Agreement Aims for Seamless Employment Supports Provided by Voc Rehab and Tenncare’s Employment and Community First CHOICES

/ June 6, 2017

By Carrie Brna

About the Author

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Carrie Brna is the Housing and Employment Specialist in the Division of Long Term Services and Supports at the Bureau of TennCare. Carrie leads the Bureau’s housing and employment initiatives for all LTSS programs. Prior to joining the Bureau, Carrie worked as a travel trainer in Chicago, supporting people with disabilities and older adults to learn the accessibility features of the fixed route public transportation system. She holds a Master’s degree from the University of Illinois at Chicago in Disability Studies.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email


Navigating state agency systems and programs can be burdensome and confusing for anyone (yes, even state employees!), but when two agencies provide the same or similar services, navigating systems becomes even more complicated.

With the launch of TennCare’s new Employment and Community First CHOICES program, a new set of employment services was implemented in order to help people with intellectual and developmental disabilities achieve their competitive, integrated employment goals. But wait– doesn’t Vocational Rehabilitation also provide employment services for people with disabilities? The short answer is yes, but the long answer demands a deeper look at what employment services each agency offers, and ends with the question of how do we serve the “common customer” (someone eligible for both ECF CHOICES and VR services) in a manner that ensures an efficient use of resources and effective, non-duplicative delivery of services.

With this question in mind, TennCare and Vocational Rehabilitation recently finalized and soon will begin implementing a Memorandum of Understanding, with the goal of providing high-quality employment services for people with disabilities that lead to competitive employment in a seamless manner. In other words, this agreement will help people achieve their employment goals and seamlessly transition between ECF CHOICES and VR services without experiencing a disruption in their employment supports. This MOU marks the beginning of an exciting new partnership between the two state agencies.

The MOU accomplishes this “simplification” of the two state agency programs by clearly outlining how someone will transition between VR and ECF CHOICES employment services, the points in time that require communication between each agency’s staff that work directly with the “common customer”: VR counselors and ECF CHOICES support coordinators, what documents need to be shared, and when this sharing needs to occur.

In addition, the MOU goes into great detail about timelines and expectations of sharing responsibility for serving the “common customer,” in order to hold each agency accountable for the employment services they provide. In fact, the high level of detail and clear explanations of which agency does what and when has made this MOU a model for the nation, as other states are now using it as a resource to develop similar MOUs between their VR and Medicaid programs.

TennCare and VR knew that it wasn’t enough to just sign the MOU.  They didn’t want to see it placed on a shelf to gather dust. The agencies needed to train their staff in order to ensure implementation of the new processes and guidelines. With this goal in mind, TennCare and VR set off on a statewide tour to train the VR counselors and ECF CHOICES support coordinators on the new MOU. These trainings provided the opportunity to deliver a cohesive message about the process of sharing and jointly serving the “common customer,” and more importantly, brought the staff together from both agencies to begin to build rapport and put faces to names (and email addresses!). I know I am more likely to respond quickly to an email or request from someone I know, and so we applied this same logic to our regional training sessions.

Under the MOU, TennCare is responsible for the following pre-employment services (if needed):

  • Exploration, which helps a person make an informed choice about whether he or she wishes to pursue individualized integrated employment or self-employment, helps identify a person’s specific interests and aptitudes for paid work, and may include business tours, informational interviews and/or job shadowing to learn about local opportunities that may be a good fit.
  • Discovery, which helps a person who wants to pursue employment to look at his or her strongest interests toward specific aspects of the labor market; the skills, strengths and other contributions likely to be valuable to employers; conditions necessary for successful employment; and provides assistance to apply to VR.
  • Benefits counseling, which helps someone decide if he or she wants to work and to examine the financial ramifications of working on their state and federal benefits, such as TennCare or Medicare and Supplemental Security Income or Social Security Disability Income.
  • Integrated Employment Path, which provides learning and work experiences, including volunteering opportunities, where a person can develop general, non-job-task-specific strengths and skills that contribute to employability. Services should be customized to provide opportunities for increased knowledge, skills and experiences specifically relevant to the person’s work goals. Training would focus on the ability to communicate effectively with supervisors, co-workers and customers; generally accepted workplace conduct and dress; ability to follow directions; ability to attend to tasks; problem-solving skills and strategies; and general workplace safety and mobility training.

When someone doesn’t know if he or she wants to work, ECF CHOICES will authorize Exploration. Then when someone decides they do want to work, they will move into Discovery, and at the beginning of Discovery the ECF CHOICES support coordinator will make the referral to VR. The aim is that when Discovery is completed, the VR eligibility determination will also be complete, and VR will pick up employment services from that point, through development of the Individual Plan for Employment (IPE).

If someone is eligible for VR, then the expectation is that VR will be the first payer for these services:

  • Job development or self-employment start-up
  • Job coaching to achieve job stabilization
  • Benefits counseling needed while a person is actively seeking competitive integrated employment

ECF CHOICES then picks up long-term employment supports (if deemed necessary) by providing one of the following:

  • Job Coaching for Individual Integrated Employment
  • Job Coaching for Self-Employment
  • Co-Worker Supports

The goal is that someone will not encounter issues with the transitions between ECF CHOICES and VR.  The transitions SHOULD be essentially invisible to the member– especially if his or her provider is both an ECF CHOICES and a VR provider).  The MOU also makes commitments between the programs to align their provider networks so common customers can have continuity of supports. We expect the ECF CHOICES support coordinator to be in frequent contact with the member while receiving VR services and to assist if or when there are issues and to help to resolve them. The VR counselor can also be contacted for assistance. Ultimately,  it’s just going to depend on the situation and with whom the member prefers to speak – but the goal is that the ECF CHOICES support coordinator and VR counselor are working as a team to support the common customer.

If anyone would like to read the Memorandum of Understanding, you can email Janet Shouse at, and she will send you a copy.

We know people with disabilities, and particularly people with intellectual and developmental disabilities, face barriers to finding integrated, competitive employment. The state agencies tasked with facilitating employment should never be one of those barriers. Our hope is that this Memorandum of Understanding will help ensure that every person enrolled in ECF CHOICES can find a smooth path to employment with the collaborative work of the ECF CHOICES program and VR.

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