Tennessee HCBS Waiver and TennCare MCO Disability Services
How HCBS Waivers Work in Tennessee
Tennessee delivers its home and community-based services (HCBS) for people with intellectual and developmental disabilities through a managed care model, not a traditional Medicaid waiver application the way many other states do. The program is called Employment and Community First (ECF) CHOICES, and it's administered by TennCare through contracted Managed Care Organizations (MCOs).
This structure means your family interacts with an MCO — not the state directly — for most day-to-day service coordination. The MCO assigns a Support Coordinator who helps develop the individual's Person-Centered Support Plan, connects them to service providers, and manages ongoing care authorizations.
The Three TennCare MCOs
Tennessee contracts with three MCOs to deliver ECF CHOICES services statewide:
- BlueCare Tennessee: 1-888-747-8955
- UnitedHealthcare Community Plan: 1-800-690-1606
- Wellpoint (formerly Amerigroup): 1-833-731-2153
When an individual is enrolled in ECF CHOICES, they're assigned to one of these MCOs. The MCO handles benefits administration, provider network management, and service authorization. If you're already enrolled in TennCare through one of these plans, contact your MCO directly to request an ECF CHOICES assessment.
What ECF CHOICES Covers
ECF CHOICES isn't a single benefit — it's organized into groups based on the level of support the individual needs.
Group 4 provides essential family supports for adults living with family members. Services include respite care, supportive home care, community integration activities, and family caregiver stipends.
Group 5 targets adults who are ready for employment and increased independence. It funds intensive vocational training, job coaching, independent living skills instruction, and community-based day services.
Group 6 serves individuals who meet a nursing facility level of care. It provides the full range of residential and behavioral supports needed for people with the most significant needs.
Across all groups, services are delivered in the community — the entire point of HCBS is keeping people out of institutional settings and in their own homes and neighborhoods.
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Financial Eligibility
ECF CHOICES eligibility runs through TennCare, which means the individual must meet both clinical and financial criteria.
On the clinical side, the individual must have an intellectual disability that manifested before age 18, or a developmental disability that manifested before age 22.
On the financial side, income limits vary by benefit group. For Group 6 (nursing facility level of care), the 2026 monthly income limit is $2,982 — 300% of the SSI Federal Benefit Rate. For Group 5, the limit is $1,995 per month. Working individuals may qualify under the Working Disabled category with income up to $3,325 per month, provided unearned income stays below $994.
Countable resources cannot exceed $2,000, excluding the primary residence. Individuals whose income exceeds the limit can establish a Qualifying Income Trust (QIT) to hold the excess and maintain eligibility.
The Referral List Reality
ECF CHOICES enrollment is capped by available state funding. When funding is exhausted for a benefit group, qualified applicants go on a referral list — effectively a waitlist. Wait times vary by region and benefit group, and there is no published timeline for when openings will become available.
This is why families of transition-aged students need to submit a self-referral years before school services end. The application goes through the TennCare PERLSS portal at perlss.tenncare.tn.gov/externalreferral, or families who aren't currently enrolled in TennCare can contact a DDA Regional Office for intake assistance.
The Role of the Support Coordinator
Once enrolled, the MCO assigns a Support Coordinator who becomes the family's primary point of contact. The Support Coordinator conducts an initial assessment to determine the individual's needs and preferences, develops the Person-Centered Support Plan, identifies and connects providers for approved services, monitors service delivery and adjusts the plan annually, and helps coordinate with other agencies (VR, SSA, school transition teams).
The quality of the Support Coordinator relationship matters enormously. If the assigned coordinator isn't responsive or isn't familiar with transition-aged adults, you can request a reassignment through the MCO.
Connecting HCBS to the School Transition
The ideal timeline has the ECF CHOICES referral submitted by age 16, well before the student exits school services. The school's transition coordinator and the MCO's Support Coordinator should be communicating directly — the IEP should document interagency responsibilities so both sides know who is handling what.
The Tennessee IEP Transition to Adulthood Guide includes a DDA and ECF CHOICES handoff planner with tracking sheets for each MCO contact, intake coordinator communications, and submitted documentation — so nothing gets lost in the multi-agency handoff.
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