Page 9

Aged, Blind and Disabled Manual Policy Manual Number: 125.005 Section: Institutional Medicaid Chapter: Institutional Status November 3, 2025 Division of TennCare 9 c. Have been identified by the state as a former member of the certified class in the United States vs. State of Tennessee, et al. (Arlington Developmental Center), a current member of the certified class in the United States vs. the State of Tennessee, et al. (Clover Bottom Developmental Center), or an individual transitioned from the Statewide Waiver (#0128) upon its renewal on January 1, 2015, because he was identified by the state as receiving services in excess of the individual cost neutrality cap established for the Statewide Waiver. 2. State-Wide ID Waiver The Statewide ID Waiver provides services to Tennessee children with developmental delays and adults and children with intellectual disabilities who meet the ICF/IID LOC criteria. 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; and b. Have been assessed and found to: i. Have an intellectual disability manifested before eighteen (18) years of age, as specified in Tennessee State law (Tennessee Code Annotated, Title 33-1-101); or ii. Have a developmental disability, which is defined as a condition of substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in an intellectual disability and be a child five (5) years of age or younger. 3. Self-Determination Waiver The Self-Determination Waiver provides community-based services to individuals with developmental disabilities who would otherwise require the level of care provided 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: i. Have an intellectual disability manifested before eighteen (18) years of age, as specified in Tennessee State law (Tennessee Code Annotated, Title 33-1-101); or,