How to Qualify for TennCare’s CHOICES Program

Written By: Eamon Smith and Allison Jones, Legal Aid Society

The CHOICES program offered through TennCare is designed both for people in need of nursing home care and people who can’t afford the cost of an assisted living facility or nursing home but need help remaining in their own homes. Most of the people served by CHOICES are seniors.
Few people know how to navigate TennCare procedures well enough to pursue these options independently. But there’s help available through the Tennessee Senior Law Alliance (TSLA), a program launched in 2018 by Legal Aid Society of Middle Tennessee and the Cumberlands with a location in Tullahoma and four partner legal services organizations across the state.
The CHOICES program offers three levels of care – from basic nursing home care to in-home care costing no more than $15,000 per year – and eligibility is determined by strict financial and medical criteria.
If an individual’s monthly income is more than $2,313 and their resources are more than $2,000 (excluding a home and one car), they do not qualify for any CHOICES services, despite his or her medical condition. With nursing home costs reaching upwards of $6,000 per month, many people are left ineligible for CHOICES and incapable of paying for needed care.
In addition to these financial requirements, CHOICES also has very strict medical criteria. For certain groups, an applicant must score a nine on TennCare’s “acuity scale,” which quantifies difficulties of daily living, such as transferring from a bed to a wheelchair or being able to eat or take medications without more than limited assistance.
Seniors may understandably be frightened if they receive a notice from TennCare that they will no longer be eligible for assistance paying for nursing home services that they cannot afford alone. However, Legal Aid Society’s Tennessee Senior Law Alliance program can help seniors navigate the CHOICES application and appeals process by proving to TennCare that their services are needed.
Tennessee Senior Law Alliance’s staff might request that TennCare perform a safety determination to see if a person should continue to be eligible for CHOICES, even without scoring a nine on the scale. If, for instance, a person can prove that they need more than seven hours per day of caregiver assistance to remain safe, they might still be eligible for CHOICES nursing home services.
Tennessee Senior Law Alliance helps seniors not only with CHOICES but also other core legal issues like housing, abuse and exploitation, consumer finance and more. They help bridge the gap between the needs of seniors and the state agencies responsible for meeting those needs.
If you feel you have unfairly lost your TennCare or CHOICES coverage, or if you are a senior struggling with another legal issue, please contact them at 800-238-1443 to learn more. Legal Aid Society in Tullahoma can be reached at 931-455-7000.