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 $2,742 per month “subject to change each calendar year” (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.
Based on current appropriations, there is an enrollment target of 1,750 for non-SSI CHOICES Group 3 (CHOICES Group 3 Reserve Capacity).
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 $18,000 per year. That doesn’t include the cost of any minor home modifications you may need.
To qualify for Medicaid long-term services and supports: (1) Your income can't be more than $2,742 per month "subject to change each calendar year” (If it is, you may be able to set up a Qualifying Income Trust);
If you are not already a TennCare member, contact your local Area Agency on Aging and Disability if you have questions. If you are a TennCare member, contact your health plan for those questions.