TennCare CHOICES in Long-Term Care Program

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 or who are “at risk” of moving into a nursing home. While CHOICES does cover nursing home care, more interesting to most families is the care offered outside of nursing homes. Participants can receive care and support services either in their home, the home of a caregiver or family member, in an adult foster care home, or in an 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 the primary caregivers of those who remain living in the community.

Personal care services are provided to assist eligible individuals with activities of daily living (ADLs), as well as instrumental activities of daily living (IADLs), such as bathing, dressing, using the bathroom, eating, grocery shopping, and preparing meals. 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.

Age and Functional Ability
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 / or be "at risk" of moving to a nursing home if they don't receive care.

Financial
There are limits on both an applicant’s income and their assets.

The 2018 income limit for an individual applicant is gross monthly income of $2,250. This figure is adjusted annually per the federal Cost of Living Adjustment (CoLA). If an applicant is married and their spouse is not applying for Medicaid, some of their income might be allocated to their spouse which can help the applicant in meeting the income limit. Another alternative is to distribute excess income into a Qualified Income Trust or Miller Trust. Both spousal and trust distribution of income are complicated processes and may require the assistance of a Medicaid planning professional.

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, if valued under $572,000 and the applicant lives in the home, and one vehicle. Assets that must be included in one’s application include the value of any checking, savings, or investment accounts, and the cash surrender values of any life insurance policies. Applicants over these limits may still qualify if they are married and their spouse is not applying. Under these circumstances, the non-applicant spouse can retain half of the total joint resources, up to $123,600 in funds. Alternatively, some “counted assets” might be converted into “exempt assets” in order to meet the asset limit. Again, these are complicated processes and professional Medicaid planning consul is recommended. One can learn more here

 

Benefits and Services

This program provides services that help individuals remain living outside of nursing homes, as well as provides some services in nursing home facilities. Some of these services may be self-directed.

  • Adult day care
  • Adult care homes – adult foster care
  • Assisted living – homemaker services, medication management, and assistance with personal care
  • Assistive technology and home modifications to make one's residence more accessible – grabbers, walk-in tub, ramp, widening of doors, etc. 
  • Home-delivered meals – fresh or frozen
  • Homemaker services - assistance with the instrumental activities of daily living, such as laundry, grocery shopping, and meal preparation
  • Home modifications 
  • Personal care assistance with the activities of daily living, sometimes also called attendant care
  • Personal Emergency Response Services (PERS)
  • Respite care to relieve the primary caregiver – in-home and in-patient
  • Rodent and insect control
  • Transportation

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 Choices 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