TennCare Tightens Rules for Nursing Home Coverage

CHATTANOOGA, Tenn. (AP) — TennCare officials say it is getting more difficult for low-income seniors to qualify for nursing homes and other services.
Officials say under old rules, elderly people could qualify for up to $55,000 to pay for a nursing home, adult day care or assisted living if they weren’t able to groom themselves. Under rules that began on July 1, TennCare will take an overall assessment of a person’s need before that level of funding is allocated. Being able to groom oneself is just one measure that TennCare uses to assess a person’s ability to handle activities of daily life.
TennCare spokeswoman Kelly Gunderson said those who don’t qualify for the maximum assessment can still get up to $15,000 annually. She said those who think they need more can ask their health care coordinator for another assessment.
The change has led to concerns.
Serenity Adult Day Care Center owner DeNessa Cartwright told the Chattanooga Times Free Press (http://bit.ly/Oj5nnV) that $15,000 might not be enough for the level of care some seniors require.
“A person can be lacking in only one ADL, but that one ADL could be so major that you still have many needs and need maximum funding,” said Cartwright.
Gunderson said changing the rules will save the agency $47 million a year and it will be able to redistribute money to serve more people.
“This is a critical next step in helping the state continue to expand access to home-based care, delay and/or prevent the need for nursing facility placement, when appropriate, and rebalance the state’s long-term care system for the elderly and adults with physical disabilities,” Gunderson said.
But Tennessee Justice Center Executive Director Gordon Bonnyman said he is concerned the state will be unable to provide needed services.
“It just defies common sense that you’re going to actually be able to maintain everybody, meet those needs and yet take $47 million out of the budget once used to pay for those services,” Bonnyman said

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