TennCare CHOICES in Long-Term Care Program

Page Reviewed / Updated - Apr. 2015

Program Description

This is a Medicaid program for elderly and / or disabled Tennessee residents that require the level of care typically provided in a nursing home and have elected to receive care outside of that environment, either in their home, the home of a caregiver or family member, or in as assisted living community. A wide range of personal care assistance and support services are covered, supporting both the person in need of assistance as well as their primary caregivers. Personal care services are provided at home, in adult day care, or in assisted living residences. Also of great interest is the support of assistive technology, personal emergency response services and minor home modifications to make a home safer and more accessible.

 Under CHOICES, the adult children of aging parents can be paid to be caregivers.

The word CHOICES in the program's name stems from the fact that some of the services can be "consumer directed." This means they are offered based on the Medicaid Cash and Counseling model in which participants are provided with the flexibility and choice to self-select their care providers. One option that is very popular for self-direction allows the care recipient to employ friends, neighbors and certain family members as caregivers. Spouses and legal guardians or individuals who have a Power of Attorney for the elder are not eligible to become paid caregivers through this program.

 Terminology - There is considerable confusion surrounding this program due to name changes. This is a Medicaid program. Tennessee Medicaid operates a managed care organization called TennCare. It falls under the Division of Long-Term Services & Supports, which was formerly called, simply, "Long Term Care." The program CHOICES now encompasses a previous Medicaid Waiver that was called the Elderly and Disabled Home and Community Based Services (E&D HCBS) Waiver.


Eligibility Guidelines

This program has qualification criteria regarding the applicant's age, functional ability and financial situation. Applicants must be disabled and at least 21 years of age. If they are 65 or older, full disability is not required, instead they should require the level of care typically provided in nursing homes and be "at risk" of moving to a nursing home if they don't receive care.

Financially, applicants must qualify for Tennessee Medicaid's long term care services. To do so, there are income and assets restrictions. The 2015 income limit for an individual applicant is $2,199 / month and the individual asset limit is $2,000 in countable assets. This excludes certain resources like pre-paid burial plans, wedding rings and one's home and vehicle and includes the value of any checking, savings or investment accounts and certain life insurance policies.

Applicant's over these limits may still qualify if they are married and their spouse is not applying. Under these circumstances, a portion of their joint income and resources can be put in the spouse's name to enable him or her to live independently. In 2015, the non-applicant spouse can have $2,981 / month in income and up to $119,220 in countable assets. The separation of funds and accounts can effectively lower the applicant's income and assets to an acceptable level.

Another alternative is to distribute excess income into a pooled or Miller Trust. This also can effectively lower income to the eligibility limit. Some excess resources can be converted to non-countable assets. This process is called Medicaid planning. One can learn more here


Benefits and Services

This program provides services that help individuals remain living outside of nursing homes. Some of these services can be self-directed.

  • Adult day care
  • Assisted living
  • Assistive technology and home modifications to make one's residence more accessible
  • Home-delivered meals
  • Homemaker services  assistance with the instrumental activities of daily living)
  • Personal care assistance with the activities of daily living sometimes also called attendant care
  • Personal Emergency Response services or PERS
  • Respite care for the primary caregiver
  • Rodent and insect control

Under certain circumstances, TennCare will limit the value of the home care services that the participant receives to $15,000 per year.

How to Apply / Learn More

Interested individuals should contact their local Area Agency on Aging or visit the TennCare Choice website to learn more about the program. Alternatively, one can call their toll-free number at 1-866-836-6678.  

The CHOICES program is available statewide. However, a waiting list for services may exist and prioritization is not necessarily first come, first serve. Persons who are currently residing in a nursing home and wish to return home receive higher priority.

Did You Know? Free assistance is available to Tennessee seniors to help them find affordable home care, Alzheimer's care and assisted living.  Get help here