What is Tenncare Choices Program

What is TennCare Choices?

TennCare CHOICES in Long-Term Care (or "CHOICES") is TennCare’s program for long-term care services. Long-term care includes help doing everyday activities that you may no longer be able to do for yourself as you grow older, or if you have a physical disability-like bathing, dressing, getting around your home, preparing meals, or doing household chores. Long-term care services include care in a nursing home. Long-term care also includes certain services to help a person remain at home or in the community. These are called Home and Community Based Services or HCBS.

CHOICES is available statewide starting August 1, 2010. For more information about the CHOICES program, contact your TennCare health plan or call your local Area Agency on Aging and Disability (AAAD) at 1-866-836-6678.

Who Qualifies for CHOICES?

To be in CHOICES, you must:

1. Need the level of care provided in a nursing home

2. AND qualify for Medicaid long-term care

To qualify for Medicaid long-term care, your income can’t be more than $2,022 per month. (If it is, you may be able to set up a Qualifying Income Trust.) AND, the total value of things you own can’t be more than $2,000. (The home where you live doesn’t count. And, you can’t have given away or sold anything for less than what it’s worth in the last five (5) years.)

There are two (2) groups of people in CHOICES.

1. CHOICES Group 1 is for people who receive nursing home care.

2. CHOICES Group 2 is 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

To enroll in CHOICES and receive 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 that TennCare provides.

This doesn’t mean you’ll receive services up to the cost of nursing home care. The care you get in CHOICES depends on your needs.

CHOICES services will not take the place of care you get from family and friends. The home care you get through CHOICES will work together with the help you already receive to help you stay in the community longer. Care in CHOICES will be provided as cost-effectively as possible so that more people who need care will be able to get help.

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.

1. 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.

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

3. Homemaker services - Help with your household chores or errands like laundry, sweeping, mopping or grocery shopping.

4. Home-delivered meals

5. Personal Emergency Response System - A call button so you can get help in an emergency.

6. Adult day care - A place that provides supervised care and activities during the day.

7. In-home respite care - Someone to stay with you in your home for a short time so your caregiver can get some rest.

8. In-patient respite care - A short stay in a nursing home or assisted care living facility so your caregiver can get some rest.

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

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

11. Pest control - Spraying your home for bugs or mice.

12. 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 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. You will also need to looks at taxes, bonding and workers compensation.

You can hire a family member, friend, neighbor or other person you know to provide care in Consumer Direction, but there are some limitations. We want to support, but not replace care provided by family and friends. You’ll find out more if you sign up for CHOICES.

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. Even if you don’t qualify for Medicaid, they can tell you about other programs that may help.