Complete Guide to Medicaid and Long-Term Care Planning in Wildwood Lake
Planning for long-term care and Medicaid eligibility can be overwhelming for families in Wildwood Lake. At Jay Johnson Law Firm, our focus is on helping local residents understand the options available under Tennessee law and make practical choices that protect assets and preserve dignity. This guide introduces key concepts, timelines, and decisions you may face when arranging care for an aging loved one, and explains how careful planning can reduce financial strain. We aim to provide clear, actionable information so families can move forward with confidence while considering both medical and financial needs.
Long-term care planning involves more than paperwork; it requires a realistic assessment of care needs, income, and property, and an understanding of how Medicaid rules interact with those factors. Many families benefit from early planning to create options that may include benefit coordination, asset protection measures permitted by law, and planning for future incapacity. This page outlines common pathways and practical steps to help families in Bradley County and the surrounding areas assess their situation, identify potential benefits, and prepare for conversations with care providers and financial advisors.
Why Medicaid and Long-Term Care Planning Matters for Wildwood Lake Families
Effective planning for long-term care and Medicaid eligibility can offer important benefits to families facing aging or disability needs. Proper planning can help protect family resources, reduce stress during medical crises, and create a smoother transition to appropriate care settings. In Tennessee, timing and documentation matter, so early action often produces better options and outcomes. Families who take steps to align their financial records, legal instruments, and care preferences are better positioned to access benefits when needed and to preserve funds for surviving spouses or heirs.
About Jay Johnson Law Firm and Our Approach to Elder Care Planning
Jay Johnson Law Firm is based in Hendersonville and serves clients throughout Bradley County, including Wildwood Lake. Our attorneys focus on practical solutions for estate planning, probate, and elder law matters like Medicaid and long-term care planning. We prioritize clear communication, thorough documentation, and a client-centered approach that respects family values and financial realities. When working with families, we outline realistic pathways, explain legal timelines, and coordinate with financial and medical advisors to create plans suited to each household’s circumstances and goals.
Understanding Medicaid Rules and Long-Term Care Options in Tennessee
Medicaid eligibility for long-term care depends on income, assets, and certain look-back periods that evaluate transfers made prior to application. In Tennessee, rules aim to ensure that individuals with limited resources can receive care while preventing improper transfers of assets meant to avoid eligibility requirements. Understanding these provisions, as well as allowable income exemptions and spousal protections, is essential to creating a viable plan. Early consultation helps identify which strategies are permitted and how to align an individual’s finances to qualify without jeopardizing necessary support for a spouse or dependent.
Long-term care itself may be provided in a variety of settings, including in-home care, assisted living, and nursing facilities, and each option has different cost structures and Medicaid coverage rules. Evaluating care needs alongside financial resources allows families to select the most appropriate path. Planning tools may include certain transfers, trusts allowed by law, and income allocation methods that help preserve some resources for the community spouse while meeting program rules. Decisions should be documented carefully and revisited as health or financial circumstances change.
What Medicaid and Long-Term Care Planning Entails
Medicaid and long-term care planning is the process of arranging finances, legal instruments, and records so that an individual can access public benefits for care when eligible while protecting family assets within the bounds of state law. This includes reviewing income sources, bank accounts, property, and past transfers, as well as preparing necessary applications and supporting documentation. Planning also addresses the coordination of care preferences, power of attorney appointments, and health care directives to ensure that medical and financial decisions can be made smoothly if the person becomes unable to act for themselves.
Key Elements and Steps in a Long-Term Care Planning Strategy
A practical planning process typically begins with a comprehensive financial and personal assessment, followed by consideration of legal tools such as powers of attorney, health care directives, and permissible arrangements to address Medicaid eligibility. The process includes reviewing income and asset protection strategies that comply with Tennessee law, preparing documentation for applications, and coordinating with care providers. Timelines, including any look-back periods and waiting periods, are reviewed to avoid unintended penalties. Communication with family members and caregivers ensures everyone understands responsibilities and expectations.
Key Terms and Glossary for Medicaid and Long-Term Care Planning
This glossary explains common terms you will encounter while planning for long-term care and Medicaid eligibility in Tennessee. Clear definitions help families understand eligibility thresholds, income diversion options, and documents that affect decision-making. Familiarity with these terms makes it easier to evaluate potential strategies and discuss options with advisors and care providers. We provide plain-language explanations to demystify the process and help you recognize which pieces of information are most relevant when preparing applications or reviewing household finances.
Medicaid Eligibility
Medicaid eligibility refers to the conditions under which an individual qualifies for public assistance to cover medical and long-term care services. Eligibility is generally based on income and asset limits set by the state, and applicants must provide documentation to verify their financial situation and medical need. Eligibility can also be affected by recent transfers of assets, which may result in a period of ineligibility if transfers fall within a look-back timeframe. Understanding eligibility rules helps families plan appropriately to obtain benefits when care is needed.
Look-Back Period
A look-back period is a timeframe preceding a Medicaid application during which the state reviews transfers of assets to ensure they were not made to improperly qualify for benefits. Transfers for less than fair market value can result in a penalty period during which Medicaid benefits are delayed. The length and rules of the look-back period are set by state and federal guidelines, and careful planning requires attention to these timelines. Proper documentation and legal review can identify permissible transfers and methods to mitigate penalties when possible.
Community Spouse Protections
Community spouse protections are rules that preserve a portion of assets and income for a spouse who continues to live at home while the other spouse receives long-term care benefits. These protections prevent the healthy spouse from being left destitute by maintaining access to resources needed for daily living. The amount allowed varies by state and is designed to balance the needs of both the spouse in care and the spouse at home. Planning considers these protections to retain an appropriate standard of living for the community spouse.
Power of Attorney and Advance Directives
A power of attorney permits a trusted person to manage financial matters if the principal becomes unable to do so, while advance directives outline medical care preferences and decision makers for health care. Both documents are central to long-term care planning because they ensure continuity of decision-making and help avoid court involvement if incapacity occurs. Properly drafted instruments and clear communication with designated agents help families act quickly in medical emergencies and provide the documentation Medicaid and care providers may request.
Comparing Limited Approaches and Comprehensive Long-Term Care Planning
When facing long-term care needs, families can choose between targeted measures that address immediate eligibility concerns and a broader planning approach that anticipates future changes. Limited approaches may be quicker and less costly upfront, focusing on a single asset or benefit application. Comprehensive planning considers multiple scenarios, seeks to protect the family’s long-term financial health, and integrates health care directives and guardianship planning. The best choice depends on the family’s goals, timing, and resources, and professionals can help weigh short-term needs against ongoing household protection.
When a Focused, Limited Planning Strategy May Be Appropriate:
Immediate Application Needs
A limited approach can be appropriate when an individual requires immediate assistance and the objective is to complete a Medicaid application quickly to cover care costs. In such cases, the priority is to gather documentation, verify income and assets, and address any straightforward eligibility obstacles. This pragmatic route helps families secure coverage for care without delay, though it may not address longer-term planning goals. It often serves families who have a short window to apply or who face acute care needs that outweigh broader asset protections.
Minimal Asset Risks
If household assets and income are already at levels consistent with Medicaid rules and the family has limited property to protect, a limited planning approach may be sensible. The focus becomes ensuring accurate and timely application rather than restructuring finances. This may involve documenting exemptions, verifying qualifying income sources, and preparing the required paperwork. While this approach addresses immediate eligibility, it is still important to consider future changes in health or finances and to keep records organized for potential reassessment.
Why a Broader, Proactive Planning Strategy Often Makes Sense:
Protecting Family Resources Over Time
Comprehensive planning looks beyond a single application and aims to protect family assets while ensuring access to needed care over the long term. This approach evaluates possible future scenarios, coordinates legal instruments, and creates pathways to maintain income and property for a community spouse or heirs. It may involve a combination of legal tools and carefully timed actions that comply with Tennessee regulations. Families with significant assets, ongoing business interests, or multiple beneficiaries often benefit from planning that anticipates future changes.
Complex Financial or Family Situations
When finances are complex or family circumstances involve blended households, multiple properties, or caregiving arrangements, comprehensive planning is usually recommended. Such planning accounts for tax considerations, ownership structures, and the needs of dependents while making provisions for long-term care. It also addresses succession issues and helps prevent disputes by clarifying roles and expectations ahead of time. This holistic approach reduces the likelihood of costly delays or unintended penalties and supports smoother transitions for families during stressful times.
