Tennessee Medicaid Waivers & Home and Community Based Programs Overview

Tennessee, known as The Volunteer State, has a well-structured Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.

Administered by TennCare, the state’s Medicaid program, in collaboration with the Tennessee Department of Intellectual and Developmental Disabilities (DIDD) and the Bureau of TennCare Long-Term Services & Supports (LTSS), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings rather than institutional care.

Key programs include the CHOICES in Long-Term Services and Supports (CHOICES) Program, which provides personal care, home modifications, and assistive technology for seniors and adults with physical disabilities, and the Employment and Community First (ECF) CHOICES Waiver, which offers residential, habilitative, and employment support for individuals with intellectual and developmental disabilities (IDD).

Other programs include the Comprehensive Aggregate Cap (CAC) Waiver, the Statewide Waiver for Individuals with IDD, and the Self-Determination Waiver, all of which support individuals with complex needs. Tennessee also offers Self-Directed Services, allowing participants to manage their own caregivers and support services.

Regulatory oversight in Tennessee is managed through TennCare and DIDD, with additional provider licensing and compliance enforcement by the Tennessee Department of Health (TDH), Office of Health Care Facilities. The state operates under a Managed Care model, with HCBS services coordinated through TennCare’s Managed Care Organizations (MCOs), ensuring cost-effective and integrated service delivery.

Tennessee has also implemented Electronic Visit Verification (EVV) for personal care services, reinforcing compliance and service integrity in home-based care programs. Providers must navigate Medicaid enrollment, prior authorization processes, and strict quality assurance measures to successfully participate in the state’s HCBS programs.

With a strong emphasis on person-centered planning, employment-first initiatives, and community-based care, Tennessee’s Medicaid waiver system ensures that individuals receive high-quality, sustainable long-term services while promoting independence, dignity, and inclusion in their communities.

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Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.

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