TennCare CHOICES Program: What It Covers, Who Qualifies, and How Groups 1–3 Work

Your parent needs more care than the family can provide alone. Someone mentioned TennCare — Tennessee's Medicaid program — might cover home care or even nursing facility placement. But the first time you look into it, you hit a wall of acronyms and group numbers that don't explain themselves.

Here's what TennCare CHOICES actually is, how the three groups work, and whether your parent is likely to qualify.

What Is TennCare CHOICES?

TennCare CHOICES in Long-Term Services and Supports is Tennessee's Medicaid program for adults who need nursing facility level of care. It was designed to give eligible Tennesseans a choice between nursing facility placement and home and community-based services (HCBS) — hence the name.

CHOICES is administered through three managed care organizations (MCOs) that contract with TennCare:

• BlueCare Tennessee
• UnitedHealthcare Community Plan
• Wellpoint Tennessee

Your parent's MCO depends on their county of residence. The MCO assigns a care manager who oversees the care plan, authorizes services, and monitors ongoing eligibility.

The Three CHOICES Groups

Group 1: Nursing Facility

Group 1 covers Medicaid-funded nursing facility placement. It is an entitlement — meaning there is no waitlist. Every Tennessean who meets the clinical and financial criteria has the legal right to nursing facility coverage.

To qualify for Group 1, your parent must:

• Meet nursing facility level of care (assessed via the Pre-Admission Evaluation)
• Meet TennCare's financial eligibility criteria (income under $2,982/month, assets under $2,000)
• Be enrolled in TennCare

Group 2: HCBS Waiver for Home and Community Care

Group 2 is the primary alternative to nursing home placement. It funds home and community-based services for members who meet nursing facility level of care but choose to remain at home or in a community setting.

Services available under Group 2 include personal care, adult day health, home-delivered meals, personal emergency response systems, respite care, and some home modifications.

The cost-neutrality cap for Group 2 is $107,627.55 per year (2026) — TennCare won't spend more on home care than it would cost to place the member in a nursing facility.

Group 2 is also technically a waiver (not an entitlement), but in practice Tennessee has managed it to avoid significant waitlists.

Group 3: At-Risk Prevention Services

Group 3 is for Tennesseans who are at risk of needing nursing facility care but don't yet meet the full clinical threshold for Groups 1 or 2.

Group 3 characteristics:

• Annual services cap: approximately $18,000/year
• Available slots: 1,750 for non-SSI recipients
• Clinical requirement: PAE score of 5–8 (compared to minimum 9 for Group 2)
• Designed as early intervention to prevent nursing facility placement

Group 3 has limited slots and can have a waitlist. It's worth applying for, but families should not count on Group 3 as their primary plan.

Clinical Eligibility: The Pre-Admission Evaluation

The gateway to all three CHOICES groups is the Pre-Admission Evaluation (PAE), a functional assessment submitted through Tennessee's PERLSS portal by an authorized assessor (typically a social worker or registered nurse).

The PAE uses an acuity scale with a maximum of 26 points:

• 21 points for Activities of Daily Living (ADL) dependencies — bathing, dressing, eating, transferring, toileting, continence, mobility
• 5 points for skilled nursing needs

Score thresholds:

• 9+ points: qualifies for Groups 1 or 2 (nursing facility level of care)
• 5–8 points: qualifies for Group 3 (at-risk)
• Under 5: does not meet CHOICES clinical criteria

Safety Determination Request: If your parent scores under 9 but you believe home safety is genuinely at risk, the assessor can submit a Safety Determination Request to TennCare. This is a formal process for arguing that the member needs services even without meeting the standard threshold. It requires documented evidence of safety concerns.

Financial Eligibility

Tennessee is an income cap state — there is no medically needy spend-down pathway for adults applying for CHOICES. If your parent's income exceeds the limit, they do not qualify unless they establish a Qualified Income Trust (Miller Trust).

Income limit (2026): $2,982/month (300% of the SSI Federal Benefit Rate)

Countable asset limit: $2,000 for an individual

Assets that don't count:

• Primary residence (up to $752,000 equity)
• One vehicle
• Household furnishings and personal property
• Pre-paid burial arrangements

For married couples (when one spouse applies):

• Community Spouse Resource Allowance (CSRA): $32,532 to $162,660 (the community spouse can keep this amount)
• Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,705 to $4,066.50/month (the community spouse's minimum income protection)

Managed Care Organizations and Your Parent's Care Plan

Once enrolled, the MCO's care manager works with your parent to develop an individualized care plan that specifies:

• Which services are authorized and how many hours/units per month
• Whether services are delivered through a TennCare-contracted agency or through consumer direction (self-directed care)
• Short-term goals and any planned reassessments

Plans are reviewed at least annually and whenever there's a significant change in condition. If your parent's needs increase, requesting a reassessment is the right move — don't wait for the annual cycle.

What CHOICES Does Not Cover

CHOICES covers long-term custodial and personal care. It does not replace Medicare for:

• Acute hospital care
• Short-term skilled rehabilitation
• Physician services and prescriptions (covered by TennCare Medicaid separately)

Most CHOICES enrollees are dual-eligible (Medicare and TennCare), which means Medicare covers their acute medical needs and TennCare CHOICES covers their long-term care needs. Coordination between the two programs is handled through the MCO.

CHOICES eligibility, the PAE process, and coordinating with an MCO care manager are complex enough that most families benefit from a clear guide. The Tennessee Home Care & Aging in Place Guide walks through the entire CHOICES application process — including what to expect at the PAE assessment, how to respond if your parent is denied, and how consumer direction works once you're enrolled.

See more Tennessee guides →