Benefits of Taking a Comprehensive Long-Term Care Planning Approach
A comprehensive approach can provide peace of mind by aligning legal documents, financial arrangements, and care preferences into a coherent plan that anticipates likely changes. This method typically preserves family resources more effectively than a reactive strategy, creates clearer pathways for decision-making, and reduces the risk of Medicaid penalties from overlooked transfers or missing documentation. It can also facilitate better coordination with care providers and reduce the administrative burden on family caregivers during challenging transitions.
Moreover, comprehensive planning supports the needs of the community spouse and remaining family members by establishing protections for income and property while addressing the applicant’s care requirements. By documenting powers of attorney and health care directives, families avoid court proceedings that might otherwise be needed to appoint decision makers. Proactive planning also allows for thoughtful estate preservation strategies that balance current care needs with the goal of maintaining resources for future generations.
Financial Protection and Predictability
Comprehensive planning provides clearer expectations about how long-term care costs will be managed and reduces uncertainty for the family. By reviewing income streams and asset ownership and applying permissible planning tools, households can better predict which resources will be available to pay for care and which will be preserved. This predictability helps families make informed decisions about living arrangements and caregiving and reduces the likelihood of sudden financial strain or unexpected eligibility issues.
Stability for Families and Caregivers
A comprehensive plan improves stability for both the person in need of care and their family by clarifying roles, documenting preferences, and coordinating benefits. Clear legal documents support swift action when health changes occur and reduce friction among family members by setting expectations in advance. Caregivers benefit from knowing what financial resources are available and who has authority to make decisions, which simplifies communication with care facilities and medical professionals and helps maintain continuity of care during transitions.
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Practical Tips for Medicaid and Long-Term Care Planning
Start Planning Early
Beginning planning long before care is needed creates more options and reduces the risk of penalties from recent transfers or rushed decisions. Early planning allows families to organize financial records, prepare necessary legal documents, and consider allowed strategies under Tennessee rules. It also provides time to discuss preferences and expectations with loved ones and to coordinate with accountants or care providers. Taking gradual steps can reduce stress and produce a more thoughtful, durable plan that serves both the person in need and their family.
Keep Clear Financial Records
Document Care Preferences and Decision Makers
Preparing powers of attorney and health care directives ensures that someone trusted can act on behalf of the person in need if they cannot make decisions themselves. These documents help avoid court involvement and provide clear instructions to health care providers and family members. Beyond legal forms, having conversations about care preferences, preferred living arrangements, and end-of-life wishes helps align planning steps with personal values. Clear communication and documentation reduce family conflict and streamline transitions when care needs change.
Reasons to Consider Medicaid and Long-Term Care Planning in Wildwood Lake
Families should consider formal planning when an aging loved one begins to show signs of increasing care needs, when medical costs rise, or when there is concern about qualifying for public benefits. Planning helps manage the financial implications of long-term care and addresses potential legal hurdles before they become emergencies. It also ensures that personal preferences for medical treatment and decision-making are documented. Taking proactive steps can protect both the person receiving care and their household from unnecessary financial hardship and administrative complications.
Another reason to engage in planning is to ease the burden on family caregivers by clarifying roles and establishing authority for financial and medical decisions. When documents are in place and finances are organized, caregivers can focus on providing support rather than navigating paperwork under pressure. Planning also helps preserve assets for a surviving spouse or heirs by using lawful strategies that align with Tennessee rules, and it improves the likelihood of a smoother, more dignified care transition when needs escalate.
Common Situations That Lead Families to Seek Long-Term Care Planning
Typical circumstances prompting planning include a recent hospital discharge after an illness or injury, a dementia diagnosis that affects decision-making, or a rapid increase in medical bills. Families also seek planning when a spouse anticipates institutional care or when there is a desire to protect a family home while preserving eligibility for benefits. These situations require timely evaluation of finances, clarification of legal authority, and coordinated action to ensure that care needs are met without unnecessary loss of family resources.
Recent Hospitalization or Declining Health
A recent hospitalization or a noticeable decline in health often triggers planning needs because it may signal an impending need for long-term assistance. In such cases, families must assess immediate care options, document medical needs, and determine whether Medicaid or other programs can help cover costs. Acting quickly to gather documentation, consult with professionals, and prepare applications can shorten the time to benefits and reduce financial pressure while ensuring the patient’s care needs are addressed.
