How to Apply for TennCare CHOICES: Step-by-Step Through the PAE and Application Process

You've determined that your parent likely qualifies for TennCare CHOICES. Now you need to figure out how to actually apply — and you've discovered that there are multiple steps, multiple agencies, and a 90-day processing window that nobody warned you about.

Here's the complete application process, in the order it actually happens.

Step 1: Confirm Basic Eligibility Before Applying

Before starting the application, verify that your parent meets the foundational criteria:

Age and residency:

• Age 65+, or
• Age 19–64 with a qualifying disability (SSI or SSDI recipient, or meets SSI disability criteria)
• Tennessee resident

Income: Monthly income under $2,982 (300% of the SSI Federal Benefit Rate for 2026). If your parent's income is above this threshold, see the Miller Trust section below — they may still qualify, but need an additional step.

Assets: Countable assets under $2,000 (individual). The primary home, one vehicle, and household goods don't count toward the $2,000 limit.

TennCare enrollment: Your parent must be enrolled in TennCare (Tennessee Medicaid) to access CHOICES. If they're not currently enrolled, the TennCare Connect application covers both standard TennCare and CHOICES in one process.

Step 2: Apply Through TennCare Connect

The application starts at TennCare Connect, Tennessee's online Medicaid application portal. You can apply:

• Online at TennCare Connect (connect.tn.gov)
• By calling TennCare at 1-800-342-3145
• In person at a local Tennessee Department of Human Services (TDHS) office
• By submitting a paper application by mail

If your parent needs CHOICES specifically (long-term services and supports), make sure to indicate that on the application — the standard TennCare application covers acute care, but long-term services enrollment triggers a separate eligibility track.

Documents you'll need:

• Proof of identity (driver's license, birth certificate, passport)
• Proof of Tennessee residency
• Social Security card and Medicare card (if applicable)
• Proof of all income sources: Social Security award letters, pension statements, any other income
• Bank statements for all accounts (typically 60 months of history for CHOICES)
• Proof of any life insurance, property deeds, or other assets
• Power of attorney documentation (if you're applying on behalf of a parent)

Step 3: The Pre-Admission Evaluation (PAE)

The Pre-Admission Evaluation is the clinical assessment that determines whether your parent meets nursing facility level of care — the clinical threshold required for CHOICES Groups 1, 2, and 3.

Who conducts the PAE? The PAE is submitted through the PERLSS portal by an authorized assessor — typically a hospital social worker, a nursing facility discharge planner, or an assessor from your parent's TennCare MCO. Family members cannot self-submit a PAE; you need to request it through a TennCare-authorized party.

How to get a PAE initiated:

• If your parent is in a hospital: ask the hospital social worker to initiate the PAE before discharge
• If your parent is in a nursing facility: the facility's social work staff handles PAE initiation
• If your parent is at home: contact your parent's TennCare MCO (or prospective MCO if not yet enrolled) and request a home assessment

What the PAE measures: The assessor evaluates functional ability across Activities of Daily Living (bathing, dressing, eating, transferring, toileting, continence, mobility) and any skilled nursing needs. The maximum score is 26 points.

Score thresholds:

• 9+ points → qualifies for Group 1 (nursing facility) or Group 2 (home and community-based services)
• 5–8 points → qualifies for Group 3 (at-risk services, limited slots)
• Under 5 → does not meet CHOICES clinical criteria (may appeal or request a Safety Determination)

If your parent scores below 9 but needs home services: Request a Safety Determination. This allows TennCare to consider safety risk factors beyond the standard ADL scoring. Documented evidence of unsafe conditions, recent falls, or medication management failures can support a Safety Determination request.

Step 4: Choosing a TennCare MCO

TennCare CHOICES is delivered through three managed care organizations:

• BlueCare Tennessee
• UnitedHealthcare Community Plan
• Wellpoint Tennessee

MCO assignment is based on county. In most Tennessee counties, only one or two MCOs are available. The TennCare eligibility process will inform your parent which MCO(s) they can enroll with.

If your parent has existing relationships with specific providers, check which MCO contracts with those providers before selecting. For CHOICES members, the MCO assigns the care manager who develops and oversees the care plan — this relationship matters.

Step 5: Care Plan Development

Once enrolled in CHOICES, your parent's MCO care manager will conduct an in-home assessment and develop an individualized care plan. The care plan specifies:

• Which CHOICES services are authorized (personal care hours, adult day, meals, respite, PERS)
• Service delivery model (agency-based or consumer direction)
• Frequency and duration of services
• Short-term goals

You and your parent have the right to participate in the care plan development process. If the initial plan doesn't reflect your parent's actual needs, request a review before signing.

Understanding Group 3 and the Slot Limitation

If your parent scores 5–8 on the PAE (Group 3), be aware that Group 3 has a capped number of slots: 1,750 for non-SSI recipients. Group 3 can have a waitlist.

Group 3 services are also capped at approximately $18,000 per year — compared to $107,627.55 per year for Group 2. It's meaningful support but not a full replacement for the home care hours a higher-needs person requires.

If your parent is waitlisted for Group 3, continue pursuing all other available options: OPTIONS for Community Living through the AAAD (state-funded, no hard income limit), Medicare-covered home health if there's a skilled need, and family caregiver support services.

The 90-Day Processing Window

TennCare has a 90-day window to process CHOICES applications. This is not a deadline they always meet — complex cases involving asset reviews, missing documentation, or high application volume can take longer.

During the processing period:

• Your parent cannot receive CHOICES services until enrollment is confirmed
• Keep all documentation organized and respond promptly to any requests for additional information
• If more than 90 days pass without a determination, contact TennCare directly and ask for the application status

For immediate safety needs during the application period, contact the regional AAAD (1-866-836-6678) about emergency OPTIONS enrollment or other bridge services.

If Your Parent's Income Exceeds the Limit

Tennessee is an income cap state — there is no spend-down pathway. If monthly income exceeds $2,982, your parent cannot qualify for CHOICES without establishing a Qualified Income Trust (Miller Trust).

A Miller Trust is a specially structured bank account where excess income is deposited each month. That deposited income is then "disregarded" for TennCare eligibility purposes. The trust must be established and the bank account opened before the application is submitted. See a Tennessee elder law attorney to set one up correctly.

The CHOICES application process has enough moving parts that most families benefit from a clear roadmap. The Tennessee Home Care & Aging in Place Guide covers the full application process — PAE preparation, income and asset eligibility, Miller Trust setup, and what to do when the application hits a snag.

See more Tennessee guides →