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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.

 

To Qualify For Choices:

 

To qualify for and remain in CHOICES Groups 1 and 2, you must:

  • Need the level of care provided in a nursing home; AND

  • Qualify for Medicaid long- term services and supports
     

To qualify for Medicaid long-term services and supports: (1) Your income can't be more than $2,250 per month (If it is, you may be able to set up a Qualifying Income Trust); (2) The total value of things you own can't be more than $2,000 (The home where you live doesn't count); AND (3) You can't have given away or sold anything for less than what it's worth in the last five (5) years.
 

To qualify for and remain in CHOICES Group 3, you must:
 

  • Be “at risk” of needing the level of care provided in a nursing home unless you receive home care; AND

  • Be getting SSI (Supplemental Security Income) payments from the Social Security Administration
     

There are three CHOICES groups:
 

CHOICES Group 1 is for people of all ages who receive nursing home care. For more information about nursing home care.
 

CHOICES Group 2 is for adults (age 21 and older) with a physical disability and seniors (age 65 and older) who qualify to receive nursing home care, but choose to receive home care services instead.
 

CHOICES Group 3 is for adults (age 21 and older) with a disability and seniors (age 65 and older) who don’t qualify for nursing home care, but need a more moderate package of home care services to delay or prevent the need for nursing home care.

To enroll in CHOICES and receive home care services:

(1) Your TennCare health plan (or Managed Care Organization) must be able to meet your needs safely at home; AND

(2) If you qualify for nursing home care, 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 that you need. If you don’t qualify for nursing home care, but are “at risk” of needing nursing home level of care, the cost of your CHOICES home care can’t be more than $15,000 per year. That doesn’t include the cost of any minor home modifications you may need.

 

 

 

 

 

Here are some of the kinds of home care covered in CHOICES. Some of these services have limits. Your MCO will help you to determine what services below will meet your needs.

  • Personal care visits - Short visits of no more than 4 hours when someone will help you do things like get out of bed, take a bath, get dressed, fix and eat meals, or use the bathroom.

  • Attendant care - The same kinds of help you get with personal care visits, but for longer periods of time.

  • Home-delivered meals – Nutritious meals that can be delivered fresh each day or frozen in bulk.

  • Personal Emergency Response System - A call button you can use to 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.

  • Assistive technology - Certain low-cost items that help you do things more easily or safely in your home like grabbers to reach things.

  • Minor home modifications - Changes to your home that will help you get around more easily and safely like grab bars or a wheelchair ramp.

  • Pest control - Spraying your home to take care of an infestation such as for bugs or mice.

  • 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.