The Tennessee CHOICES program is TennCare’s long-term care benefit for seniors age 65 and older and adults 21 and older with a physical disability. It pays for nursing home care or, more often, for the help that lets people stay in their own homes: personal care, meals, home modifications, adult day care, and similar supports. To qualify in 2026, your gross monthly income generally cannot exceed $2,982, your countable assets must be at or below $2,000, and a state assessor must confirm your care needs meet the right level for the group you’re applying under.
Who CHOICES Covers
CHOICES places every participant in one of three groups, and the group decides where you receive care and how much the program will spend on you.1TennCare. CHOICES
Group 1 is for people of any age who live in a nursing facility. It is the only group without an age restriction.
Group 2 is for adults 21 and older with a physical disability, and for seniors 65 and older, who meet the nursing facility level of care but would rather receive services at home or in a community setting such as an assisted care living facility. Group 2 has no published annual dollar cap on services, but slots can carry a waitlist depending on funding.
Group 3 is for the same age groups when the person does not yet need nursing home care but is at risk of getting there without help. Group 3 participants must already be receiving Supplemental Security Income from the Social Security Administration, and their services are capped at $18,000 per year (minor home modifications don’t count against the cap).2East Tennessee Human Resource Agency. CHOICES
Across Groups 2 and 3, the covered services include personal care and attendant care, home-delivered meals, a personal emergency response device, adult day care, respite for your regular caregiver, assistive technology, minor home modifications like grab bars and ramps, companion care, and community-based residential alternatives. Your managed care organization builds the specific care plan after you’re approved.
Financial Eligibility
CHOICES uses the standard Medicaid long-term care rules: tight limits on income and on what you own.
Income
Your gross monthly income cannot exceed 300 percent of the SSI Federal Benefit Rate. The 2026 SSI rate is $994, which sets the CHOICES income cap at $2,982 per month.3Social Security Administration. SSI Federal Payment Amounts The cap adjusts each January with the cost-of-living increase.
Being over the limit does not automatically disqualify you. Tennessee allows a Qualified Income Trust, sometimes called a Miller Trust, which is an irrevocable trust where you deposit the income that pushes you past $2,982. Money in a valid trust doesn’t count toward eligibility. The trust must name the State of Tennessee as the sole remaining beneficiary at your death, and the trustee must distribute nearly all deposited funds each month, keeping no more than $20 for trust expenses.4TennCare. ABD Trusts Policy Manual Setting one up usually requires an attorney, and it has to be in place before your eligibility date.
Assets
Countable assets for an individual applicant generally cannot exceed $2,000. Several things don’t count: your primary home as long as you intend to return or a spouse still lives there, one vehicle, personal belongings, household furnishings, a small amount of life insurance, and prepaid burial contracts or irrevocable funeral trusts.
The Five-Year Look-Back
Tennessee reviews your financial transactions for the 60 months before you apply. Reviewers are looking for assets you gave away, sold under market value, or transferred to get below the $2,000 ceiling. Disqualifying transfers trigger a penalty period during which CHOICES won’t pay. This is where many applications fall apart, so any planning around assets needs to happen well before you apply, not in the weeks leading up to it.
If You Have a Spouse at Home
Federal spousal impoverishment rules protect the spouse who isn’t the one needing care. For 2026, the community spouse can keep up to $162,660 in countable assets under the Community Spouse Resource Allowance. On the income side, the community spouse is entitled to a Minimum Monthly Maintenance Needs Allowance of $2,705 per month (effective July 1, 2026).5Medicaid.gov. 2026 SSI and Spousal Impoverishment Standards If the community spouse’s own income falls short of that floor, some of the applicant’s income can be redirected to make up the difference. Families who believe the standard allowance doesn’t cover their real expenses can request a fair hearing for a higher amount.
Medical Eligibility
Clearing the money rules is only half the test. A state-contracted nurse or assessor comes to your home or current care setting to perform a Pre-Admission Evaluation, observing your functional abilities and your living environment.
For Groups 1 and 2, you must meet the nursing facility level of care. In practice, that means you need substantial help with activities of daily living such as bathing, dressing, eating, toileting, or moving around, or you have a medical condition that requires the kind of monitoring a nursing home provides.1TennCare. CHOICES
Group 3 uses a lower threshold. You don’t need to qualify for nursing home care, but the assessor has to find that without basic help with personal care, meals, or safety monitoring, you’d likely end up there.1TennCare. CHOICES The evaluation determines both whether you qualify and which group you land in.
How to Apply
Where you start depends on whether you already have TennCare.
If you’re already enrolled in TennCare, call the managed care organization listed on your TennCare card and ask them to begin a CHOICES referral.6TennCare. How to Apply
If you don’t have TennCare, call your local Area Agency on Aging and Disability at 1-866-836-6678. The toll-free line routes you to the nearest regional office, and an AAAD representative can come to your home to help you complete the application. That home visit option matters if mobility is already a problem. Even if you ultimately don’t qualify for Medicaid, the AAAD can point you to other programs. For general questions, the LTSS Help Desk is at 1-877-224-0219.6TennCare. How to Apply
What to Gather Before You Apply
Missing paperwork is the single most common reason applications stall. Pull these together early:
- Government-issued ID, birth certificate, and Social Security card.
- Bank statements for every account going back five years, plus records for investments, CDs, and other holdings.
- Deeds for any real estate and titles for any vehicles.
- Life insurance policies and any prepaid burial or funeral contracts.
- Current diagnoses, treatment history, and contact information for your primary care doctor and specialists.
Start with the five years of bank statements. That piece takes the longest, and the look-back review hinges on it.
Timeline and What Happens Next
CHOICES applications run on a 90-day decision window, longer than the 45 days for standard TennCare, because of the added medical review.7TennCare. TennCare Frequently Asked Questions Your medical file goes through the Pre-Admission Evaluation while the Department of Human Services reviews your finances. Both tracks have to end in approval. You’ll get a written notice in the mail with the result, your group placement if approved, and the name of the managed care organization that will handle your services.
If You’re Denied
A denial is often fixable, especially when it comes down to missing documents rather than real ineligibility. You can file an eligibility appeal by calling TennCare Connect at 855-259-0701, logging into your account at tenncareconnect.tn.gov, or sending a written appeal by mail or fax using the instructions on your denial notice.8TennCare. How to File an Eligibility Appeal
If you were already getting CHOICES services and you file your appeal before the state’s reduction or termination takes effect, your benefits keep running until the hearing is resolved.9Medicaid.gov. Understanding Medicaid Fair Hearings An expedited hearing is available if waiting could seriously harm your health. The state generally has 90 days from receiving your appeal to issue a decision on CHOICES cases.8TennCare. How to File an Eligibility Appeal