WHAT IS CHOICES?
Tennessee's CHOICES program includes nursing facility services and home and community-based services (HCBS) for adults 21 years of age and older with a physical disability and seniors (age 65 and older).
TennCare CHOICES in Long-Term Services and Supports (or CHOICES for short) is for adults (age 21 and older) with a physical disability and seniors (age 65 and older). CHOICES offers services to help a person live in their own home or in the community. These services are called Home and Community Based Services or HCBS. These services can be provided in the home, on the job, or in the community to assist with daily living activities and allow people to work and be actively involved in their local community. CHOICES also provides care in a nursing home if this is needed.
WHAT SERVICES ARE COVERED BY CHOICES?
Personal Care Visits
Hands-on help with self-care tasks like getting out of bed, taking a bath, getting dressed, eating meals, or using the bathroom. If you need hands-on help, it may also include help with household chores or errands.
The same kinds of help you would get with Personal Care Visits, but for longer periods of time.
Up to one meal per day.
Personal Emergency Response System
A call button so you can get help in an emergency.
Adult Day Care
A place that provides supervised care and activities during the day.
In-Home Respite Care
Someone to stay with you in your home for a short time so your caregiver can get some rest.
In-Patient Respite Care
A short stay in a nursing home or assisted care living facility so your caregiver can get some rest.
Certain low-cost items that help you do things more easily or safely in your home, like grabbers to reach high items.
Minor Home Modifications
Changes to your home that will help you get around more easily and safely, like grab bars or a wheelchair ramp.
Spraying your home to get rid of bugs or mice.
Assistance researching facts needed to decide which health plan would help you get all the care you need.
Community-Based Residential Alternatives
Places to live that offer care and support for someone who can no longer live alone that include the following:
Assisted Care Living Facility – A place you live that helps with personal care needs, homemaker services, and taking your medicine. You must pay for your room and board.
Community Living Supports – A shared home or apartment where you and no more than 3 other people live. The level of support provided depends on your needs and can include hands-on assistance, supervision, transportation and other supports needed to remain in the community.
Community Living Supports – Family Model – A shared home or apartment where you and no more than 3 other people live with a trained host family. The level of support provided depends on your needs and can include hands-on assistance, supervision, transportation and other supports needed to remain in the community.
Critical Adult Care Home – A home where you and no more than 4 other people live with a health care professional that takes care of special health and long-term care needs. Under state law, this is available only for people who are ventilator dependent or who have traumatic brain injury. You must pay for your room and board.
Companion Care – Someone you hire who lives with you in your home to help with personal care or homemaker services whenever you need it. This is available only for people in consumer direction who need care throughout the day and night that can’t be provided by unpaid caregivers. And only when it costs no more than other kinds of home care that would meet your needs.
Some of these services can be provided through Consumer Direction. Consumer Direction is a way of getting some of the home care you need that offers more choice and control over WHO gives your home care and HOW your care is given than receiving CHOICES services and not consumer directing. You actually employ the people who provide some of your home care services - they work for you (instead of an agency). This means you must be able to do the things that an employer would do - like hire, train, and schedule workers.
AM I ELIGIBLE FOR CHOICES?
Currently, there are three (3) groups of people who can qualify to enroll in CHOICES.
CHOICES Group One
For people of all ages who receive nursing home care.
To qualify in CHOICES Group One, you must:
Need the level of care provided in a nursing home;
AND qualify for Medicaid long-term services and supports.
CHOICES Group Two
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 Two.
To be in CHOICES Group Two, you must also:
Need the level of care provided in a nursing home;
AND qualify for Medicaid long-term services and supports because you receive SSI payments OR because you need and will receive home care services instead of nursing home care.
If both of these things are true, to enroll in CHOICES Group two 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 Two. But you may still qualify for care in a nursing home.
CHOICES Group Three
For certain people who receive home care to prevent or delay the need for 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 Three.
To be in CHOICES Group Three, you must also:
Be at risk for needing nursing home care;
AND qualify for Medicaid because you receive SSI payments OR because you need and will receive home care services to prevent or delay the need for nursing home care.
If both of these things are true, to enroll in CHOICES Group Three 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 CHOICES home care can't be more than the annual $15,000 expenditure cap. The cost of your home care does not include the cost of any minor home modifications that you may need.
If your needs can't be safely met at home, OR if your care would cost more than $15,000 per year, you can't be in CHOICES Group Three.
WHO WILL MANAGE THE SERVICES I RECEIVE THROUGH CHOICES?
In CHOICES, your TennCare health plan or Managed Care Organization (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 called 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. Your MCO will tell you who your Care Coordinator is, and how to reach them.
WHAT IS CONSUMER DIRECTION?
Consumer Direction is a way of getting some of the kinds of home care you need. It offers more choice and control over WHO gives your home care and HOW your care is given.
In Consumer Direction, you actually employ the people who give some of your home care services—they work for you (instead of for a provider). This means that you must do the things an employer would do, like hire, train, schedule, supervise, and even fire workers.
