A state program designed to keep seniors and those with disabilities at home and out of full-time care facilities will expand to those with somewhat higher incomes for the first time since 2015.
Starting in October, TennCare CHOICES Group 3 will open to those earning up to 300 percent of the poverty level. The group was introduced in 2012 but saw its income limits tightened to the federal Supplemental Security Income level of 80 percent of poverty level in 2015.
This change will allow up to 1,750 new enrollees for a cost of approximately $58.8 million, which was approved during the 2022 state legislative session as part of the state budget. Enrolling in Group 3 will give a person up to $18,000 per year in services, which could include stays at short-term nursing facilities, home-delivered meals, respite care, assistive technology and adult day care.
CHOICES has three levels of offerings for home- and community-based care. Group 1 is for those in a nursing facility, Group 2 is for those receiving full-time care at home, and Group 3 (also known as the CHOICES At Risk Demonstration Group) is meant to prevent or prolong the time before a person needs to move to a nursing facility.
Amy Lawrence, TennCare spokesperson, said those in Group 3 “do not qualify for nursing home care but need ongoing hands-on support to delay or prevent the need for nursing home care.” She gave an example of someone who needs hands-on assistance at least four days a week to transfer to and from beds, chairs and toilets.
Because of the cost of at-home services for seniors and those with disabilities, Gordon Bonnyman, staff attorney for health advocacy organization Tennessee Justice Center, said the prior Group 3 income restriction was keeping out plenty who still needed the care.
“When they cut it back to 80 percent [of the federal poverty level] they were really excluding many people that they knew could not remotely afford the care they needed,” Bonnyman said. “That was sort of penny-wise and pound-foolish because what that meant was they were withholding from a group of people that they knew could not afford those services, the services that will help the state save on money downstream. This is a smart as well as more humane step back in the right direction.”
The public feedback period for this change lasts through July 8, and TennCare has a public hearing planned for June 23.