There are two parts to getting CHOICES.
- 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.”
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 chair, wheelchair, tub, or toilet.
- Mobility – You need help with walking.
- Eating – You need help putting food in your mouth.
- Toileting – You need help using the toilet, 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).
- Orientation – You need help knowing and remembering people (like your family members) and where you are.
- Medication Administration – You need help taking your medicine.
- Behavior – You have behavior problems like taking off your clothes or trying to run away.
- 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 (Money) 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 2017 income limit is $2,205/month. The resource limit (excluding a house and a car) is $2,000.
The rules for 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). To get help doing this, you can call an elder lawyer. For help finding an elder lawyer, you can call the Tennessee Justice Center or your local Legal Aid office.
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.