If you enroll in CHOICES and need any of the services provided through Consumer Direction, your Care Coordinator will tell you more about the program and the help you'll get.
WHAT IS ESTATE RECOVERY?
Estate Recovery is the way TennCare collects money from the estates of people who passed away and received TennCare long-term services and supports, such as nursing home care or home and community based services. If TennCare pays for nursing facility and other long term care services, TennCare is required by federal law to recoup these payments after the death of the recipient. This is referred to as “estate recovery.”
Estate recovery is using the value of property you leave behind when you die to pay TennCare back for care you received while you were living. Your “estate” is the property, belongings, money, and other assets that you own at the moment immediately preceding death. Estate recovery only occurs after your death, and your family is not personally responsible for the debt.
For more information on TennCare estate recovery, CLICK HERE.
HOW DO I APPLY FOR CHOICES?
If you have TennCare and are interested in the CHOICES Long-Term Services and Supports program, you can call your TennCare health plan (MCO). The number is on your TennCare card.
If you don't have TennCare, and are interested in CHOICES, contact the First Tennessee Area Agency on Aging and Disability (FTAAAD) at 1-866-836-6678 to see if you might be eligible. Even if you don't qualify for CHOICES, they can tell you about other programs that may help.
You may call on your own behalf, or on behalf of someone else. Before calling, please review the one-page REFERRAL FORM and make sure you have on hand all the information needed to answer the questions on this form. They include both medical and financial questions, as well personal information like date of birth and Social Security Number. The FTAAAD staff member will be unable to complete the screening unless all the information is provided on the call.
WHAT DOCUMENTS DO I NEED TO HAVE FOR MY CHOICES VISIT?
—ID and proof of citizenship (i.e. driver's license and birth certificate) for you and your spouse (if applicable)
—Social Security Number and date of birth for you and your spouse (if applicable)
—Bank statements for the month of the application, and for two months prior to applying. Statements should be provided for each financial account, including checking, savings, IRA, CD, stocks, bonds, and 401(k).
—Life insurance policies owned by you or your spouse. The following information must be included: company name, address, policy numbers, date issued, face value and cash value for each policy.
—Health insurance premiums, including Medicare Supplement or Medicare Part D plans
—Any insurance cards
—All gross income for you and your spouse (if applicable). This includes any income from a pension, VA pension, VA Aid & Attendance benefits, rental income, alimony, etc.
—Vehicle registration (including make, model and year) for any vehicle owned by you or your spouse
—Any owned property (including county, address and value), including the home you currently reside in or previously resided in before entering the nursing home
—Prepaid burial contracts, including an itemized statement for goods and services and whether it is revocable or irrevocable
—Basic living expenses for you and your spouse, including one month's rent or mortgage receipt and one month of utility bills
—All proof of the sale or transfer of any resource made in the last five (5) years (real estate, financial, etc.)
—Value of cemetery plots
—Marriage certificate (if applicable)
—Power of attorney paperwork (if applicable)
WHAT IS EMPLOYMENT AND COMMUNITY FIRST CHOICES?
This is a program for people who have an intellectual or developmental disability (I/DD). The program will provide services for people with I/DD in the home and community. These types of services are called home- and community-based services or HCBS.
Services in Employment and Community First CHOICES will help you get or keep a job and live as independently as possible in the community. They will help you do things in the community that you want to do—to help you build relationships and reach your goals. If you live at home with your family, they will also help your family support you in planning for and reaching your goals.
Do you want to be placed on the referral list for Employment and Community First CHOICES? There is a limited amount of funding to serve people each year. This means that not everyone who wants to apply can enroll or get services right away.
There is a referral list for Employment and Community First CHOICES. To get on the referral list, you can complete a self-referral. Filling out the self-referral for Employment and Community First CHOICES does not mean you will be enrolled in the new program. You must qualify to enroll in the program. There must be room in the new program to enroll you. AND, you must be in one of the groups that may qualify to get services now.
To self-refer to the new program, please complete the SELF-REFERRAL FORM.
Do you need help to complete the self-referral? The East Tennessee Regional Office of the the Department of Intellectual and Developmental Disabilities can help you fill out the form. OR they can fill out the form for you with the facts you provide. Call 1-888-531-9876 and let them know you need help with a self-referral for Employment and Community First CHOICES.
FREQUENTLY ASKED QUESTIONS
1. What is a PAE?
A PAE is a Pre-Admission Evaluation. This is the document that determines if the applicant meets the medical guidelines to be eligible for Long-Term Care Medicaid.
2. What is Medicaid?
A program that provides medical benefits to medically- and financially-eligible individuals. Medicaid is operated and administered by the state governments and subsidized by the federal government. In Tennessee, the Medicaid program is called TennCare.
3. What is the difference between income and resources?
Income is what you receive every month from various sources, such as your pension and/or your Social Security payment.
Resources are the things you currently have available to you, such as money, cash values on life insurance policies, CDs, 401(k), etc.
