CHOICES Groups

Which Group is Right for You?

For now, there are three (3) 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 be in CHOICES Group 1, you must:

  • Need the level of care provided in a nursing home;
  • And qualify for Medicaid long-term services and supports;
  • And receive nursing home services that TennCare pays for.

TennCare will decide if you need the level of care provided in a nursing home. The Department of Human Services (DHS) will decide if you qualify for Medicaid long-term services and supports. We will help you fill out the papers TennCare and DHS need to decide. What if both TennCare and DHS say yes? If you're receiving nursing home services that TennCare will pay for, TennCare will enroll you into CHOICES Group 1. If TennCare or DHS say no, you'll get a letter that says why. It will say how to appeal if you think it's a mistake. To see if you qualify to enroll in CHOICES, call us at 1-800-468-9698.

CHOICES Group 2 is for certain people who receive home care instead of nursing home care.
To be in CHOICES Group 2, you must:

  • 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.
  • AND be an adult 65 years of age and older;
  • OR be an adult 21 years of age and older with a physical disability.

If you need home care services, but don't qualify in one of these groups, you can't be in CHOICES Group 2, but you may qualify for CHOICES Group 3.

TennCare will decide if you need the level of care provided in a nursing home. DHS will decide if you qualify for Medicaid long-term services and supports for one of the reasons listed above. We will help you fill out the papers TennCare and DHS need to decide.

If both TennCare and DHS say yes, to enroll in CHOICES Group 2 and begin receiving home care services:

  • We 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 we can't safely meet your needs at home, or if your care would cost more than nursing home care, you can't be in CHOICES Group 2. But, you may qualify for other kinds of long-term services and supports.

If TennCare or DHS say you don't qualify, you'll get a letter that says why. It will say how to appeal if you think it's a mistake.

To see if you qualify to enroll in CHOICES, call us at 1-800-468-9698.

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. (The number of people who can enroll is sometimes called "slots".) 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. We must decide if you would go into a nursing home right away and provide proof to TennCare. And, we must show TennCare that there are home care providers ready to start giving your care at home.

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 go into a nursing home. (But, you don't have to receive nursing home care 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. (These are people who have moved out of nursing homes or people already on TennCare would have gone into a nursing home right away 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.

CHOICES Group 3 is for certain people who do not meet nursing home care level of care, but need some services to help them stay at home.
To be in CHOICES Group 3, you must:

  • Meet the "at risk" for nursing home level of care;
  • AND qualify for Medicaid long-term services and supports because you receive SSI payments OR because you need and will receive home care services to keep you from going into a nursing home.
  • AND be an adult 65 years of age and older;
  • OR be an adult 21 years of age and older with a physical disability.

TennCare will decide if you meet the "at risk" level of care. DHS will decide if you qualify for Medicaid long-term services and supports for one of the reasons listed above. BlueCare will help you fill out the papers TennCare and DHS need to decide.

If both TennCare and DHS say yes, to enroll in CHOICES Group 3 and begin receiving home care services:

  • BlueCare must be able to safely meet your needs at home

If BlueCare can't safely meet your needs at home, you can't be in CHOICES Group 3 and receive services in your home. But, TennCare may decide that you qualify for other kinds of long-term services and supports, including nursing home care.

To see if you qualify to enroll in CHOICES, call us at 1-800-468-9698.

Limits on Enrollment into CHOICES Group 2" portion of the page preceded with this: "Once the type and amount of services the member needs have been determined, the member may elect to receive one or more of the eligible HCBS through a Contract Provider, or they may participate in Consumer Direction. The following video is available to provide information on Consumer Direction. BlueCare Consumer Direction