TennCare Extended Care Program Opens to Higher Income Levels | Health care

A state program designed to keep older people and people with disabilities home and out of full-time care facilities will extend to those with slightly higher incomes for the first time since 2015.

Starting in October, TennCare CHOICES Group 3 will be open to those earning up to 300% of the poverty line. The group was introduced in 2012 but had its income limits tightened to the federal Supplemental Security Income level of 80% of the poverty level in 2015.

This change will allow for up to 1,750 new enrollees at a cost of approximately $58.8 million, which was approved in the 2022 state legislative session as part of the state budget. Enrollment in Group 3 will give a person up to $18,000 per year in services, which could include stays in short-term nursing care facilities, meals delivered to homes, respite care, technology assistance and day care for adults.

CHOICES offers three levels of home and community care delivery. 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 intended to prevent or prolong the time before a person needs to move to a nursing home.

Amy Lawrence, spokeswoman for TennCare, said people in Group 3 “are not eligible for nursing home care but need ongoing practical support to delay or prevent the need for nursing home care” . She gave the example of a person who needs practical assistance at least four days a week to get to and from beds, chairs and toilets.

Due to the cost of in-home services for the elderly and disabled, Gordon Bonnyman, staff attorney for the health advocacy organization Tennessee Justice Center, said the former Group 3 income restriction prevented many people who still needed care.

“When they brought it down to 80% [of the federal poverty level] they were really excluding a lot of people who they knew couldn’t remotely afford the care they needed,” Bonnyman said. “It was kind of a crazy penny and pound because it meant they were withholding from a group of people who they knew they couldn’t afford these services, the services that will help the state save money. downstream money. It’s a smart, more humane step back in the right direction.

The public feedback period for this change lasts until July 8, and TennCare has a public hearing scheduled for June 23.

Julio V. Miller