services and Supports:[7]
- Group 1 is for people of any age who receive nursing home care.[7]
- Group 2 provides care at home or in the community for people who qualify for nursing home care.[6]
- Group 3 serves people at risk of needing nursing home care; its slots are limited by funding.[6]
The care-needs assessment: every CHOICES applicant needs an approved Pre-Admission Evaluation (PAE). It’s submitted by the Area Agency on Aging and Disability, a hospital, a health plan or the nursing facility, and approved by TennCare.[6] The financial side, called Institutional Medicaid, is decided separately.[1]
What care costs in Tennessee
Most families pay privately until TennCare starts, so this is what’s at stake each month:
| Tennessee, 2025 median | Per month |
|---|---|
| Nursing home, semi-private room | $9,429 (about $113,150 a year) |
| Nursing home, private room | $10,038 |
| Assisted living | $5,845 |
| In-home care, 44 hours a week | $5,911 |
Source: CareScout Cost of Care Survey 2025.[11] TennCare’s own average private-pay rate for nursing facility care, the one it uses for transfer penalties, is $295.87 a day in 2026.[2]
Why timing matters
- Apply the day care begins. For nursing home care, TennCare’s CHOICES rules start coverage no earlier than the later of the application date or the admission date, and coverage generally isn’t extended to dates before the application is received.[6][9]
- A semi-private nursing home room in Tennessee costs a median of about $9,429 a month.[11]
- Without a plan, families often drain savings or sell investments at the worst possible time, not because the law required it, but because nobody told them the rules. Once money is spent, the protections that could have applied to it are gone.
- The longer a family waits, the fewer choices the law leaves. Gifts made now are counted for five years.[13]
Tennessee’s 2026 Medicaid numbers at a glance
These are the figures TennCare uses in 2026. Most change every January, and the spouse’s income allowance changes every July.
| 2026 figure | |
|---|---|
| Asset limit (single applicant) | $2,000[1] |
| Income cap (gross) | $2,982 a month. Above it, a Qualified Income Trust is required.[1] |
| Personal needs allowance (nursing home) | $70 a month[3] |
| Assets the spouse at home can keep | Half of the couple’s countable assets, at least $32,532 and at most $162,660[4] |
| Spouse at home’s monthly income allowance | $2,705 (from July 1, 2026); the federal maximum is $4,066.50[3][14] |
| Home equity limit | $752,000[5] |
| Transfer-penalty divisor | $295.87 a day[2] |
| Look-back period for gifts and transfers | 60 months (5 years)[13] |
| When coverage can start (nursing home) | No earlier than the later of the application date or the admission date[6] |
| How long it takes | Within 45 days of the application (90 if based on disability)[9] |
Where Tennessee is different. Tennessee is an income cap state, so income over $2,982 needs a Qualified Income Trust.[1] The spouse at home keeps half of the couple’s countable resources, within a floor and a ceiling.[4] And for nursing home care, coverage starts no earlier than the later of the application date or the admission date, so the application date matters more here than in states that back-date.[6]
What Tennessee’s rules let a family keep
TennCare’s long-term care program isn’t only for families with nothing. Sooner or later, nearly every family is touched by long-term care, directly or through a parent. Tennessee’s rules name specific things a family can keep.
The home
TennCare won’t pay for long-term care when home equity is over $752,000. Within that limit, the family home generally isn’t counted.[5]
The spouse’s share
The spouse at home keeps half of the couple’s countable resources, never less than $32,532 and never more than $162,660, plus a monthly allowance.[4][3]
Burial funds and prepaid funerals
Each spouse can set aside $1,500 for burial expenses, in addition to burial plots, and an irrevocable prepaid funeral contract is excluded when TennCare’s conditions are met.[5]
A monthly allowance
A nursing home resident keeps $70 a month for personal needs; most other income goes toward the cost of care.[3]
An example, using Tennessee’s 2026 numbers. Mary, 85, is moving into a nursing home in Knoxville. She and her husband Bill own their home and have $140,000 in countable savings. Bill’s share is half, $70,000, which falls between TennCare’s $32,532 floor and $162,660 ceiling, and Mary can keep $2,000.[4][1] About $68,000 is above what the rules let them keep, which is what the rules expect to go toward care, or be spent in ways they allow, before Mary qualifies. Mary’s income is $3,100 a month, over the $2,982 cap, so she needs a Qualified Income Trust.[1] Once she qualifies, she keeps $70 a month for personal needs, and if Bill’s own income is under $2,705, part of hers can go to him.[3] (The names and amounts are made up to show how the rules fit together. Every family’s numbers are different.)
