TennCare Eligibility Worksheet

From caidee.org · Tennessee TennCare resource

Calculate where you stand on income, assets, and timing before you apply. Numbers are based on 2025-2026 TennCare standards.

SECTION 1 — Who is applying?

Adult applying for self (nursing home or LTC)

Spouse applying with one needing care

Parent applying for child (Katie Beckett / TEFRA)

Adult applying for disabled child age 18+

SECTION 2 — Monthly Income

List GROSS monthly income for the applicant (and spouse if married):

Source	Applicant	Spouse
Wages / salary	$________	$________
Social Security	$________	$________
Pension	$________	$________
VA benefits	$________	$________
Self-employment	$________	$________
Rental income	$________	$________
Other	$________	$________
TOTAL MONTHLY	$________	$________

SECTION 3 — Income Limits to Compare Against

Nursing home / LTC (CHOICES Group 1): $2,901/month gross (single, 2025) or up to $5,802/month combined (married, special rules apply)

Katie Beckett / TEFRA: Parental income IGNORED — only child's own income counts (typically $0)

Standard adult TennCare (Aged/Blind/Disabled): Approximately $1,255/month gross (single)

SSI / auto-TennCare: $943/month federal SSI cap (2025) — slightly higher in TN with state supplement

SECTION 4 — Countable Assets

List the CURRENT value of ALL accounts/assets owned:

Asset	Value
Checking accounts	$________
Savings accounts	$________
Money market	$________
CDs	$________
Brokerage / stocks / bonds	$________
IRAs / 401(k) / retirement	$________
Life insurance cash value (over $1,500)	$________
Second home / investment property	$________
Second vehicle	$________
Annuities (countable)	$________
Trust assets (if not properly irrevocable)	$________
TOTAL COUNTABLE ASSETS	$________

SECTION 5 — Asset Limits

Single applicant (nursing home/CHOICES): $2,000 in countable assets

Married, one spouse to nursing home: Community Spouse Resource Allowance up to $157,920 (2025) for the at-home spouse + $2,000 for the institutionalized spouse

Katie Beckett: Only the CHILD's assets count — typically $2,000 limit for child

SECTION 6 — Look-Back Period (Nursing Home/CHOICES only)

Were any of the following done in the last 60 months (5 years)?

Gifted money or property to family members (>$1,000)

Sold property below fair market value

Transferred real estate to children

Funded an irrevocable trust

Paid large amounts to caregivers without a written contract

If you checked any, calculate the penalty period: Total transferred ÷ $7,755 (2025 Tennessee divisor) = months of ineligibility. Then read our Look-Back Guide for exceptions.

SECTION 7 — Quick Take

Based on this worksheet:

Income is below the relevant limit → likely qualify on income

Assets exceed the limit → spend-down or planning needed

Look-back transfers found → consult elder law attorney before applying

Katie Beckett applicant → income/assets irrelevant for parents — focus on medical documentation

This worksheet is a starting point. Final eligibility is determined by TennCare. Consult an elder law attorney for complex situations.

caidee.org/downloads/eligibility-worksheet · Updated for 2026 TennCare rules · Not legal advice — for navigation guidance only