New ECF CHOICES Director Has Served Many Roles in Provider Agencies

By Amber Cockings

About the Author

Amber Cockings is the director of Employment and Community First CHOICES program at TennCare.

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.

For many of you, this is my first opportunity to reach out and introduce myself.  My name is Amber Cockings, and in February I was hired by TennCare as the director of Employment and Community First CHOICES program. My primary role is managing and directing the ECF CHOICES program to support the achievement of employment and other quality-of-life outcomes for persons with intellectual and/or developmental disabilities.

When I was in college at Hendrix College, in Conway, AR, I was hired by Easter Seals to work one on one with a child with intellectual disabilities and cerebral palsy in new program called “Waiver.” I absolutely fell in love with him, his family, and the work. I have been hooked since then. I finished my bachelor’s degree, traveled, had a lot of fun, and then returned home to Little Rock, AR, to “settle down.”

I started as a case manager in the waiver world and worked my way up for the next 25 years. I have done almost every job in a community provider agency. I have been a case manager, van driver, direct support professional, program director for various services, as well as an administrator.

During this time, I got married, renovated old houses, completed my master’s degree, adopted my two girls from the foster care system and watched them grow up and go off to college. With our children grown, my husband and I felt it was a perfect time to make a big change. My husband had a wonderful opportunity here in Nashville, so I quit my 25-plus-year job, and we moved!

I am thrilled to be working with this special group of people once again. I am obviously on the state side of things now and have a lot to learn, but I am enjoying the challenge of this new experience. I am inspired by the vision and passion of the people around me at TennCare, but as always, my favorite thing to do is to work with individuals with disabilities, their families and advocates. I have already had opportunities to do this and look forward to working with them even more.

But enough about me! Many exciting things are happening at TennCare. There are two new opportunities for people with IDD in Tennessee; the addition of Group 7 and Group 8 in ECF CHOICES and the legislative approval for a new “Katie Beckett” waiver.

Group 7 and Group 8 will focus exclusively on children and adults with IDD with significant behavioral health needs. Group 7 will provide Intensive Behavioral Family Supports for children under the age of 22 who live at home with family caregivers and have IDD and severe co-occurring behavioral health and/or psychiatric conditions. These co-occurring conditions may:

  • Place the child/youth) or others at significant risk of physical harm (but that does not rise to the level of inpatient treatment or for which such treatment would not be appropriate)
  • Significantly strain the family’s ability to adequately respond to the needs of the child/youth
  • Threaten the sustainability of the family living arrangement and place the child/youth at imminent and significant risk of placement outside the home (e.g., state custody, hospitalization, residential treatment, incarceration).

Group 8 provides Comprehensive Behavioral Supports for Employment and Community Living for adults age 21 and older, unless otherwise specified by TennCare, with IDD and severe behavioral and/or psychiatric conditions, who are:

  • Transitioning out of a highly structured and supervised environment
  • Meet nursing facility level of care
  • Need and are receiving specialized services for IDD.

TennCare and our managed care health plans have laid the foundation to provide these services. We continue to wait for approval by the Center for Medicare and Medicaid Services and expect this any day now.

As many of you know, the Tennessee General Assembly passed a bill this spring that proposes to create a new waiver program for children under age 18. These are children who have disabilities or complex medical needs, and do not qualify for Medicaid because of their parents’ income or assets (like bank accounts or other property). This type of program is frequently referred to as the “Katie Beckett” waiver. The waiver originated in the early 1980s, when the parents of a young child named Katie Beckett fought to overturn a Medicaid regulation that would have forced the child into a nursing home. After she was hospitalized for several years due to encephalitis, her doctors determined that she could be treated at home, given appropriate support. And her family won their battle to get Medicaid support to care for their child at home.

The new Tennessee bill directs TennCare to ask the federal government to approve a program that would have two parts or groups. Part A would serve children with the most significant disabilities or complex medical needs. These are children who would qualify for care in an institution but want care at home instead. Their parents’ income and assets would not be counted in determining their eligibility for Medicaid. If they qualify, they would receive full Medicaid benefits to help pay for care their private insurance doesn’t cover. They may also receive home and community based services for other things they need that Medicaid and private insurance do not cover. Parents may be required to purchase private insurance and pay premiums for Medicaid (on a sliding fee scale based on income) to help offset program costs.

Part B would also serve children with disabilities or complex medical needs.  But they may not qualify for care in an institution. Children in Part B would not be enrolled in Medicaid.  They would receive up to $10,000 per year in services to help them cover the cost of private insurance premiums and things their insurance does not cover.  The Department of Intellectual and Developmental Disabilities would run Part B.

The earliest we expect people could begin enrolling in the new program is 2020.  This is because there are many steps we must to take to start a Katie Beckett program. We must make sure the program is approved by the Center for Medicare and Medicaid Services, and then we begin the long process of putting the program into effect. We know people are anxious to get these services started and to sign up for the new program, so TennCare and DIDD are working on a process to begin collecting interest forms at the DIDD Regional Offices. To get this information and to stay up to date on the Katie Beckett program as we move forward, go to: https://www.tn.gov/tenncare/long-term-services-supports/katie-beckett-waiver.html OR https://www.tn.gov/didd/katie-beckett-waiver

I look forward to working alongside all of you to make a difference in the lives of those we serve. If anyone has any questions or just wants to know more about Employment and Community First CHOICES, you are welcome to contact me at: amber.cockings@tn.govor call 615-253-5452.


I want to thank Amber for taking the time to share some information about herself and why she has taken on this role with ECF CHOICES. I am also extremely pleasantly surprised to see that Amber has included her email address and her phone number. This is important information, and for those of you who are involved with ECF CHOICES, you may want to tuck that away for future use. I am looking forward to working with Amber in the coming years, and I am delighted to have her in Tennessee. Thank you, too, Amber for the information about Groups 7 and 8. I know many families are very interested in these options. If you have questions, you are, as always, welcome to email me at janet.shouse@vumc.org. Thanks for reading!