Who Qualifies 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 $2,199 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.
What Home Care Services Are Covered in CHOICES?
Here are some of the kinds of home care covered in CHOICES. Some of these services have limits.
- Personal care visits – Short visits of no more than 4 hours where 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'd get with personal care visits, but for longer periods of time.
- Homemaker services – Help with your household chores or errands like laundry, sweeping, mopping or grocery shopping.
- Home –delivered meals
- 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.
- 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 for bugs or mice.
- Community-Based Residential Alternatives – places that offer care and support for someone who can no longer live alone, like an Assisted Living Facility.
Some of these services can be provided through Consumer Direction.Consumer Direction
is a way of getting some of the home care you need. It offers more choice and control over WHO gives your home care and HOW your care is given. You employ the people who give some of your home care services – they work for you (instead of a provider). This means you must be able to do the things that an employer would do – like hire, train and schedule workers.
You can hire a family member, friend, neighbor or other person you know to provide care. (CHOICES can't pay a spouse to provide care.)
How Do I Apply for CHOICES?
If you have TennCare
, you can call your TennCare health plan (MCO). The number is on your TennCare card.If you don't have Tenncare
, Contact your local Area Agency on Aging and Disability (AAAD) for free at 1-866-836-6678
. If you don't qualify for Medicaid, they can tell you about other programs that may help.
"Choice gives us the independence and dignity we all seek to maintain as we age. That's what we are so excited to see embodied in this new system for long-term care choice." – Margot Seay, AARP Tennessee State President