Check Out Latest Data on Who is Supported by Employment and Community First CHOICES

/ July 7, 2020

By Janet Shouse

As many of you know, Employment and Community First CHOICES is Tennessee’s newest Medicaid waiver program offering home and community-based services to individuals with intellectual and developmental disabilities. I recently asked Matthew Brown, the director of Employment and Community First CHOICES, for an update on the program, and he was kind enough to gather all this data for me. (I hope you find it as interesting as I do.)

One thing I often hear is that ECF CHOICES, which launched in July 2016, is strictly for adults, because the name of the program is EMPLOYMENT and Community First CHOICES, and little kids aren’t employed. But the program DOES serve children. It is open to people with IDD of all ages.

As of June 11, 2020, there are 242 children ages 0-18 being served in the program. Many of these are children would not otherwise qualify for Medicaid/TennCare and are eligible only by waiving the deeming of the parents’ income to the child—this is the Katie Beckett eligibility mechanism currently applied in ECF CHOICES. (Once the Centers for Medicare and Medicaid Services approves Tennessee’s new, separate Katie Beckett waiver program, and it’s implemented, children who qualify for TennCare only if their parents’ income or assets isn’t counted will be directed to the new Katie Beckett program. However, children who ARE eligible for TennCare could still qualify for ECF CHOICES.)

Matt emphasized, however, that except for “reserve capacity slots,” enrollment into ECF CHOICES is based on a prioritization framework, which was developed with advocacy partners that favors age groups focused on employment.  These include youth of transition age who are planning for employment (so yes, under age 16 because in Tennessee, transition planning begins at 14), but do not generally target younger children. The idea behind this prioritization is the importance of helping young people move from the structure and routine of school into the structure and routine of work, without having to wait a year or two to become employed.

Several of the reserve capacity groups do however include younger children, such that we see in the enrollment numbers for those ages 0-18 listed above.

Here’s a breakdown of enrollment numbers by age as of June 11:

  • 0-9: 19
  • 10-15: 65
  • 16-20: 512
  • 21-25: 1,166
  • 26-30: 527
  • 31-35: 277
  • 36-40: 155
  • 41-45: 118
  • 46-50: 91
  • 51-55: 100
  • 56-60: 98
  • 61-70: 79
  • 71-80: 20
  • 81+: 3

I learned in talking with Matt that TennCare does not collect data on racial or ethnic makeup, as this information is optional for an applicant to share.  Because that data is not complete, the program does not track these demographics. Matt said this information has no impact on enrollment into ECF CHOICES or the ability to receive services.

Male/female (as of June 11)

  • Female: 1,213
  • Male: 2,017

Those with intellectual disability vs. those with developmental disabilities:

  • ID: 1,404 (43.6%)
  • DD: 1,826 (56.4%)

Numbers supported in each group as of June 11 (You can see the specifics of each group—ages, eligibility–listed here):

  • Group 4: 869
  • Group 5: 1,499
  • Group 6: 828
  • Group 7: 18
  • Group 8: 16
  • Total: 3,230
Matthew Brown smiling

Matthew Brown, Director, ECF CHOICES

Another concern that I often hear is that once an individual is enrolled in ECF CHOICES, they may wait a long time before services begin. So, I asked Matt about this issue. He said that this is information TennCare monitors and tracks on an ongoing basis.

“Of the thousands of people enrolled in the program, 62 members have been enrolled in the program for at least 30 days and have not yet begun receiving services for a variety of reasons—in some cases, because the family has requested additional time to select providers, or because the family has elected to use consumer direction and has not yet identified workers,” Matt said.  “We work with MCOs (managed care organizations) on a regular basis regarding any individuals for whom services have not yet begun to ensure that services are provided as needed.”

Of course, I had to ask about the number of people on the waiting list or the “referral list” as it is called now. As of June 11, there were 5,246 individuals on the referral list.

  • 4,006 are actively seeking to receive services at this time.
  • 1,240 are deferred—meaning they do not actively want services at this time but want to remain on the list for future needs.

The final question that I had for Matt was about funding for additional slots for the program. Earlier this year, when Gov. Bill Lee unveiled his budget plans for the state, his budget included 2,400 new spots for ECF CHOICES. As the pandemic hit our nation, and states issued recommendations to stay at home, businesses suffered, and tax revenues dropped dramatically. In addition, COVID-related Medicaid expenditures increased significantly. State budget cuts had to be made, and most of the newly approved funding for ECF CHOICES was lost, including all of the funding that had been approved to serve 2,000 new people from the waiting list. Only 300 of the 2,400 new slots remain funded–these are for people who must be enrolled into services during the coming year.  This includes people in crisis circumstances, children aging out of state custody, and individuals discharged from institutions.  It also includes individuals with aging caregivers for whom enrollment is required by state law. These slots were funded through “attrition” dollars from the HCBS waivers operated by DIDD—funds that are available to serve additional people with IDD as individuals leave those waivers for a variety of reasons. Additionally, as members disenroll from ECF CHOICES, slots are opened back up to be filled by other individuals.

I very much appreciate Matt’s willingness to gather this information and share it, as I’m sure he had other things that he needed to do. And I appreciate the work TennCare is doing to help individuals with intellectual and developmental disabilities to be able to work and participate in their communities. As always, if you have questions or concerns about this post or related information, please email me at, and I will strive to find answers to your questions. Thanks for reading, and please stay safe!

Janet Shouse smilingJanet 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.

July 7, 2020

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