There are 2 parts to getting help through the CHOICES program.
Medical Need for CHOICES
To get CHOICES, your medical needs must be so serious that you need help with your daily tasks. These are called “activities of daily living” or ADLs.
If you need help with any of these, you might be able to get CHOICES.
- Transfer – You need help moving from your bed to your bed, chair, or toilet.
- Mobility – You need help with walking.
- Eating – You need help or constant one-on-one observation and verbal assistance to put food in your mouth, chew, or swallow safely.
- Toileting – You need help adjusting your clothes to toilet, cleaning yourself , changing your own diaper, or cleaning up toileting accidents
- Expressive / Receptive Communication – You need help telling others about your needs and wants (like you’re hungry or are in pain). OR you need help following simple directions
- Orientation – You need help knowing and remembering people (like your family members) and where you are.
Medication Administration – You need help taking, injecting, or applying your medicine.
- Behavior – You have behavior problems which cause you or others to be at risk for serious harm.Need for
- Skilled Nursing or Rehabilitative Services – TennCare also looks at your need for some types of health care from a nurse. Needing this care could also help you get CHOICES.
- Need for Skilled Nursing or Rehabilitative Services – You need some types of health care from a nurse. You might be able to get CHOICES if you need help with daily tasks. TennCare will give you a score on their “acuity scale.” Acuity means how bad your health problems are. You can get more information about the medical rules for CHOICES from this flier from Legal Aid Society of Middle Tennessee and the Cumberlands.
Here is a short flier that tells you exactly how the State defines these problems. You might want to show this paper to your doctor.
You have the right to appeal if TennCare says you can’t get CHOICES. You also have the right to appeal if TennCare says you can only get CHOICES 3, but you need more care than what CHOICES 3 will pay for.
Financial Need for CHOICES
To get CHOICES, you also need to show that you have income and resources that are low enough. You will fill out a paper that asks you about what money you get each month. The paper also asks about money that you have in the bank. It also asks about other things you own that are worth money, like your house or car. Only the applicant’s income counts, and only the applicant’s share of the resources.
The 2018 income limit is $2,250/month. The resource limit (excluding a house and a car) is $2,000.
The rules for the financial need for CHOICES are confusing. If you are told you can’t get CHOICES because you make too much money, you may still be able to get CHOICES. You may be able to set up a Qualified Income Trust (QIT), also called a Miller Trust. Tennessee Justice Center can help you set up a QIT.
If you are told you cannot get CHOICES for financial reasons, but you think that TennCare has made a mistake, you can appeal.
You can get more information about the financial rules for CHOICES from this flier from Legal Aid.