Employment and Community First CHOICES Program Hits a Milestone

/ April 4, 2017

By Janet Shouse

About the Author

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Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.

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 janet.shouse@vumc.org.


I recently received an update on Tennessee’s new Employment and Community First CHOICES waiver program, and while many of you may have seen the “Advocates Newsletter,” I am sure many of you have not. I want to share some of that information with you.

In mid-March, enrollment in the ECF CHOICES program hit 1,000. Many people consider this a big milestone, and that it indicates the program will fill the 1,700 slots budgeted for the 2016-2017 year, which ends June 30.

“The partnership and commitment from the advocacy community has helped to make this program a success. Together, we are helping individuals with intellectual or developmental disabilities better integrate into their communities, develop independent living skills, participate in training activities, learn job skills, explore employment opportunities, and find meaningful jobs in their communities,” the newsletter says.

So, thank you to all the folks in the advocacy community who helped get the word out that this new program was available to assist individuals with disabilities and their families! And congratulations to the individuals and families who applied and have been able to enroll!

Tennessee is leading the way with the Employment and Community First CHOICES waiver program, and I appreciate that fact, because many people with disabilities want to work. I also know that the initial rollout, starting on July 1, 2016, hit some significant bumps along the way. I know from hearing personal stories that a number of individuals have experienced difficulties in enrolling, in getting appropriate services in a timely manner, in being able to use what is called “consumer-directed” services, and as always, finding appropriate transportation. But I also know that a number of individuals are now employed and getting services to help them stay employed and participate to a greater degree in their community, which is exactly what the program is aimed at doing. That is wonderful!

TennCare reports that 94% of the people in the program are in a priority category that places them on the pathway to employment. The individuals are either planning or preparing for integrated employment or now working in a job along with people without disabilities. Yay!

As you may know, there are three benefit groups in the Employment and Community First CHOICES program, and there are enrollment targets for each group, based on the funding appropriated by the Tennessee General Assembly. Two of the three groups still have open slots.

The Essential Family Supports (Group 4) provides services for families caring for a child under 21 who has an intellectual or developmental disability who lives at home. Adults who are age 21 or older with IDD who are living at home with their family can also choose to enroll in this program, if they qualify. Funding for 500 people has been allotted for this group. If all of the people in the intake process for Group 4 qualify, the enrollment target will be met very shortly. Therefore, TennCare is processing new referrals for intake into Group 4 only as a slot becomes available. However, TennCare wants to encourage individuals potentially eligible for Group 4 to continue to self-refer – even if the program is at the enrollment cap. Certain individuals may qualify for an exception to the enrollment caps, which are explained further in the program rules.

Essential Supports for Employment and Independent Living (Group 5) provides services for adults age 21 and older who have an IDD but do not qualify for the level of care in a nursing home. (A person age 18-21 with IDD may be enrolled in this group, if the person cannot live with his or her family anymore.) TennCare has funding to serve up to 1,000 individuals in this group. A number of open slots in Group 5 still exist, and people may continue to be enrolled in this group as they qualify.

Comprehensive Supports for Employment and Community Living (Group 6) provides services for adults 21 and older who would qualify to get care in a nursing home. (A person age 18-21 with IDD may be enrolled in this group, if the person can no longer live with his or her family.) The person must qualify for nursing home care, but this program will provide care at home and in the community. Comprehensive Supports are for people who need more services to help them live in the community and achieve their employment and community living goals. Funding for 200 people was allotted for this group. Since TennCare still has a number of open slots in Group 6, all new referrals for Group 6 will be sent for intake right now.

For a listing of the priority categories for Groups 5 and 6, see this list.

The program encourages those or working age to explore what work might mean for them. This process involves exploration and discovery – and takes time. The definition of work is flexible, and jobs can be tailored to each individual.

Overall, TennCare has received more than 2,200 self-referrals. However, the referral list stands at more than 6,200, and includes about 4,000 individuals with intellectual disabilities who are actively seeking services and about 2,000 individuals with ID who say they may need services in the future who had been on the waiting list for the Department of Intellectual and Developmental Disabilities. TennCare, to its credit, sent a second letter to those who had been on the DIDD waiver waiting list in February that explained in plainer detail the need for individuals on that waiting list to apply/self-refer for the new waiver program in order to be evaluated for eligibility for the new program.

I had heard that many families who received the first letter about ECF CHOICES last July did not understand the individual had to make a self-referral, and they were, instead, waiting on someone to contact them to enroll the individual. So I appreciate TennCare’s effort to reach out and clarify that information.

If you know someone who you think might be eligible or who has been on the DIDD waiver waiting list and you think might not have applied for the new program, please encourage him or her to complete the self-referral form:


I am glad to learn that TennCare has requested and Gov. Bill Haslam has recommended funding to serve up to 700 new people in the ECF CHOICES program next year. If the General Assembly approves this funding, enrollment in all three groups is expected to resume around July 1.

As always, if you have questions, please email me at janet.shouse@vumc.org or post your questions below. I will seek to get answers.

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