Tennessee Medicaid Waiver Program: TennCare CHOICES Home Care Groups and Waiting Lists

Your parent qualifies for a nursing home level of care, but you want to keep them at home. In Tennessee, the Medicaid waiver that pays for home and community-based services is not a separate program you apply to — it's built into TennCare CHOICES as Groups 2 and 3. The catch: unlike nursing home care (Group 1), which is a guaranteed entitlement, home care groups have enrollment caps and waiting lists that leave families paying out of pocket for months.

How Tennessee's Waiver Works

Tennessee operates its long-term care system under the TennCare III Section 1115 demonstration waiver, approved by CMS through December 31, 2030. Unlike states that run their nursing home and home care programs separately, Tennessee wraps everything into a single managed care delivery system called CHOICES.

Three Managed Care Organizations — BlueCare Tennessee, UnitedHealthcare Community Plan, and Wellpoint Tennessee — administer all long-term care benefits. When your parent is approved, they're assigned to one of these MCOs, which then develops their individualized care plan.

The structural problem: Nursing facility care (Group 1) carries no enrollment caps — it's a Medicaid entitlement. But home and community-based services (Groups 2 and 3) are capped. The state sets a statewide enrollment limit, and when slots are full, eligible applicants go on a priority waitlist.

CHOICES Group 2 vs. Group 3

Group 2 (Full HCBS): For seniors 65+ and disabled adults 21+ who meet the same clinical threshold as nursing home residents (9+ points on the PAE acuity scale). Services can include personal care assistance, adult day care, home modifications, assistive technology, and care in an Assisted-Care Living Facility (ACLF). Individual cost neutrality cap: $294.87/day ($107,627 annually). If your parent's projected care plan exceeds this daily amount, the MCO denies home care and redirects to institutional placement.

Group 3 (At-Risk): For seniors and disabled adults who don't yet meet the full nursing home threshold but are at risk of institutionalization. Annual service ceiling of approximately $18,000. Limited primarily to SSI recipients. Services are more basic — personal care, homemaker services, and limited adult day care.

Key difference: Group 2 members receive the same clinical eligibility determination as Group 1 (nursing home) but receive services at home instead. Group 3 serves people who aren't quite sick enough for a nursing home but need support to avoid getting there.

The Waiting List Reality

CHOICES Group 2 uses a priority-based waitlist, not a simple first-come-first-served queue. Priority factors include:

• Clinical acuity: Higher PAE scores move up the list faster
• Current setting: People already in nursing homes who want to transition home (supported by the Money Follows the Person program) often get priority
• Risk of institutionalization: Applicants at immediate risk of nursing home placement may receive expedited processing

Wait times fluctuate based on the state's enrollment cap decisions, MCO capacity, and regional demand. Families in urban areas (Nashville, Memphis, Knoxville) sometimes face longer waits due to higher demand, while rural areas may have shorter waits but fewer available providers.

What happens during the wait: Your parent remains eligible but does not receive CHOICES Group 2 services. Families must cover home care costs privately — either through savings, family caregiving, or hiring private-pay aides. The state does not provide interim services while someone is on the waitlist.

Strategies While Waiting

Pursue Group 1 as a bridge: Some families accept a nursing home placement under Group 1 (which has no waitlist) and then use the Money Follows the Person program to transition back home once a Group 2 slot opens. MCOs earn substantial federal bonuses ($1,000-$10,000) for successful nursing-to-community transitions, so care coordinators are financially incentivized to help with this process after 60 days of institutional residence.

Check Group 3 eligibility: If your parent doesn't quite meet the 9-point threshold for Group 2, they may qualify for Group 3 immediately (Group 3 also has caps, but they're separate from Group 2 and sometimes have openings). The $18,000 annual cap covers basic personal care and adult day services.

Contact your MCO care coordinator regularly: Once assigned an MCO, the care coordinator manages your parent's waitlist position. Regular check-ins ensure your parent's clinical status is up to date — if their condition worsens, the increased acuity score can move them up the priority list.

Private-pay bridge planning: Budget for 2-6 months of private home care. In Tennessee, home health aides cost approximately $22-$28/hour through agencies. If your parent also needs a QIT or has assets to spend down, this private-pay period can be structured to accomplish both simultaneously.

Room and Board Is Never Covered

One critical distinction families miss: even when your parent is approved for Group 2 and receives home care services, TennCare CHOICES never pays room and board. If your parent moves to an Assisted-Care Living Facility (ACLF), CHOICES covers the care services, but monthly room and board ($2,000-$4,000) comes from your parent's income. Most Tennessee ACLFs don't accept CHOICES patients at all, further limiting options.

For in-home care, this isn't an issue — your parent already has housing. But it means Group 2 doesn't eliminate all costs; it covers the care staff, not the living arrangements.

Getting Through the Process

The enrollment caps and waitlists make it essential to file correctly the first time — a denied application means restarting from scratch while the waitlist continues moving. The Tennessee Medicaid Long-Term Care & Asset Protection Guide covers the complete CHOICES application process, including how to structure a private-pay bridge strategy, when to accept Group 1 as a stepping stone, and how to prepare for the Group 2 transition once a slot opens.

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