Note: This information is valid as of January 2025, but is subject to change based on Tennessee State and the Federal Government laws and procedures.
Some seniors who receive TennCare (Medicaid) may be eligible to use those benefits to employ a family member, friend, or other trusted individual to provide them with care in their own home (“Consumer Direction”). There are many criteria an individual must meet to qualify for Consumer Direction care. Consumer Direction care is unlikely to be approved if other forms of care available through TennCare will suit your individual needs.[1]
CHOICES Program
To qualify to receive this type of care, you must be a participant in Tennessee’s CHOICES program.[2] There are three groups of participants within the CHOICES program:
- Group 1: individuals of any age that receive nursing home care
- Group 2: adults 21 years of age or older with a physical disability AND seniors aged 65 and older who qualify for nursing home care but chose to receive home care services
- Group 3: adults 21 years of age or older with a physical disability AND seniors aged 65 and older who do not qualify for nursing home care but still require care to delay or prevent the need for nursing home care
Only Group 2 and Group 3 CHOICES participants can qualify for Consumer Direction.[3]
Who Qualifies to be a CHOICES Participant?
To qualify for CHOICES, you must meet the following requirements in addition to the requirements for each group listed above:
- Medical Eligibility- you require help for daily living activities
- Financial Eligibility- you are receiving SSI (Supplemental Security Income) OR qualify for Medicaid Long-Term Services and Support
How Do I Apply for CHOICES?
If you are already enrolled in TennCare, contact your MCO (Managed Care Organization) for assistance applying for CHOICES (BlueCare, United Healthcare Community Plan, Wellpoint, etc.) If you are not already enrolled in TennCare, contact your local AAAD (Area Agency on Aging and Disability) with assistance in enrollment.[4]
What is Consumer Direction?
Consumer Direction allows eligible participants to choose who provides them with care and how that care is provided.[5] Through consumer direction, you act as the employer of your caretaker. This means you take on responsibilities such as hiring, training, monitoring, and managing your employee caretaker.
What Services Are Available Through Consumer Direction?
The following services are available to Consumer Direction participants:
- Personal Care Visits- caretaker visits you at your home to assist you with tasks such as bathing, getting dressed, preparing meals, etc. Up to two visits per day, up to 4 hours per visit
- Companion Care- caretaker lives in your home and assists you with personal care when you need it. Only available if: 1) you are a Group 2 CHOICES participant; 2) you require care that cannot be provided by unpaid caregivers; and 3) the cost of companion care is no more than other kinds of in-home care that meets your needs
- In-Home Respite Care- someone comes and stays with you for a short time to give your caretaker time off. Up to 216 hours per year
- When you enroll in CHOICES, you will be assigned a Care Coordinator. The Care Coordinator will prepare a PCSP (Person-Centered Support Plan) which will list the services the Care Coordinator has determined you need. You are only eligible to receive the Consumer Direction Services that are listed on your PCSP.
Do I Qualify for Consumer Direction?
To be a Consumer Direction participant you must meet the following criteria:
- Be enrolled in CHOICES Group 2 or Group 3
- You cannot live in an Assisted Living Facility, Community Living Support Housing, or Adult Care Home
- Be able to complete your duties as an employer OR you have someone acting as your representative
- You have a PCSP showing that you need services that can be provided through Consumer Direction
- Your MCO can safely meet your needs while you’re in Consumer Direction
What are My Duties as an Employer?
If you qualify for and enroll in Consumer Direction you will be assigned a Support Broker who assists you with your various employer duties, including necessary paperwork,[6] interviewing workers, writing job descriptions, training workers, etc. However, these are ultimately the duties of the Consumer Direction participant, and the Support Broker only assists. Additionally, a Support Broker will not be involved in the day-to-day management and supervision of your employee caretaker.
Can a Family Member or Friend Help Me with My Employer Duties?
Yes, a family member, friend, or other trusted individual may serve as an Employer of Record to perform all or some of your employer duties. This individual will need to sign a Representative Agreement. The Employer of Record cannot be paid for serving in this role.
FOOTNOTES:
[1] TennCare Long-Term Care Programs Rules- http://publications.tnsosfiles.com.s3.amazonaws.com/rules/1200/1200-13/CurrentTennCareEffectiveRules_20241210.pdf
[2] CHOICES- https://www.tn.gov/tenncare/long-term-services-supports/choices.html
[3] CHOICES Member Benefit Table- https://www.tn.gov/content/dam/tn/tenncare/documents/CHOICESMemberBenefitTable.pdf
[4] Area Agency on Aging and Disability Map- https://www.tn.gov/content/dam/tn/tenncare/documents/AAADMap.pdf
[5] Consumer Direction Handbook- https://www.consumerdirecttn.com/wp-content/uploads/2024/12/CHOICES-Member-Binder-Handbook-20241231.pdf
[6] Consumer Direct Service Agreement- Wage Memo- https://www.consumerdirecttn.com/wp-content/uploads/2024/09/CHOICES_Wage-Memo_20240628.pdf (Example of a contract between a Consumer Direct employer and their employee caretaker)
[7] Appointment of Designated Representative- https://www.consumerdirecttn.com/wp-content/uploads/2023/08/CDTN_Appointment-of-Designated-Representative_20230712.pdf