What is Spend Down for Medicaid/TennCare?

Would-be TennCare CHOICES applicants often find themselves in a nursing home having a conversation with facility staff about TennCare and a process called “spend down.” At a stressful time with important health care decisions being made, this term can be confusing – and scary. Applicants and their families immediately imagine a process of divesting themselves of all their assets until they are completely impoverished. But that’s not necessarily the way of things.A “spend down,” as it relates to TennCare CHOICES, is the process of becoming financially eligible for benefits by spending assets down to the resource limit for the program. For an individual, that resource limit is $2,000*. For a married applicant, the spouse who is not applying for benefits can keep between $24,720 and $123,600*.There are many options for spending down funds. The cardinal rule is that the funds must be spent on the applicant or their spouse. Money cannot be given away without incurring penalties. Some ideas for spend down include: personal items like clothing or toiletries, home repairs or renovations, vehicle purchases or upgrades, or paying off debt. There can also be some asset protection options that take into consideration which types of assets are “countable” for Medicaid/TennCare and which ones are “exempt.”Before embarking on a spend down process, talk to a qualified elder law attorney who can recommend the best options for your unique situation. A good spend down strategy for one person or family may be a bad strategy for another, depending on the circumstances. By taking advantage of asset protection strategies recommended by a qualified professional, you can maximize the assets you can keep while making sure the TennCare applicant gets the care they need.*Medicaid/TennCare figures are subject to change over time. To determine eligibility, always make sure you are working with the latest TennCare and Medicaid figures.Photo © Andrey Frolov