Dementia or Cognitive Decline
When someone shows signs of dementia or cognitive decline, planning becomes urgent to appoint decision makers and protect assets before capacity is lost. Establishing powers of attorney and health care directives while the person can still express preferences is especially important. Families should also plan for likely care needs and review financial arrangements to determine how best to qualify for programs that assist with long-term care. Early planning reduces the need for court involvement and supports respectful handling of the individual’s wishes.
Significant Medical Expenses or Care Costs
Rising medical bills or the prospect of expensive long-term care can threaten household finances and prompt families to explore Medicaid planning strategies. Identifying allowable deductions, organizing expense records, and evaluating asset ownership are steps that help determine eligibility and potential protections. Planning can reveal options to manage costs while complying with state rules and can provide a roadmap for maintaining a reasonable standard of living for the community spouse during the applicant’s period of care.
Local Legal Support for Medicaid and Long-Term Care Matters in Wildwood Lake
Jay Johnson Law Firm serves Wildwood Lake and Bradley County with legal assistance for Medicaid and long-term care planning. We focus on clear communication and practical solutions tailored to the needs of local residents. Whether you are beginning to plan or need help with an immediate application, we assist with document preparation, benefit analysis, and coordination with care providers. Our goal is to help families navigate the process efficiently while protecting household resources and honoring the preferences of the person receiving care.
Why Families Choose Jay Johnson Law Firm for Long-Term Care Planning
Families turn to Jay Johnson Law Firm because we provide comprehensive guidance grounded in local practice and Tennessee law. We help clients evaluate options, organize financial information, and prepare required documentation for Medicaid or other benefit programs. Our approach emphasizes realistic strategies designed to fit family goals and timelines. We work to reduce uncertainty and to create plans that anticipate changes in health or finances while keeping family members informed at every step of the process.
Our team assists with more than applications; we help clients create durable powers of attorney, health care directives, and coordination plans with care providers. We also review property ownership and income allocations to identify opportunities that comply with legal requirements. Our focus on communication and practical problem solving helps families move forward confidently, knowing key documents are in place and that pathways to benefits have been thoughtfully considered.
We serve Wildwood Lake and the broader Bradley County area with a commitment to responsive service and thorough preparation. From initial consultations to application submission and follow-up, we guide families through the administrative steps and help address questions that arise during the process. Our aim is to minimize bureaucratic obstacles and to provide clear next steps so families can focus on care decisions rather than paperwork.
Contact Jay Johnson Law Firm in Wildwood Lake to Discuss Your Options
Our Process for Medicaid and Long-Term Care Planning
Our process begins with an in-depth review of the client’s financial situation, care needs, and family goals. We gather necessary documents, review income and asset ownership, and identify potential eligibility issues or planning opportunities. After outlining recommended steps, we assist with preparing powers of attorney, health care directives, and any allowable strategies to protect resources. We then guide clients through the application process, maintain communication with agencies, and help resolve follow-up questions to ensure the plan is implemented effectively.
Step One: Initial Assessment and Document Review
The first stage is a comprehensive intake that examines financial records, property deeds, income sources, and any prior transfers. This assessment clarifies eligibility parameters and highlights immediate needs or risks. We also discuss the client’s medical condition and care preferences so that planning addresses both legal and practical concerns. Clear documentation gathered during this phase supports timely application and informs decision-making for subsequent planning steps.
Gathering Financial and Medical Records
Collecting current statements, deeds, income records, and medical documentation is essential to assess eligibility accurately. These materials help determine what assets are countable for Medicaid purposes, identify exempt resources, and reveal any transfers that could trigger penalties. Detailed records also streamline communication with benefits agencies and reduce delays during application. A thorough review provides a foundation for recommending lawful measures to align finances with program rules while addressing immediate care needs.
Discussing Goals and Family Considerations
We talk with clients and family members about short- and long-term goals, including preferences for living arrangements, concerns about asset preservation, and responsibilities of caregiving relatives. Understanding the family dynamic and future expectations allows us to tailor recommendations that balance eligibility needs with the household’s values. This conversation establishes priorities and helps determine whether a limited or comprehensive plan is the best path forward.
