How Medicaid Can Help Pay for Long-Term Care in Tennessee

Q: Does Tennessee have a waitlist for home-based Medicaid long-term care?

Generally, no — CHOICES is notable for enrolling eligible applicants who meet financial and medical requirements on a rolling basis, unlike most states' HCBS waivers with multi-year waitlists. One enrollment group for lower-need, non-SSI applicants does have a smaller enrollment target, which functions differently than the higher-need groups.

Q: What is the annual spending cap under Tennessee's CHOICES program?

$18,000 per year for home and community-based services, excluding minor home modifications. This is a real ceiling on what CHOICES will spend on your care at home or in the community per year.

Q: What is the difference between CHOICES, ECF CHOICES, and Katie Beckett?

CHOICES is Tennessee's long-term care pathway for seniors and disabled adults. ECF CHOICES serves people with intellectual or developmental disabilities, administered separately through the Department of Disability and Aging. Katie Beckett is a distinct pathway for children with disabilities, based on the child's own income rather than their parents'.

Published August 28, 2026 How we keep this accurate

This page is Tennessee-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

Genuinely more accessible than most states' waivers

Tennessee's Medicaid program is called TennCare, and its long-term care pathway is CHOICES (Community Health Choices Options Initiative for the Community-based Elderly Support) — for seniors 65+ and disabled adults 21+ who meet a nursing-facility level of care. Unlike most states' HCBS waivers, which run enrollment caps and waitlists stretching for months or years, CHOICES enrolls eligible applicants who meet both financial and medical requirements on a rolling basis for higher-need groups — one of the more accessible home-based long-term care programs in the Southeast.

One nuance worth knowing: CHOICES Group 3, which serves lower-need, non-SSI applicants who don't yet meet the full nursing-facility standard, has a smaller enrollment target than the higher-need groups. If you're being considered for Group 3 specifically, ask directly about current availability rather than assuming the same rolling-enrollment rule applies.

A real spending ceiling worth planning around

CHOICES caps home and community-based services spending at $18,000 per year per person, excluding minor home modifications. This is a genuine, concrete limit — if your care needs would cost more than this annually through CHOICES, it's worth understanding upfront rather than assuming unlimited coverage.

Three separate pathways, easy to confuse

Program	Who it serves
CHOICES	Seniors 65+ and disabled adults 21+ needing nursing-facility-level care
ECF CHOICES	People with intellectual or developmental disabilities (separate DDA intake)
Katie Beckett	Children with disabilities, based on the child's own income, not parents'

Source: TennCare (Tennessee's Medicaid program), Bureau of TennCare; figures effective 2026.

The 2026 financial numbers

Income limit: $2,982/month (300% of the federal benefit rate) for nursing home care and CHOICES alike.

Asset limit: $2,000 for a single applicant — the standard federal figure.

Community Spouse Resource Allowance: $32,532 to $157,920 — notably, Tennessee's maximum sits slightly below the $162,660 federal ceiling most other states use.

60-month look-back applies to nursing home Medicaid and CHOICES alike, with real legal exceptions (spousal transfers, transfers to a disabled child, sole-benefit trusts) — but nothing to attempt without an elder law attorney's review.

A real investment in the system

In July 2025, TennCare's Long-Term Services & Supports division launched a $50 million, five-year investment in its HCBS provider network, aimed at expanding community-based care capacity statewide — worth knowing as context for why CHOICES has been able to maintain more accessible enrollment than many comparable programs.

How to actually start

Apply through TennCare Connect at TennCareConnect.tn.gov or call 1-855-259-0701 — the LTC Help Desk at 1-877-224-0219 can help with referrals and eligibility questions specifically.

If a gift or asset transfer is being considered ahead of applying, talk to an elder law attorney first — see Questions to Ask an Elder Law Attorney before doing anything inside the 60-month look-back window.

Common Questions

Does Tennessee have a waitlist for home-based Medicaid long-term care?

Generally no for higher-need applicants — CHOICES enrolls on a rolling basis, unlike most states' multi-year waitlists.

What is the annual spending cap under Tennessee's CHOICES program?

$18,000/year for HCBS, excluding minor home modifications.

What is the difference between CHOICES, ECF CHOICES, and Katie Beckett?

CHOICES serves seniors and disabled adults; ECF CHOICES serves I/DD populations separately; Katie Beckett serves children based on their own income.