Employment and Community First (ECF) CHOICES

ECF CHOICES is meant to serve people of all ages with Intellectual and Developmental Disabilities. It is a relatively new program beginning in July 2016, intended to help people live as independently as possible at home or in the community. Supports are designed to help people build relationships, be active in the community, and seek employment, if desired.

To get on ECF CHOICES, you must meet certain priority categorization, level of care criteria, and financial eligibility criteria. See below for more information on how to apply, eligibility requirements, and services offered.

There are three different groups in ECF CHOICES, each with a specific population the group is targeting, certain benefits, and different expenditure caps:

  • ECF CHOICES Group 4

    (Essential Family Supports)

  • ECF CHOICES Group 5

    (Essential Supports for Employment and Independent Living)

  • ECF CHOICES Group 6

    (Comprehensive Supports for Employment and Community Living)

Group Comparison

Group 4Group 5Group 6
Target PopulationFamilies with children under 21 who meet nursing facility level of care or are “at risk”; Adults living with family that meet the “at risk” criteria may opt in as wellAdults age 21 and older in the “at risk” categoryAdults over 21 meeting the nursing facility level of care criteria
Services and SupportsRespite, Family Caregiver Stipend or Supportive Home Care, Community Transportation, Assistive Technology/Equipment/Supplies, Independent Living Skill Training, Minor Home ModificationsEmployment Services and Supports, Personal Assistance, Community Transportation, Assistive Technology, Minor Home ModificationsEmployment Services and Supports, Personal Assistance, Community Transportation, Assistive Technology Minor Home Modifications
Expenditure Cap$15,000 per year (excluding minor home modifications)$30,000 plus a $6,000 emergency-needs exception$45,000 for low to moderate needs, $60,000 for high-need individuals
First Year Enrollment Limit5001,000200

“To know that somebody was gonna be standing there with me, that was the biggest blessing. Not everyone gets what you’re feeling and thinking, what we’re going through. I feel confident moving forward now.”

Katreda N.

“TJC is standing up for people. You being articulate, fluent, punctual, organized, has been a huge help. I feel like you all are great advocates for people like me, so we know what to do when we face a problem like this.”

Sylvia T.

“I’m very appreciative for the assistance I’ve received from TJC – you’ve been extremely nice, helpful, and informative. You’ve led me in directions I didn’t even know I needed to go in. I had no idea that some of those things were even possible. I would have been lost without it.”

Jeff M.

“I appreciate TJC so much. You’ve been a great sounding board. You’re able to listen to me and help me get a perspective on what my next move should be.”

Birdie N.

“I’ve been very impressed with all that TJC has done for us. It definitely made a difference. People started paying attention. My sister was able to get better care because of that. I’m so grateful for everything that TJC does.”

John C.

“Having that kind of hope, and a number to call, and people who actually care about the disabled, and have a little more knowledge about how to navigate through a system, was huge. You just gave us hope, and then the next step to step on, to make it through another day.”

Tracy K.

Common Questions

Who can get ECF CHOICES?

People with I/DD who TennCare deems to be in certain priority categories can qualify for ECF CHOICES. TennCare lists all the priority categories here, but they include individuals with emergent needs or multiple complex health conditions, individuals who are employed, seeking employment, or desire to be employed, and individuals with aging caregivers 75 or older. See the image below for examples of people who may qualify:
ECF Priority CategoriesIf an individual is determined by TennCare to be in one of these priority categories, they then have to meet certain level of care criteria. An individual must either meet nursing facility level of care, or be at-risk of needing nursing facility level of care. An individual must also be evaluated based on an ICAP (Inventory for Client and Agency Planning).
ECF Level of Need
ECF AssessmentIf an individual meets this level of care, they must also be financially eligible for ECF CHOICES. Their income must be below $2,205 and they must have resources valued at less than $2,000. Note:  The parents’ income counts for an applicant only if the child’s level of need is determined to be “at-risk” and not at nursing facility level of care.
ECF Financial Eligibility

How do I apply for ECF CHOICES?

To apply, you will need to fill out TennCare’s self-referral form online.

If you are already on TennCare, contact your MCO. BlueCare (888-747-8955) and Amerigroup (866-840-4991) participate in ECF CHOICES, but United Healthcare does not. Call DIDD if you have United Healthcare and are interested in ECF CHOICES.

If you are not on TennCare, contact DIDD. DIDD Regional Intake Office Contact information:

West Tennessee Regional Office Office of Intake (866) 372-5709
Middle Tennessee Regional Office Office of Intake (800) 654-4839
East Tennessee Regional Office Office of Intake (888) 531-9876
ECF Applying Flowchart

What services are provided in each group?

