The OPTIONS for Community Living Program provides care and support services to elderly and / or disabled Tennessee residents in their homes. Services include personal care, meals, and assistance maintaining one’s home. These services are provided free of charge to persons under certain income levels. Individuals with income exceeding these levels pay for services based on a sliding scale. If a co-payment is charged, the fees are well less than would be if one were required to purchase the services from a home care provider directly.
Each applicant is assessed to determine what their care needs and functionality limitations are, and also to ascertain the amount of care that can reasonably be provided by their family members given the financial resources they have. Once these factors have been considered, a care plan is created. Re-assessments of care requirements and revisions of care plans occur annually at a minimum.
OPTIONS also allows for “self-direction care”. Using this option, friends and family members (but not spouses) can be hired to provide personal care.
OPTIONS program eligibility is based on a combination of factors. First and foremost, the applicant must be a Tennessee state resident. Persons aged 60 and older must require assistance to perform their Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) as certified by a medical professional. These include actions, such as mobility, toiletry, hygiene, dressing, light housekeeping, and cooking. Persons between the ages of 18 and 60 must be disabled as determined by the Office of Social Security.
The candidate’s financial asset information is requested on the application. Having “countable assets” greater than the Medicaid limit of $2,000 does not preclude participation. However, priority may be given to those persons with assets less than these limits.
The OPTIONS Program does not have a hard income limit, but there may be a cost of share for services, which is determined by the applicant’s income. Persons whose income is more than 600% of the Federal Poverty Level will not receive financial assistance. Greater detail below.
Each applicant is assessed during the application process and a plan of care is developed, which specifically states the care services for which they are eligible. These services are limited to a specific dollar value, which may change from year to year, and may differ based on geographic location within the state. The most recent information available, as of April 2019, shows that limit to be $5,000 / year in some areas and $7,000 / year in other areas. On average, eligible applicants receive approximately $3,500 / year worth of services. Possible services include:
The cost of services depends on the applicant’s income and is determined by a cost share worksheet, which is based on the Federal Benefit Rate (FBR). Some beneficiaries receive services free of charge while others are subject to a cost share. Persons whose income is at or below 200% of the FBR, receive services free of charge. As of 2019, this means a single individual may have a monthly income up to $1,542, or an annual income up to $18,504. For married couples, the monthly income limit is $2,314, and the annual income limit is $27,768.
Participants with income between 200% and 600% of the FBR (between $1,542 / month and $4,626 / month for single individuals and between $2,314 / month and $6,942 / month for married couples) pay a share of cost of up to 45% of their income.
Those with income over 600% of the FBR are responsible for the complete cost of services. As of 2019, this includes single individuals with a monthly income over $4,626 ($55,512 / year) and married couples with a monthly income over $6,942 ($83,304 / year).
This program is funded by the state of Tennessee and is under the administration of the Commission on Aging and Disability. The administration has a network of local Area Agencies on Aging and Disability offices that manage the application process for consumers. Find your local Area Aging Agency or call 1-866-836-6678 statewide.
The Tennessee Commission on Aging and Disability maintains a webpage on the program, but rather scarce information is provided.
Applicants should be aware that in past years a waiting list for services has existed. This means that an applicant may be qualified but still has to wait to receive services. Prioritization on the waiting list is based on income.