In an experiment being watched nationally, Tennessee has revised its Medicaid long-term care options to make it harder for certain low-income elderly people to qualify for state-paid nursing home care.

The state is creating a new category of seniors who officials say need assistance but not in a nursing home and not with an equivalent level of treatment via home –or community-based services. The state TennCare Medicaid program will pay up to $15,000 a year to help these participants stay in their homes or receive meals and other services in adult day-care facilities or other less-restrictive community settings.

But consumer advocates worry that the $15,000 annual limit will fall short of meeting the needs of some seniors, who could end up going without services or relying on funds from family or friends. Gordon Bonnyman, executive director of the Tennessee Justice Center, said he feared that "a lot of frail people are not going to make it on the reduced package."