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Employment and Community First (ECF) Choices 

What is it?

It is a Home and Community Based Services (HCBS) program administered through TennCare and managed by the managed care organizations (MCO) that is supposed to provide essential services and supports in a coordinated and cost-effective manner for individuals with intellectual and developmental disabilities (I/DD). According to the ECF program’s objectives, it is meant to help people find employment, if desired, and improve their quality of life.

Who is eligible?

  • The Employment & Community First (ECF) Choices is a program for people who have an intellectual or developmental disability: An intellectual disability that started before the age of 18.
  • An IQ Score under 70.
  • A developmental disability that started before the age of 22.
  • Must be a Tennessee Resident Must have Medicaid (Tenncare) or be eligible for Medicaid (Tenncare)

To qualify for ECF CHOICES, a person must meet medical and financial requirements.

  • To qualify for Employment and Community First CHOICES, a person must:
    • Provide proof that they have an intellectual disability or other developmental disability.
      • An intellectual disability must start before the age of 18.
      • A developmental disability must start before the age of 22.
    • Provide proof of financial eligibility.
      • Here is a list of documents you can use as your proof: https://www.tn.gov/content/dam/tn/tenncare/documents/EmploymentCommunityFirstCHOICESApplicationItemsFinancialEligibility.pdf
      • As of January 2025, the person’s income can’t be more than the following amount:
        • $2,901 per month if the person is approved with nursing facility level of care;
        • $1,957 per month if the person is not approved with nursing facility level of care, but is approved with at risk level of care; or
        • $3,261 per month if the person is working and has less than $967 in unearned income.
      • These amounts are subject to change each calendar year. If the person’s income is over the limit, they may be able to set up a Qualifying Income Trust.
      • For children under age 18, the parent’s income and resources count too, unless the child is age 17 or older and qualifies for nursing home level of care, or the child is enrolling in or transitioning from Intensive Behavioral Family Supports (sometimes called “Group 7”).
      • The total value of things you own can’t be more than $2,000 (The home where you live doesn’t count); AND
      • People in one of the groups on the green page may qualify to enroll in the program and get services now. These are people who need services right away because they have the most urgent needs.
      • People in one of the groups on the pink page may qualify to enroll in the program and get services when there is a slot. These slots are VERY limited right now. There is a very long waiting list. Qualify financially to get TennCare. This means:

What services does ECF offer?

All services are subject to availability. There are provider shortages across the state and it is common for members to be approved for services but unable to access them.

What are the Benefit Groups? (You DO NOT pick your group, the member is assigned based on need determined by assessments completed by the Tennessee Department of Disability and Aging.)

  • Group 4 is for families caring for a child under the age of 21 or over the age of 21 who has an intellectual or developmental disability (I/DD) who is living at home.
    • You can receive a stipend for caring for your child at home.
  • Group 5 is for adults age 21 and older who have an intellectual or developmental disability (I/DD) but do not qualify for the level of care in a nursing home.
  • Group 6 is for adults that are 21 and older in an emergent group who would qualify to get care in a nursing home.
    • (This does not mean the person has to receive care in a nursing home. This program provides services at home and in the community. They just need to qualify for nursing home care.)
  •  Group 7 is for a small number of children under age 21 who live with their family and have an intellectual or developmental disability (I/DD) and severe behavior support needs that place the child or others at risk of serious harm.
  • Group 8 is for a small number of adults who have an intellectual or developmental disability (I/DD) and severe behavior support needs and are moving into the community from a place with lots of structure and supervision.

How do you apply?

  • You can fill out the self-referral form online at: https://perlss.tenncare.tn.gov/externalreferral
  • If you have TennCare, call your managed care organization (MCO) to learn more. You can find this information on the member’s medical insurance card. Be sure to tell them you need help with a self-referral for ECF CHOICES.
    • MCO contact information is listed below:
      • Wellpoint (formally Amerigroup): 866-840-4991
      • BlueCare: 888-747-8955
      • United Healthcare: 800-690-1606.
  • Unsure of who your Managed Care Organization (MCO) is? You can contact: 1-855-259-0701 and ask who your MCO is.
  • If you don’t have TennCare, call your Department of Disability & Aging (DDA) regional office and ask for help with a self-referral for ECF CHOICES. The regional office information is listed below.

There IS a waiting list.

Got Questions?

Contact the Tennessee Department of Disability and Aging Regional Offices:

  • West Tennessee: (800) 308-2586
  • Middle Tennessee: (800) 654-4839
  • East Tennessee: (888) 531-9876

Questions for caregivers to consider:

  • When should I apply for ECF Choices
  • How long will it take to get into ECF services
  • What assessments will be used to determine how much help/support they receive
  • Does Tenncare or the Managed Care Organization (MCO) to complete meetings, evaluations, and developing our support plan
  • How will I know that category my child will be place in
  • What kind of services and supports can ECF Choices provide?
  • Who will be delivering the services?
  • Who can I contact to find out the status of my application?

For additional information about your ECF plan and services please visit the following links to review your member handbook: