The TennCare Bureau announced a new policy that will help TennCare enrollees receive care at home or in community settings instead of going to nursing homes.
A new presumptive eligibility policy for enrollees who need traditional nursing home care provides the effect of Medicaid eligibility from the first instead of the thirtieth day of admission so enrollees do not have to enter a nursing home before accessing a home and community based services (HCBS) option.
“Our commitment to grow the HCBS program took a giant step forward today, “said TennCare Director, J.D. Hickey. “We have removed a prominent stumbling block for people who prefer HCBS services to institutional care. This is a move that will improve choice for our enrollees and have positive effects on their day-to-day living.”
In some cases, many people cannot qualify for Medicaid without a 30-day stay in an institutional setting. While the larger nursing home industry can usually afford a 30-day stay without pay knowing that retroactive reimbursement will likely come, smaller HCBS programs often do not have the capital to risk.
“The market and government regulation combined have created a climate that pushes people into nursing homes even when they could benefit from and prefer care at home or in a community program,” said Steve Hopper, Chief of Long Term Care for TennCare. “With presumptive eligibility, we expect to see more enrollees take advantage of the HCBS option.”
The federal government caps the number of enrollee slots available for HCBS programs. Currently, TennCare has just over 3,420 HCBS slots and has asked the federal government to raise TennCare’s HCBS allotment by 475. Today about 34 percent of the current HCBS slots are in use.
“We have capacity for more than 2,000 TennCare enrollees to access HCBS programs in our portion of the allotment alone,” said Nancy Peace, Executive Director of the Tennessee Commission on Aging and Disability. “TennCare’s move to presumptive eligibility is an exciting change that will bring more seniors and those living with disabilities care at home or in community settings.”
The Commission on Aging and Disability is one of two state contractors that operate HCBS programs and the only one with a statewide service.
TennCare is Tennessee’s expanded Medicaid program, providing health insurance coverage to 1.2 million Tennesseans including 640,000 children. For more information about the TennCare program or to access this news release online, visit http://www.tennessee.gov/tenncare.

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