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Aged, Blind and Disabled Manual Section: Financial Eligibility Requirements Policy Manual Number: 110.055 Chapter: ABD Trusts

May 1, 2026 Division of TennCare 9 vi. Payment for Nursing Facility Care, HCBS, and other TennCare Medicaid-Covered Services Any available income not placed in the QIT and any Trust income remaining after allowable deductions are made shall be paid monthly to the facility by the individual or from the Trust in an amount not to exceed the Medicaid reimbursement rate. Any excess income not distributed from the Trust shall accumulate in the Trust monthly. vii. Restrictions on Other Expenses No other deductions or expenses may be paid from the Trust. Expenses which cannot be paid from the Trust, except as specifically provided herein include, but are not limited to, trustee fees, attorney fees and costs (including attorney fees and costs incurred in establishing the trust), accountant fees, court fees and costs, fees for guardians ad litem, funeral expenses, past due medical bills, and other debts. viii. Home and Community Based Services (HCBS) For an individual with a valid Trust receiving HCBS, the following methodology will be used to determine the financial liability of the individual for the cost of care. 1. Determine the amount of the individual’s gross monthly income. Based on federal regulations and guidance, all of the individual’s income is counted, including the amount placed in the Trust. 2. Deduct the individual’s Personal Needs Allowance (PNA). The PNA for HCBS is 300% of the SSI/FBR for HCBS enrollees and Self-Determination Waiver; and 300% for the Comprehensive Aggregate Cap (CAC) and Statewide Waivers. 3. A deduction not to exceed $20, or another verified amount, for trust expenses, i.e. bank charges is allowed. 4. A deduction may be made for spousal allocation, health insurance or any approved non-covered medical or remedial care expense (Item D). Approved non-covered services are listed in TennCare State Rules. 5. The remainder, after the above deductions, is the individual’s financial liability amount. 5. Undue Hardship An individual applying for or receiving TennCare Medicaid-reimbursed LTSS may request an undue hardship waiver if application of the trust provisions would work an undue hardship. We will consider the possibility of undue hardship if: a. Counting an irrevocable trust as a resource would make the individual ineligible due to excess resources;