If income is over the limit
Tennessee is an income cap state. The Medicaid Income Cap is $2,982 a month in 2026.[1] If the gross income of the person who needs care is higher, TennCare says they “will be provided with the opportunity to establish a Qualified Income Trust (QIT).”[1]
A Qualified Income Trust, sometimes called a Miller trust, holds the income that’s over the cap. When it’s set up correctly and funded, it can address the income cap; the other eligibility rules still apply. Because coverage generally can’t start before the application date, families shouldn’t wait on the trust to apply.
Gifts, transfers and the 5-year lookback
Medicaid looks back five years at gifts and transfers made for less than their value.[13] TennCare divides the value of a gift by its daily rate of $295.87 to set the number of days it won’t pay for long-term care.[2] A $50,000 gift works out to about 169 days, roughly five and a half months.
A past gift isn’t the end of the road. Transfers to a spouse are generally exempt, and federal law says no penalty applies if all of the transferred assets are returned. How these rules apply depends on the details, so check before relying on them.[13] Get the facts before moving any money.
Estate recovery in Tennessee
TennCare must seek repayment from the estate of a member who received CHOICES services at age 55 or older. Recovery is waived when the member is survived by a spouse, a child under 21, or a blind or disabled child. Questions go to TennCare at 866-389-8444.[10]
First steps for your situation
Where your family is today changes what to do first.
Already in a nursing home, or leaving the hospital
- Apply the day of admission, or as soon as you can. TennCare generally won’t cover dates before the application is received.[6][9]
- Ask the hospital or nursing home to submit the Pre-Admission Evaluation (PAE).
- Check the monthly income against the $2,982 cap. If it’s higher, plan for a Qualified Income Trust.
- List bank accounts, investments and property, and any gifts in the last five years.
- Don’t move or give away money until you understand the rules. Some moves hurt eligibility.
Planning ahead
- Learn how the three CHOICES groups work, and whether care at home is realistic for your family.
- Remember the five-year look-back before making any gifts.[13]
- Know the spouse’s share: half of countable resources, up to $162,660.
- Review your estate plan. Standard estate moves aren’t always Medicaid-friendly.
- Start early. The longer a family waits, the fewer choices the law leaves.
How our free case review works
Short 60-second survey
A few questions about the care situation — a parent, a spouse, or yourself — and the general asset picture.
Free 30-minute case review
A real conversation about your family’s situation and an honest read on what Tennessee’s rules allow in your family’s case.
Your family’s next steps
A clear, step-by-step look at how the rules apply to your family, so you know what to ask and what to do next.
How to apply in Tennessee
- Apply for TennCare online at TennCare Connect or by calling 1-855-259-0701. You can also apply by phone, fax, mail or at any DHS office.[8]
- Start CHOICES. If the person isn’t on TennCare yet, contact the Area Agency on Aging and Disability for free at 1-866-836-6678. Current members call their health plan: BlueCare 1-888-747-8955, UnitedHealthcare Community Plan 1-800-690-1606, or Wellpoint 1-833-731-2153.[8][7]
- Get the PAE approved. The Pre-Admission Evaluation confirms the need for nursing-home-level care.[6]
- Send what TennCare asks for. A decision is due within 45 days of the application.[9]
- If income is over $2,982, set up the Qualified Income Trust.
