TennCare CHOICES: Tennessee 2026 Guide

TennCare CHOICES in Long-Term Services and Supports is Tennessee’s Medicaid program for nursing facility care and home and community-based services for older adults and adults with physical disabilities. CHOICES is delivered through TennCare’s managed care organizations, which coordinate medical and long-term care.

Below we cover the 2026 eligibility rules for CHOICES, the services it can pay for, the steps to apply, how waiting lists work, and how the program sits alongside nursing home Medicaid in Tennessee. For the full statewide rules on income, assets, spouses and the look-back, see our Tennessee Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What CHOICES is

CHOICES has groups. Group 1 covers people receiving nursing facility care. Group 2 covers people who meet nursing facility level of care and receive home and community-based services instead. Group 3 covers people who do not meet nursing facility level of care but are at risk of needing it, with a smaller package of services. Groups 2 and 3 have enrollment targets. Members can use Consumer Direction, which lets Group 2 and 3 members hire workers, including family members. A spouse cannot be hired as a paid Consumer Direction worker, though a qualified spouse may be employed through a contracted agency.

Managed long-term services and supports (MLTSS) means the state pays a private health plan a monthly amount to arrange and pay for a member’s long-term care. A care coordinator from the plan writes and updates the care plan, and members can usually pick their plan. The state still sets the financial rules, and the right to a fair hearing still applies when a plan reduces or denies services.

Who qualifies in 2026

Tennessee looks at both how much help a person needs and what they own and earn. In general, to qualify for CHOICES an applicant must:

• be 65 or older, or 21 or older with a physical disability;
• live in Tennessee;
• for Groups 1 and 2, meet nursing facility level of care through a PreAdmission Evaluation; for Group 3, be at risk of nursing facility placement;
• meet TennCare’s long-term care financial rules; and
• for Groups 2 and 3, be within the enrollment target, or qualify for a reserve slot.

Financial rules. For CHOICES, TennCare applies the long-term care Medicaid rules for income and assets, generally the same ones used for nursing home care. Countable assets include bank accounts, investments and property other than the home, while the home, one car, personal belongings and certain burial funds are usually not counted. Gifts and below-value sales in the last 60 months are reviewed, and a transfer penalty can push back the start of services.

Tennessee is an income-cap state. In 2026, the limit is $2,982 a month, with a Qualified Income Trust for people above it. The single-person asset limit is $2,000.

For reference, these are Tennessee’s key 2026 long-term care Medicaid figures:

Married applicants. When one spouse applies and the other stays at home, spousal impoverishment protections generally apply, so the spouse at home can keep a share of the couple’s assets and may receive part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services CHOICES can cover

Services under CHOICES are authorized through the plan of care and can include:

• care coordination
• personal care visits and attendant care
• home-delivered meals
• adult day care
• assisted care living facility services
• community living supports
• in-home respite and short-term inpatient respite
• personal emergency response systems
• minor home modifications
• pest control
• nursing facility care (Group 1)
• consumer direction

What is usually not covered. Waivers pay for care and support, not rent, food or other living costs, so in an assisted living or residential setting the person usually pays room and board from their own income. Plans of care are built around any unpaid help family already gives, and doctor, hospital and drug coverage continue separately.

How to apply for CHOICES

Here is how applying for CHOICES usually works. Filing the Medicaid application and the waiver request together saves time.

1. Contact the local Area Agency on Aging and Disability (AAAD), or the TennCare health plan if already a member, to request CHOICES.
2. A PreAdmission Evaluation is completed to show level of care or at-risk status.
3. Apply for TennCare long-term care financial eligibility.
4. The health plan’s care coordinator assesses needs and builds a plan of care.
5. Services start once enrollment is approved.

Staying organized. Copy every form before you send it and keep a simple call log. At the assessment, talk about the hardest days, not the best ones, and bring someone who sees the care needs firsthand. Supervision needs, confusion and falls matter as much as hands-on help. A denial notice explains the fair hearing process and its deadline.

Waiting lists and timing

CHOICES Group 1 has no enrollment target. Group 2 has a statewide cap, and Group 3 has an enrollment target (including a target of 3,750 for people who do not receive SSI, as of July 1, 2025). When the target is reached, people may wait, with some reserve capacity for priority cases such as hospital discharges. Nursing facility care (Group 1) is not limited this way.

Starting the process early keeps options open if a wait develops. Stopgaps can include state plan home care, adult day centers, PACE where it operates and local aging services. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

CHOICES Group 1 is nursing facility care, so moving between home and a nursing facility happens within the same program and health plan.

A move from home to a nursing facility, or back, generally happens within CHOICES rather than requiring a new program. In a nursing home, the member pays most of their income toward care and keeps a small personal needs allowance.

Tips for families

Network matters: check whether each plan includes the providers you already rely on. Get a written copy of the care plan, and if services are reduced, get the decision in writing and note the appeal deadline. Gather five years of financial records early, and get advice before moving money, because the look-back still applies.

Because CHOICES combines a care test, a money test and sometimes a wait, a Certified Medicaid Planner familiar with Tennessee can be a real help: checking finances against the 2026 limits, flagging look-back issues and keeping the application on track. Costs range widely, from about $150 to $600 an hour, about $500 to $6,000 for application help, and about $2,500 to $15,000 or more for full planning.

Related pages

• Tennessee Medicaid guide
• Miller trusts
• Managed long-term services and supports
• Nursing home level of care
• Fair hearings
• Dual eligibility
• The five-year look-back

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.