TennCare CHOICES Eligibility: A Family's Guide

What TennCare CHOICES is

TennCare is Tennessee's Medicaid program. CHOICES is the part of TennCare that covers long-term services and supports — the help an older adult or person with a disability needs to live safely at home rather than in a nursing facility. The official name is long-term services and supports (LTSS), and it includes personal care, attendant care, homemaker services, adult day services, respite, and home-delivered meals.

CHOICES is different from regular TennCare. Regular TennCare is medical Medicaid — it pays for doctor visits, hospital stays, and prescriptions for low-income adults and children. CHOICES is the layer on top that pays for the day-to-day care that keeps someone independent. A person can be on regular TennCare without being on CHOICES, and being approved for CHOICES requires a separate eligibility process.

Who CHOICES serves

TennCare CHOICES has three eligibility doors. Most families come in through one of the first two.

• Adults 65 and older — by far the largest group. CHOICES is built around the needs of older Tennesseans who want to stay home but need help with bathing, dressing, mobility, meals, and supervision.
• Adults 21 and over with a physical disability — the door for younger adults whose physical disability creates daily-care needs comparable to those of an older adult who qualifies on age.
• Adults 21 and over with an intellectual or developmental disability — this door is the ECF CHOICES program, run jointly by TennCare and the Tennessee Department of Intellectual and Developmental Disabilities (DIDD). ECF CHOICES is a parallel program with its own eligibility process, not a sub-track of standard CHOICES.

All three doors lead to similar in-home services — personal care, respite, attendant care — but the agencies that deliver care, the case managers who write the plan, and the path to enroll are different. This guide covers standard CHOICES; for ECF CHOICES, see our DIDD waiver guide.

The financial test (income, assets, look-back)

CHOICES eligibility runs the same financial test that Medicaid LTSS programs use nationally, adapted to Tennessee. There are two main numbers (income and assets) and one big rule (the five-year look-back).

• Income limit (2026) — $2,982 per month for an individual. This number is three times the federal Supplemental Security Income (SSI) benefit and updates every year. Income above the limit doesn't automatically disqualify a person; Tennessee allows a Qualified Income Trust (often called a Miller Trust) to bring countable income under the cap.
• Asset limit — $2,000 in countable assets for an individual. The primary residence is excluded if the applicant intends to return home (or if a spouse, minor child, or disabled child still lives there). One vehicle is excluded. Personal items, an irrevocable burial trust, and a small life-insurance face value are also excluded.
• Five-year look-back — Medicaid reviews asset transfers in the 60 months before the application. Gifts and below-market transfers in that window can trigger a penalty period during which CHOICES won't pay for care. The look-back is the most-misunderstood part of the financial test and is the reason elder-law attorneys exist.
• Spousal protections — when only one spouse needs CHOICES, the at-home spouse keeps a protected share of income and assets so they're not impoverished. The specific numbers update annually and are calculated during the financial review.

The functional test (nursing-facility level of care)

The financial test asks whether the family can pay; the functional test asks whether the loved one actually needs the level of help that CHOICES is designed to fund. The technical phrase is "nursing-facility level of care" (often written NF-LOC). In plain English, it means: needs the kind of help a nursing home provides.

Most families who qualify on this test do so for one of two reasons. Either the loved one needs hands-on help with multiple activities of daily living — bathing, dressing, toileting, transferring, eating — or the loved one has a cognitive impairment (advanced dementia is the most common) that requires supervision to stay safe.

• An NF-LOC assessment is conducted in the home, not in a clinic. The assessor watches and asks about a typical day, looks at the home environment, and talks with the family caregiver.
• The assessor is usually the MCO care coordinator for someone already on TennCare, or an AAAD intake nurse for a new applicant.
• The assessment looks at activities of daily living (ADLs), instrumental activities of daily living (IADLs, things like managing medications and finances), cognitive status, and safety risks.
• Approval at the NF-LOC level isn't a one-time judgment — care plans are reassessed periodically, and a loved one whose needs change can move between benefit groups over time.

