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

November 3, 2025 Division of TennCare 8

living goals. Individuals enrolled must either meet NF LOC or be at risk for NF placement in the absence of HCBS. In addition, enrollees must:

1. Have been assessed and found to have an intellectual disability manifested before eighteen (18) years of age or a developmental disability manifested before twenty-two (22) years of age, as specified in Tennessee State law (Tennessee Code Annotated, Title 33-1-101); and

Note: For children five years old or younger a “developmental disability” refers to a condition of substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in developmental disability if services and supports are not provided.

2. Be enrolled in TennCare Medicaid as an SSI recipient or through one of the demonstration groups: ECF CHOICES 217-Like Group or Interim ECF CHOICES At- Risk Group.

Eligibility for the ECF CHOICES 217-Like Group and the Interim ECF CHOICES At- Risk Group is determined based on Institutional Medicaid non-financial and financial eligibility rules.

iii. DDA Waivers

The DDA waivers provide LTSS for individuals with intellectual disabilities through ICF/IIDs and HCBS.

Individuals eligible for a DDA waiver must meet the non-financial and financial eligibility requirements of the Institutional Medicaid category or receive Medicaid through SSI. There are three DDA HCBS waivers for individuals with intellectual disabilities:

1. Comprehensive Aggregate Cap Waiver

Individuals qualify for, and absent the provision of waiver services would be placed in, an ICF/IID.

To enroll in this waiver program, an individual must:

a. Meet TennCare ICF/IID LOC criteria (TennCare Rule 1200-13-1-.15) and financial eligibility criteria and have a PAE approved by TennCare; b. Have been assessed and found to have an intellectual disability manifested before eighteen 18 years of age, as specified in Tennessee State law (Tennessee Code Annotated, Title 33-1-101); and