ECF CHOICES Waitlist and Referral List Tennessee: Priority Groups, Reserve Capacity, and Wait Times

How the ECF CHOICES Referral List Works

ECF CHOICES is not an entitlement — it's a capped program funded by annual state legislative appropriations. When qualified applicants can't be enrolled immediately, they're placed on the statewide ECF CHOICES Referral List. This is not a simple first-come, first-served queue. TennCare assigns enrollment priority based on urgency categories, and some applicants bypass the list entirely through reserve capacity slots.

Families submit their self-referral through the PERLSS online portal. After the self-referral, the applicant is placed on the statewide ECF CHOICES Referral List; the clinical eligibility process, including a Pre-Admission Evaluation when applicable, determines whether the applicant qualifies and which priority category applies. Their position on the list depends on which priority group they fall into, not when they applied.

The Priority Groups Explained

TennCare's published priority structure (the "Pink Page") includes employment-focused Priority Groups B and D for transition-age youth:

Priority Groups B and D cover transition-age youth (ages 18 to 22) who are exiting school with a committed job offer or an active desire to work. These groups get meaningful priority because ECF CHOICES is structured around an "Employment First" philosophy — the program's design prioritizes people who are working or actively pursuing employment.

The specific B or D assignment depends on the applicant's circumstances; both are employment-focused categories for transition-age youth who need community-based supports to continue their employment path.

General referral applicants who don't meet the Priority B or D criteria wait in the standard queue, where movement depends entirely on how many funded slots open in a given budget year.

Reserve Capacity: The Immediate Enrollment Path

TennCare sets aside a portion of enrollment slots — historically around 250 slots across Groups 4, 5, and 6 — as "reserve capacity" for individuals in acute crisis. These slots allow immediate enrollment without waiting on the referral list.

Reserve capacity criteria include:

• Institutional discharge — the applicant is being discharged from a nursing facility or acute care setting and would be at imminent risk of institutionalization without community supports
• Emergent health or safety conditions — determined by an Interagency Review Committee, these cases involve documented immediate risk of harm to the individual or others
• Aging caregiver — the applicant has a custodial parent or caregiver who meets the statutory age threshold

The aging caregiver criterion is the most commonly misunderstood. Under Tennessee rules, the caregiver must be at least 75 years old if the young adult has an intellectual disability, or at least 80 years old if the disability is developmental (such as autism or cerebral palsy). A 65-year-old caregiver with health problems does not qualify for this priority category, regardless of the severity of their condition.

How Long the Wait Actually Takes

TennCare does not publish official wait time estimates for the referral list. Anecdotally, families report wait times ranging from several months for Priority B applicants with active employment to several years for general referral applicants seeking Group 6 comprehensive residential supports.

Movement on the list is not continuous. TennCare opens new slots in batches when the legislature appropriates additional funding or when existing members leave the program. In years with flat or reduced appropriations, the list may barely move. Families should plan as though services will not be available immediately and arrange interim supports through other channels — VR employment coaching, school-based transition services through age 22, or Medicaid state plan services that don't require waiver enrollment.

What Families Can Do While Waiting

The referral list is not a passive queue. Families should:

Keep clinical records current. If the applicant's condition changes or additional evaluations are completed, update the DDA regional intake office. A deterioration in functioning or new diagnosis may change the applicant's priority group or qualify them for reserve capacity.

Report changes in family circumstances. If the primary caregiver reaches the aging caregiver threshold, experiences a serious health crisis, or passes away, notify TennCare immediately. These events can trigger reserve capacity enrollment.

Maintain Medicaid eligibility. ECF CHOICES requires active TennCare Medicaid enrollment. If the applicant loses Medicaid while on the referral list, contact TennCare or DDA promptly to confirm how the lapse affects the referral and any future enrollment.

Apply early. The self-referral can be submitted at age 17.5. Families who wait until the young adult ages out of school at 22 miss the opportunity to start the referral process earlier.

The Tennessee SSI at 18 & Adult Disability Benefits Guide includes an ECF CHOICES application tracker with space to log referral dates, priority group assignments, and communications with the DDA intake office — keeping everything in one place while the family waits.

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