Step Two: Preparing Legal Documents and Strategy
After assessment, we prepare the necessary legal documents and outline a strategy that fits the client’s timeline. This might include drafting powers of attorney, health care directives, and documents related to property or income arrangements that comply with Tennessee rules. We also advise on documentation needed for applications and help implement lawful measures to protect appropriate assets. Our goal is to create a robust plan while avoiding approaches that could jeopardize eligibility.
Drafting Powers of Attorney and Health Care Directives
Powers of attorney and health care directives are drafted to reflect the client’s wishes regarding financial and medical decisions. These documents designate trusted individuals to act on the client’s behalf and provide guidance to medical providers about treatment preferences. Properly executed instruments reduce the likelihood of court involvement and ensure continuity of care and financial management if the client becomes incapacitated. Clear wording and proper execution are important to avoid ambiguity.
Implementing Financial Planning Steps
This phase includes actions to align asset ownership and income reporting with program rules, where appropriate and lawful. We advise on documentation and timing to avoid penalties and help families understand how certain arrangements can protect resources for a community spouse. The focus is on strategies that meet the client’s care needs while conforming to Tennessee Medicaid regulations, and on preparing supporting paperwork for a smooth application process.
Step Three: Application Submission and Follow-Up
Once documents are in order and the strategy is implemented, we assist with preparing and submitting the Medicaid application and related materials. We monitor the application, respond to agency requests, and help resolve any questions or additional documentation needs that arise. Continued follow-up ensures that approvals or denials are handled promptly and that any appeals or corrections are managed efficiently to minimize delays in accessing care.
Managing Agency Communication
We handle communications with the Medicaid office and other agencies on behalf of the client, ensuring that all requested documents are submitted and clarifying any discrepancies. Proactive communication can reduce back-and-forth and help secure benefits more quickly. Our involvement helps families avoid common administrative pitfalls and keeps the application moving forward while the client receives necessary care.
Addressing Denials and Appeals
If an application is denied or additional documentation is requested, we assist with preparing an appeal or providing supplemental information to address the agency’s concerns. Timely and accurate responses are important to avoid interruptions in coverage and to correct misunderstandings that may have led to a denial. Our role is to advocate for the client through the administrative process and to pursue remedies that restore or secure needed benefits.
Frequently Asked Questions About Medicaid and Long-Term Care Planning
What is the look-back period for Medicaid in Tennessee and how does it affect eligibility?
The look-back period is a timeframe during which the Medicaid agency examines transfers of assets to determine whether they were made for less than fair market value. In Tennessee, transfers made within this period may result in a penalized period during which Medicaid will not cover long-term care costs. Planning must take this timeframe into account to avoid unintended consequences when applying for benefits. Reviewing past financial activity helps identify potential penalties and allows for strategies that comply with program rules.Understanding the look-back period helps families evaluate options and timing. If transfers occurred within the look-back timeframe, documentation and legal review can sometimes mitigate issues or explain the circumstances. When planning ahead of need, families can structure arrangements and timing in a way that aligns with eligibility requirements and reduces the risk of delay when a Medicaid application becomes necessary.
Can transferring assets to a family member prevent Medicaid eligibility?
Transferring assets to family members can affect Medicaid eligibility if those transfers are made within the look-back period and are for less than fair market value. Such transfers may create a period of ineligibility based on the value of the transfer, which can delay access to benefits. It is important to evaluate the timing and nature of any transfer and to document any legitimate reasons for transfers, such as care payments or compensation for services.Before making transfers, families should review state rules and consider lawful alternatives that protect assets while maintaining eligibility. Some permitted planning approaches and exemptions may be available depending on the household’s circumstances. Consulting with legal counsel early helps families weigh options and avoid actions that could unintentionally trigger penalties.
How does a community spouse’s income and assets affect Medicaid qualification?
The community spouse’s income and assets are considered when determining eligibility and the amount of resources that may be preserved while the other spouse receives long-term care benefits. Rules are designed to prevent the spouse at home from becoming impoverished while the institutionalized spouse receives care. Certain allowances and minimum resource levels are provided to the community spouse to support daily living expenses and maintain a basic standard of living.Planning must account for these protections to strike a balance between eligibility and household needs. Proper documentation of income and expenses is important, and strategies may include allocating income or designating certain resources in a way that aligns with the protections allowed under Tennessee law. Thoughtful planning helps ensure that the community spouse retains necessary support while the applicant receives care.
When should we create powers of attorney and health care directives?