4. Why do I have to show my financial information, especially the life insurance policies?
TennCare needs to know your gross income from all sources and the value of your resources so that you can prove you are under the income limit and under the resource limit to qualify. Your life insurance policies may be whole life and have a cash value which TennCare considers part of your total resources. In addition, TennCare wants to see who the owner of the policy is, and what the face value of the policy is. TennCare will let you know if you need to assign a life insurance policy irrevocably to a funeral home to take care of any cash value.
5. Is the government going to take my house?
If you are 55 or older and own a home, Tenncare can get back some of the money spent on your care in a nursing home or home- and community-based services after your death. This is called Estate Recovery.
Estate recovery is using the value of property you leave behind when you die to pay TennCare back for care you received while you were living. Estate recovery only occurs after your death and the death of your spouse, and your family is not personally responsible for the debt.
6. Where do I send financial documentation needed for my application?
Please send this documentation to the First Tennessee Area Agency on Aging and Disability (FTAAAD). We are the agency assisting you with this application process for CHOICES. We will ensure that it is sent to TennCare, and will keep a record of it.
You can send this to us by fax at 1-423-926-8291, or mail it to us at FTAAAD, 3211 N. Roan St., Johnson City, TN 37601. If you are unable to fax or mail the information, please contact FTAAAD at 1-423-722-5207.
7. Someone has contacted me to follow up on the home visit. Who is this?
This person may be staff from our office calling to complete a phone survey about your experience through the application process, or to remind you of financial documents needed for your application. Another agency, Ascend, may also be calling to meet with you to review the recent visit from one of our qualified assessors. They regularly conduct these visits after us to ensure our compliance in the application process.
8. I received a letter saying my PAE was approved. Does that mean I have CHOICES??
Once you receive the letter saying that your PAE was approved, that means you met the medical guidelines for eligibility. The next step is waiting for approval for the financial part, which is Medicaid.
9. Why can't I get services if I'm approved for Group Three?
TennCare currently only allows those who are SSI (Supplemental Security Income) recipients to receive Group Three services. If you are not an SSI recipient, you can appeal your Group Three decision with TennCare and request Group Two, which will allow you to receive home- and community-based services and/or services in a nursing home if you win the appeal.
10. What is a denial?
You may receive a denial for either the Pre-Admission Evaluation (PAE) or Medicaid application. The letter you receive will explain why the PAE or Medicaid was denied. If your PAE was denied, you may be able to have it resubmitted. You should contact FTAAAD to see if resubmission is possible. If not, you can follow the guidelines listed in your denial letter to appeal the decision within 30 days of the date on the denial letter.
If your Medicaid application was denied, your letter will include an explanation of why it is denied. If you are able to supply the verifications, or complete the requests, such as a spend-down or completing a qualified income trust, your application may be reopened. If not, you can follow the guidelines listed in your denial letter to appeal.
11. What is an MCO?
An MCO is a Managed Care Organization. This is the insurance company that coordinates the services that the enrollee will receive. The MCOs are United Healthcare, Blue Care and Amerigroup.
12. When will my services start after I get approved?
Once you are enrolled and the MCO is notified, you will be contacted and a visit scheduled, usually within 10 business days. Once the visit has been completed, services should start within 20 days.
13. How much help will I get?
CHOICES offers many services that can be used to supplement the care you already receive. When the Care Coordinator meets with you, a plan will be developed that is centered around meeting your needs. The Care Coordinator will be able to explain the specific types of services for which you are eligible, and how many hours can be provided.
14. What if I want a different MCO than I was assigned?
Once you are enrolled, you will receive a notice from TennCare Connect. If you want a different MCO, you must follow the guidelines listed in the packet to request a different MCO. This should be done as soon as possible. If you do not make the request within the 45-day period after you are assigned, you will not be able to make a change until the next open enrollment period unless certain hardships exist.
15. Once I am enrolled in CHOICES, who do I contact for further questions on services?
Your Care Coordinator at the Managed Care Organization will be your contact person regarding your services. This person will reach out to you once you are enrolled in CHOICES. It will be someone from Amerigroup, BlueCare or United Healthcare. If you do not know who your Care Coordinator is, you can call member services. The number is located on the back of your Medicaid insurance card.
WHAT IS TENNCARE?
TennCare is the State of Tennessee’s Medicaid program. It provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children and individuals who are elderly or have a disability. To get Medicaid, you must meet the income and resource limits. You can apply anytime for TennCare through the ACA Marketplace or through TennCare Connect.
There are several different groups of people that may qualify. And, each group has different income limits. Some of the groups also have limits on how much you own-your "resources." These are things like bank accounts, cars, and land. The number of people who live in your household count too.
Some of the groups TennCare Medicaid covers are:
Children under age 21
Women who are pregnant
Parents or caretakers of a minor child (The child must live with you and be a close relative.)
Women who need treatment for breast or cervical cancer
People who get an SSI check (Supplemental Security Income)
People who have gotten both an SSI check and a Social Security check in the same month at least once since April, 1977 AND who still get a Social Security check
A person who:
Lives in a nursing home and meets monthly income and resource requirements, or
Gets other long-term-care services that TennCare pays for.