The three benefit groups (Group 1, 2, and 3)

CHOICES sorts approved members into three groups. The group determines what kinds of services are authorized and how many hours per week the program pays for.

• Group 1 — members who meet NF-LOC and are actually receiving care in a nursing facility. CHOICES pays the facility. Most families reading this guide are not Group 1; they're choosing home care over a facility.
• Group 2 — members who meet NF-LOC but choose to stay home. This is the most common home-care path. The MCO writes a care plan authorizing personal care hours, respite, attendant care, adult day, and other community-based services up to a budget that's typically below the cost of facility care. Group 2 is the door for most older adults who want to age at home with professional support.
• Group 3 — members who do not yet meet NF-LOC but are at risk of needing it. Group 3 covers a smaller package of preventive home and community-based services designed to delay or prevent the need for nursing-facility care. The benefit set is narrower than Group 2 but the eligibility threshold is lower.

How to apply for TennCare CHOICES — step by step

The path depends on whether the loved one is already on TennCare. The two paths converge after the financial and functional tests are complete.

• If already on TennCare — call the MCO listed on the loved one's TennCare card (BlueCare, UHC Community Plan, or Wellpoint, formerly Amerigroup) and ask for a CHOICES referral. The MCO assigns a care coordinator who schedules the in-home NF-LOC assessment and walks the family through the next steps.
• If not yet on TennCare — call the AAAD Statewide Help Line at 1-866-836-6678 to find the right local agency (Aging Commission of the Mid-South for the Memphis area; Southwest Tennessee Development District for Jackson and the surrounding counties). The AAAD runs the initial screen, walks the family through the TennCare application, and coordinates the financial and functional reviews.
• What to gather — Social Security card, Medicare card if applicable, current health insurance cards, list of medications, two months of bank statements, the deed or rental agreement, Social Security and pension income statements, and any long-term care insurance policy. Having these ready cuts the timeline materially.
• Timeline — AAAD intake screen usually happens within a few days of the first call. The TennCare financial determination runs through the Department of Human Services and can take a few weeks. The NF-LOC assessment is scheduled within roughly 30 days of TennCare approval. MCO authorization of a specific home care provider usually follows within about two weeks of the assessment.
• After approval — the MCO sends a list of contracted home care agencies. The family picks the agency they want, and the agency starts service after a short intake. Resource One is contracted with all three TennCare MCOs (BlueCare, UHC Community Plan, and Wellpoint), so families on any MCO can choose us when the list arrives.

Two phone numbers do most of the work in this process. The AAAD Statewide Help Line (1-866-836-6678) is the front door for new applicants and the LTSS Help Desk (1-877-224-0219) is the troubleshooting line if anything stalls. Both are free, both are staffed by people who navigate this every day, and both will tell you exactly what step you're on.

What CHOICES covers — and what it doesn't

CHOICES is non-medical home and community-based care. It covers the help that keeps someone safe and independent at home; it doesn't cover skilled nursing visits or medical procedures.

• Personal care — bathing, dressing, grooming, toileting, mobility, transferring, feeding. The core of what an in-home caregiver does.
• Attendant care — extended personal-care support, often for adults with disabilities who need a consistent caregiver across multiple hours per day.
• Respite care — short-term coverage so the family caregiver can take a break. CHOICES authorizes a defined annual amount, usually 300+ hours.
• Homemaker services — light housekeeping, laundry, meal preparation, errands.
• Home-delivered meals — for members who can't safely prepare their own meals.
• Adult day services — community-based daytime programs for supervision, meals, activities, and socialization.
• Assistive technology — items like personal emergency response systems and home modifications that support independence.
• What it doesn't cover — skilled nursing visits (those run through Medicare home health or private home health, regulated separately), 24/7 caregiver coverage (CHOICES authorizes hours, not continuous coverage), durable medical equipment beyond a specific scope, and most facility-based services other than respite.