See the chart below for the comparison for who each group serves, what services are available, and the monetary cap on services provided.

ECF Groups Chart

What employment services are available?

Below is a list of possible employment services for enrollees in ECF CHOICES:

  • Individual Employment Support*
  • Supported Employment-Small Group
  • Integrated Employment Path Services (Prevocational Training)
  • Employment Discovery and Customization
  • Career Advancement
  • Community Integration Support Services
  • Benefits Counseling

*Exploration, Discovery, Situational Observation and Assessment, Job Development Plan or Self-Employment Plan, Job Development or Self-Employment Start-Up, Co-Worker Supports.

What is consumer direction and how does it work?

Consumer Direction is a way of getting some of the kinds of home care you need.

In Consumer Direction, you actually employ the people who give some of your support services— they work for you (instead of a provider). This means that you must do the things an employer would do – like hire, train, schedule, supervise, and even fire workers. You also have to be able to manage the services you need within your approved budget for each service.

What if you can’t do some or all of these things?

    • Then you can choose a family member, friend, or someone close to you to do these things for you. It’s called a “Representative for Consumer Direction.” If you decide to join Consumer Direction and need a Representative, your Support Coordinator will tell you who qualifies to be a Representative. The person you pick can’t be paid to give any of your support services in Consumer Direction. It’s important that you pick someone who knows you very well that you can depend on.

Services available through consumer direction:

    • personal assistance
    • supportive home care
    • in-home respite care
    • community transportation

Note: you can’t pay anyone who lives with you to be your consumer-directed worker.

You can decide if you want to join Consumer Direction or use providers contracted with your managed care organization (BlueCare or Amerigroup) to give your services. You can change your mind any time.

I applied for ECF CHOICES. But I’m still waiting to hear back. What can I do?

The State has 90 days after you apply to let you know whether you can get CHOICES. You should not have to wait more than 90 days.

You can appeal if you applied more than 90 days ago. A court case called Wilson v. Gordon says that you can get a hearing. There is more information here.

What if I need to appeal?

Tennessee Justice Center helps some people with ECF CHOICES issues. Call our office at 877-608-1009, or call our CHOICES Client Advocate, Sarah Connette, at 615-846-4713. Even if we cannot represent you in the hearing, we can help talk through the situation, take a look at documents, and see what options you have. If your application was denied or you are experiencing service issues, an appeal may address these situations.

You may be able to get a free lawyer to help at your hearing. Call your local legal aid office. You can find the phone number for your local legal aid office here.

You can go to your hearing yourself if you can’t get a lawyer. You can win your hearing even without a lawyer. You can take a friend or advocate with you. Tell the judge about why you need CHOICES and what mistake you think the State made.

Where can I find out more about ECF CHOICES?

  • To apply, you will need to fill out TennCare’s self-referral form online.
    • If you are already on TennCare, contact your MCO. BlueCare (888-747-8955) and Amerigroup (866-840-4991) participate in ECF CHOICES, but United Healthcare does not. Call DIDD if you have United Healthcare and are interested in ECF CHOICES.
    • If you are not on TennCare, contact DIDD. DIDD Regional Intake Office Contact information:
      • West Tennessee Regional Office Office of Intake (866) 372-5709
      • Middle Tennessee Regional Office Office of Intake (800) 654-4839
      • East Tennessee Regional Office Office of Intake (888) 531-9876

How can TJC help?

We help individuals and families across the state who contact us for assistance at various stages of the process—whether they are exploring options and want to learn about eligibility requirements, plan on applying and need information, have applied but haven’t heard anything, were denied eligibility, or are on the program and experiencing service issues.

We try to help gather information, communicate between agencies, and resolve issues so that families can move forward in receiving the care they or their loved ones need. We primarily advocate for our clients if they are experiencing problems with TennCare or with their MCO. We also advocate for our clients if they are experiencing problems with a provider agency, but the advocacy looks a little different.

Folks are welcome to call us at any stage of the process, but historically our services are most often utilized when an individual is denied eligibility for a program or is denied services while in a program, and we then work with TennCare and/or appeal the issue. When folks contact us with problems they’re experiencing, we’re grateful for the chance to identify issues that many are facing so that we can try and resolve the individual issue as well as address the systemic problem.

Please call our CHOICES Client Advocate, Sarah Connette, at (615) 846-4713 if you have questions, need technical assistance, or would like to reach out.

Need Help?

If you need TJC’s help with ECF CHOICES issues or have further questions, call our CHOICES Client Advocate, Sarah Connette, at (615) 846-4713.