Free help in Tennessee
These programs are free and independent of Medicaid Answers.
Area Agency on Aging and Disability (AAAD)
Free help starting CHOICES for people not yet on TennCare. · 1-866-836-6678
Apply for TennCare or check an application. · 1-855-259-0701
State Health Insurance Assistance Program (SHIP)
Free, unbiased counseling on Medicare and Medicaid. · 1-877-839-2675
Finds local services for older adults. · 1-800-677-1116
About our free case review
A free 30-minute phone or video conversation with the Medicaid Answers team for families in Tennessee whose savings, home or other assets make TennCare eligibility complicated — the situations where the rules are hardest to navigate alone. We listen to your family’s situation, explain how TennCare’s long-term care rules apply to it, and point you to next steps and official resources. It’s free, and what you do afterward is entirely your choice.
If your family needs hands-on help, we’ll explain your options and point you to the right kind of help, such as Tennessee’s free counseling programs, legal aid, an elder law attorney or a Medicaid planner.
- If the person needing care has little or no savings, you can usually apply directly with TennCare; the steps under “How to apply” walk you through it.
- It is educational, not legal or financial advice.
- It doesn’t replace TennCare, which makes every eligibility decision.
If a hospital discharge or nursing home admission is happening now, reach out this week. Applications and assessments take time, and starting early keeps more options open.
Questions families ask
What is a PAE, and who submits it?
What if we already gave money or property to family?
What if the income is over the cap?
Can TennCare pay for months before we applied?
Can CHOICES pay for care at home instead of a nursing home?
Will TennCare take the house?
Sources
Figures and rules on this page come from these sources. Reviewed September 2026.
- TennCare ABD Manual, 115.015 Institutional Medicaid, January 5, 2026. www.tn.gov/content/dam/tn/tenncare/documents/InstitutionalMedicaid.pdf
- TennCare ABD Manual, 125.010 Transfer of Assets and Penalty Periods, January 5, 2026. www.tn.gov/content/dam/tn/tenncare/documents/TransferOfAssetsAndPenaltyPeriods.pdf
- TennCare ABD Manual, 125.020 Post-Eligibility Treatment of Income, July 1, 2026. www.tn.gov/content/dam/tn/tenncare/documents/PostEligibilityTreatmentOfIncome.pdf
- TennCare, Resource Assessment, January 5, 2026. www.tn.gov/content/dam/tn/tenncare/documents/ResourceAssessment.pdf
- TennCare, ABD Countable and Excluded Resources, September 1, 2026. www.tn.gov/content/dam/tn/tenncare/documents/ABDCountableAndExcludedResources.pdf
- TennCare, 130.005 CHOICES policy. www.tn.gov/content/dam/tn/tenncare/documents/CHOICES.pdf
- TennCare, CHOICES in Long-Term Services and Supports. www.tn.gov/tenncare/long-term-services-supports/choices.html
- TennCare, LTSS Assistors’ Guide, March 2026. www.tn.gov/content/dam/tn/tenncare/documents/LTSSAssistorsGuide.pdf
- TennCare Administrative Manual, 200.040 Eligibility Determination, June 2, 2025. www.tn.gov/content/dam/tn/tenncare/documents/EligibilityDetermination.pdf
- TennCare, Estate Recovery. www.tn.gov/tenncare/legal/estate-recovery.html
- CareScout, Cost of Care Survey 2025, state median cost tables (data collected July–November 2025, published March 2026). assets.carescout.com/x/5c90319b6a/298701.pdf
- Medicare.gov, “Nursing home care”. www.medicare.gov/coverage/nursing-home-care
- 42 U.S.C. § 1396p (transfers of assets, the 60-month look-back and exempt transfers). www.law.cornell.edu/uscode/text/42/1396p
- Centers for Medicare & Medicaid Services, “Updated 2026 SSI and Spousal Impoverishment Standards,” April 27, 2026. www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf