Tennessee CHOICES: The Medicaid Waiver That Pays for Home Care
Many families assume Medicaid only pays for nursing home care. But Tennessee operates a program called CHOICES — which stands for Community and Home-based Options through Integrated Care for Elders and Individuals with Disabilities — that funds in-home care services for qualifying seniors, allowing them to remain at home rather than entering a nursing facility.
CHOICES is administered by the Tennessee Commission on Aging and Disability (TCAD) through managed care organizations (MCOs) under the state's TennCare program.
What CHOICES Covers
CHOICES Group 1 (for seniors who would otherwise require nursing home level care) can cover:
- Personal care assistance (bathing, dressing, grooming)
- Homemaker services (light housekeeping, laundry, meal preparation)
- Companion care
- Transportation to medical appointments
- Assistive technology and home modifications
- Adult day services
- Respite care for family caregivers
The goal is to support aging in place — keeping seniors in the community with the help they need, rather than institutionalizing them before necessary.
Who Qualifies
CHOICES eligibility has two components:
1. Functional eligibility: You must meet nursing facility level of care — meaning you need substantial assistance with at least two Activities of Daily Living (ADLs) such as bathing, dressing, toileting, eating, or mobility. A nurse assessor from your MCO will conduct an in-home evaluation.
2. Financial eligibility: You must meet Tennessee's Medicaid income and asset limits. For 2026, the general income limit for a single individual is around $2,742/month. Asset limits exclude the primary home, one vehicle, and certain other items. Married couples have different calculations.
If income exceeds the limit but the senior has high medical expenses, a special rule called the "medically needy pathway" may still allow eligibility.
How to Apply
1. Contact your managed care organization: Tennessee's CHOICES program is administered through three MCOs — Aetna Better Health, BlueCare, and United Healthcare Community Plan. Which one you use depends on your county of residence.
2. Contact TCAD directly: The Tennessee Commission on Aging and Disability can help connect you with the right MCO and navigate the process. Call 1-866-836-6678.
3. Expect an assessment: Once your application is submitted, a nurse assessor will contact you to schedule an in-home evaluation. This typically takes several weeks.
4. There is a waiting list: CHOICES Group 1 currently has no waiting list for qualifying individuals, but this can change. Beginning the process as early as possible — before a crisis forces a nursing home admission — is strongly recommended.
CHOICES and Harmony at Home
Harmony at Home works with clients enrolled in CHOICES to provide authorized home care services. If you're already enrolled or in the application process, we can coordinate with your MCO to provide covered services.
If you're not yet enrolled and want to understand whether CHOICES might be an option for your family, our care coordinators are happy to explain the process during a free consultation. Contact us or call (865) 269-6345.
Harmony at Home serves clients across East Tennessee through CHOICES and private-pay arrangements. Eligibility and program details change — confirm current rules with TCAD or your MCO.