Page 7

Aged, Blind and Disabled Manual Policy Manual Number: 125.005 Section: Institutional Medicaid Chapter: Institutional Status

November 3, 2025 Division of TennCare 7

b. Children Currently Receiving TennCare Medicaid

TennCare Medicaid or TennCare Standard children who enter residential treatment facilities, such as those for sex offenses or alcohol and drug abuse and are in the custody of a parent or caretaker relative may be eligible in their existing COE. Children in this situation should still be considered a member of the household whose absence from the home is temporary.

As long as the child intends to return, the child will continue to be considered a member of her household and retain eligibility in the original COE received prior to placement in the treatment facility. If at any time during the absence it is determined that the child is no longer eligible for benefits, eligibility will be terminated.

10. HCBS

a. General Description

HCBS is provided in a home or community setting as an alternative to, or to delay the need for, LTSS in a NF or ICF/IID. HCBS is available to individuals who qualify for and are enrolled in CHOICES.

b. Waiver Types

i. HCBS

The HCBS program is authorized by a waiver of TennCare Medicaid statutory requirements. In this waiver program:

1. Services are provided to individuals in their own homes, in the home of a caregiver or family member or in a facility participating in the HCBS program (such as an Assisted Living Facility) who would otherwise require the level of care (LOC) provided in an ICF; 2. Services are required to be furnished under an individual written plan of care; and 3. Individuals enrolled must meet the same eligibility criteria as if admitted to an ICF.

Note: Group homes are considered a community-based setting, so individuals living in those settings could be eligible for HCBS benefits.

ii. Employment and Community First (ECF) CHOICES

ECF CHOICES is an HCBS program designed to support individuals with intellectual and developmental disabilities (I/DD) of all ages in realizing their employment and independent