Do I Have to Sell My House to Pay for a Nursing Home in Tennessee?

Nursing home care costs more than most retirement incomes cover, and TennCare is the program that pays when a family runs out. You don't have to sell your house to qualify for it.

Your home is an excluded resource while you're living, even after you move into the facility. What happens to it after you die is a separate question.

I'm a licensed insurance agent in Rogersville, TN. I'm not an attorney, and none of this is legal advice.

01What does TennCare actually count?

TennCare's long-term care program is CHOICES. Group 1 pays for nursing facility care. Groups 2 and 3 pay for care at home instead.

According to TennCare, in 2026 you have to be under $2,982 a month in income and under $2,000 in countable assets.

Your house isn't in that $2,000. TennCare's Aged, Blind and Disabled manual excludes your principal residence, and once you're in a facility it stays excluded as long as you intend to return home. The rule asks for intent, not proof.

There's a ceiling on it. TennCare sets the home equity limit at $752,000, and that limit doesn't apply at all if your spouse, a child under 21, or a blind or disabled child lives there.

02What if I make too much money for TennCare?

A dollar over $2,982 puts you out. TennCare's manual treats it as a hard cap, not a sliding scale.

So what happens if you're in the middle? You don't make enough to cover the bill at a long-term care facility, and you make too much to be eligible for Medicaid.

That's why most families end up looking at the house as the way to pay. There's another option to look at first.

It's called a Qualified Income Trust, or a QIT. You'll also hear it called a Miller Trust.

Your income goes into the trust each month and comes back out that same month to pay for care. TennCare counts money in a valid QIT as unavailable, so it isn't looked at as yours.

Nearly all of it goes to the facility. According to TennCare's post-eligibility manual, you'd get $70 a month for personal needs.

Under TennCare's trust policy the trust has to be irrevocable, and the State of Tennessee has to be named as a beneficiary alongside you. Anything left in the trust when you die goes to the state, up to what it spent on your care.

A QIT doesn't change what you have. It changes where it sits.

There are strict rules for setting one up and running it correctly. Seek guidance from counsel before deciding whether it's right for you.

03Where did the Miller Trust come from?

In 1990, a woman named Jeanette Miller took the State of Colorado to court over her mother.

Lottie Ham needed nursing care and couldn't afford it. She made slightly too much money for Medicaid to help her, and nowhere near enough to pay the bill herself. A Colorado court had already ordered her income into a trust and named her daughter as trustee. The state counted it against her anyway. By then Miller had spent more than $40,000 of her own money on her mother's care.

She sued Irene Ibarra, the Executive Director of the Colorado Department of Social Services, which in practice meant the state itself. Her second aim was to stop the state counting court-ordered trust income toward Medicaid eligibility.

The judge ruled in her favor. In 1993 Congress wrote the protection into federal law, and the trust took the name of the case.

It only works in states that use a hard income cap. Tennessee is one of them.

04What is the 5-year look-back?

TennCare reviews 60 months of financial history before your application. Anything given away or sold for less than it was worth inside that window gets counted.

The penalty isn't a fine. TennCare divides what you transferred by the average daily private-pay nursing rate, $295.87 for 2026, and that's how many days you're ineligible. Roughly 200 days for $60,000. The clock doesn't start until you'd otherwise qualify, which is usually after the money is already spent.

Some transfers are exempt. TennCare's transfer policy allows the home to go to a spouse, a child under 21, a blind or disabled child, a sibling with an equity interest who lived there a year, or a child who lived with you for two years and provided the care that kept you out of a facility. That last one is the caregiver child exception.

Not sure how this applies to your own situation? I'll walk through it with you. No cost for the help, and no obligation to enroll.

Logan Cope · Licensed Insurance Agent

Request a call

05Will TennCare take the house after I die?

This is where the house enters the picture. Estate recovery is federally required, and it runs against your estate after death, not against you while you're living.

Per TennCare, recovery applies when the member was 55 or older, received CHOICES services, and has died. TennCare recovers what it paid for long-term care, and its own page states that holds even if the services weren't used.

It's waived entirely if you're survived by a spouse, a child under 21, or a blind or disabled child.

TennCare also grants an undue hardship waiver. It waives or delays recovery when the property is the family's only income-producing asset, such as a farm or a business, and when a sibling or an adult caretaker child meets its residency and care requirements.

06What to do next

1. Put the numbers on paper. Income by source, what's in the accounts, what's owned outright.
2. Count back 60 months on anything given away, sold cheap, or moved between names.
3. If income is over the cap, ask about a QIT before applying rather than after.
4. Ask who lives in the home, and who has lived there. Most of the exceptions turn on that.
5. Talk to a Tennessee elder law attorney before moving any money. A wrong move costs months of eligibility.

If income is low enough that Tennessee might also help with Medicare costs, that runs on a separate set of rules. I wrote those up in do I qualify for a Medicare Savings Program.

This is a better conversation to have before a hospital discharge than during one.