CHOICES

What is CHOICES?

TennCare CHOICES in Long-Term Care (or "CHOICES" for short) is TennCare's program for long-term care services. Long-term care includes help doing everyday activities that you may no longer be able to do for yourself as you grow older, or if you have a disability-like bathing, dressing, getting around you home, preparing meals, or doing household chores. Long-term care services include care in a nursing home. Long-term care also includes care in your own home or the community that may keep you from having to go to a nursing home for as long as possible. These are called Home and Community Based Services or HCBS.

Who can qualify to enroll in CHOICES?

For now, there are two (2) groups of people who can qualify to enroll in CHOICES.

CHOICES Group 1 is for people of all ages who receive nursing home care.

To qualify in CHOICES Group 1, you must:

Need the level of care provided in a nursing home;
AND qualify for Medicaid long-term care.

CHOICES Group 2 is for certain people who receive home care instead of nursing home care. It's only for:

Adults 65 years of age and older;
OR adults 21 years of age and older who have physical disabilities.

If you need home care services, but aren't in one of these groups, you can't be in CHOICES Group 2.

To be in CHOICES Group 2, you must also:

Need the level of care provided in a nursing home;
AND qualify for Medicaid long-term care because you receive SSI payments OR because you need and will receive home care services instead of nursing home care.

If both or those things are true, to enroll in CHOICES Group 2 and begin receiving home care services:

Your TennCare health plan (or MCO) must be able to safely meet your needs at home.
AND, the cost of your home care can't be more than the cost of nursing home care. The cost of your home care includes any home health or private duty nursing care you may need.

If your needs can't be safely met at home, OR if your care would cost more than nursing home care, you can't be in CHOICES Group 2. But, you may still qualify for care in a nursing home.

Limits on Enrollment into CHOICES Group 2

Not everyone who qualifies to enroll in CHOICES Group 2 may be able to enroll. There is an enrollment target for CHOICES Group 2. It's like a limit on the number of people who can be in the group at one time. This helps to ensure that the program doesn't grow faster than the State's money to pay for home care. It also helps to ensure that there are enough home care providers to deliver needed services.

The enrollment target for the number of slots that can be filled in CHOICES Group 2 will be set by the State in TennCare Rules. It doesn't apply to people moving out of a nursing home. AND, it may not apply to some people who are on TennCare that would have to go into a nursing home right away if less costly home care isn't available.

Some slots will be held back (or reserved) for emergencies. This includes things like when a person is leaving the hospital and will be admitted to a nursing home if home care isn't available. Reserved slots won't be used until all of the other slots have been filled. The number of reserved slots and the guidelines to qualify in one of those slots will be in TennCare Rules. If the only slots left are reserved, you'll have to meet the guidelines for reserved slots to enroll in CHOICES Group 2.

If you don't meet the guidelines for reserved slots or there are no slots available and you qualify to enroll in CHOICES Group 2, your name will be placed on a waiting list. OR, you can choose to enroll in CHOICES Group 1 and receive nursing home care. There is no limit on the number of people that can be enrolled in Group 1 and receive nursing home care. (But, you don't have to go into a nursing home unless you want to. You can wait for home care instead.)

People enrolled in CHOICES Group 2 above the enrollment target must get the first slots that open up. (Those are people who moved out of nursing homes or people already on TennCare would have gone into a nursing home if less costly home care wasn't available.) When everyone in CHOICES Group 2 is under the enrollment target and there are still slots available, TennCare can enroll from the waiting list based on need.

Care Coordination and Role of the Care Coordinator

In CHOICES, you TennCare health plan (or MCO) will be responsible for managing all of your physical health, mental health, and long-term care needs, and the services that you receive to address these needs. This is call care coordination.

These functions are carried out by a Care Coordinator. Your Care Coordinator will play a very important role. Your Care Coordinator is your primary contact person and is the first person that you should go to if you have any questions about your services.

After you're enrolled in CHOICES, your MCO will tell you who your care coordinator is and how to reach them.

Federal Estate Recovery Program

Medicaid, including CHOICES, is a government program. CHOICES pays for long-term care for people who don't have enough income and/or resources (things they own) to be able to pay for all of that care themselves.

To help the federal government pay for long-term care services, every state is required by federal law to have a Medicaid Estate Recovery Program.

An estate is property, such as money, a house, land, cars, or other things of value that a person leaves to family members or others when he or she dies.

Estate recovery applies to:

Persons of any age who receive nursing facility services.
Persons age 55 and older who receive long-term care services-nursing home services or home care (HCBS) as an alternative to nursing home care.

If a person in one of these groups receives Medicaid long-term care services, the State of Tennessee must ask for money back from that person's estate after he or she dies to help pay for certain kinds of care he or she received. The money that is collected goes back to TennCare to help pay for long-term care services for others who need it.

In some cases, the State may wait to recover from the estate because someone else is living in the home, such as:

A surviving spouse.
A minor child.
A child of any age who has been blind or permanently and totally disabled since before age 18.

If the value of the estate or the cost of long-term care provided is very small, the State may not pursue recovery.

There are limited circumstances in which a hardship waiver may be requested and granted-for example, a family farm where the property is the sole source of income for surviving relatives.