Powers of attorney and health care directives should be created as soon as possible, while the person still has capacity to make decisions and express their wishes. These documents designate trusted agents to handle financial and medical decisions and provide clear guidance to caregivers and providers. Having these instruments in place reduces the likelihood of court proceedings and helps ensure that decisions are made in accordance with the individual’s preferences.Waiting until a crisis can complicate matters and limit options, so early execution of these documents is advisable. Families should review these instruments periodically to confirm they still reflect current wishes and that the named agents are willing and able to serve. Clear communication among family members about roles and expectations supports effective implementation when needed.
Will my home always count as an asset for Medicaid purposes?
Whether a home counts as an asset for Medicaid purposes depends on factors such as who lives in the home and how it is titled. In many cases, a primary residence is treated as an exempt resource if the spouse or dependent relative continues to live there. There are also potential exemptions for homes that are needed for the applicant’s care or that are being preserved for a minor or disabled child living in the home.However, home equity limits and other rules can affect treatment of the residence, and probate or title arrangements may have implications. Families should evaluate home ownership carefully and consider options such as appropriate titling or other lawful measures to protect the home while complying with Tennessee Medicaid rules.
How long does the Medicaid application process take in Tennessee?
The length of the Medicaid application process varies depending on the completeness of documentation and the agency’s workload. When applications are prepared thoroughly with clear records of income, assets, medical necessity, and any supporting documentation, the process tends to move more quickly. Delays often stem from missing paperwork or questions about transfers or resource valuations.Proactive preparation and timely responses to agency requests help shorten processing time. Working with professionals who understand the documentation requirements can reduce back-and-forth and improve the chances of an expedited review. Even so, families should expect some administrative processing time and plan accordingly for short-term care needs during the application period.
What steps can protect assets while still qualifying for benefits?
Protecting assets while qualifying for benefits typically involves lawful planning measures such as arranging ownership in a way that is consistent with program rules, documenting exempt resources, and using allowable income allocation techniques. The goal is to align financial arrangements with Medicaid eligibility criteria without engaging in transfers that would trigger penalties. Each family’s situation is unique, so tailored planning is needed to identify appropriate actions that comply with Tennessee rules.Clearly documenting the purpose of transactions and maintaining organized financial records can help demonstrate legitimacy of transfers and avoid misinterpretation by agencies. Early planning increases flexibility and allows families to implement steps that protect household resources while keeping the door open to benefits when care becomes necessary.
Can we qualify for Medicaid if we own a small business?
Owning a small business does not automatically disqualify someone from Medicaid, but business assets and income may be evaluated as part of the eligibility determination. The treatment of business interests depends on factors such as the structure of the business, whether the business provides income to the applicant, and how assets are titled. Proper planning and documentation are needed to clarify the value of business assets and to identify exempt elements, if any.Business owners should work with advisors to structure ownership and recordkeeping in a way that supports benefit applications if long-term care is anticipated. Planning may involve documenting legitimate business expenses and income flows, and in some cases, adjustments can be made to align with program rules while preserving the ability to operate the business.
What documentation is typically required for a Medicaid long-term care application?
A typical Medicaid long-term care application requires documentation such as recent bank statements, deeds for real property, proof of income like Social Security or pension statements, and records of medical necessity from a physician. Applicants must also provide identification, birth records, and any documentation of past transfers or gifts. Clear, well-organized paperwork helps the agency evaluate the application efficiently and reduces the chance of delays due to missing information.In addition to financial and medical documents, completed forms and properly executed powers of attorney or health directives may be requested to verify decision-making authority. Preparing these materials in advance and keeping copies available streamlines the application and supports a timely review by the agency.
What should family caregivers know about managing benefits and care coordination?
Family caregivers should understand the importance of maintaining organized financial and medical records and documenting caregiving expenses that may affect eligibility. Caregivers often serve as primary contacts for applications and should be prepared to collect statements, bills, and medical notices. Clear communication with the person receiving care about preferences and decision makers helps ensure that powers of attorney and health directives reflect current wishes and that caregivers can act effectively when needed.Caregivers should also be aware of community spouse protections and how household income and resources may be allocated. Seeking guidance early and coordinating with legal advisors can help caregivers manage administrative tasks, avoid common pitfalls, and focus on the well-being of the person in care while navigating benefit applications and care coordination.