Get the Latest Numbers on Employment and Community First CHOICES Enrollment

/ December 13, 2016

By Janet Shouse

About the Author

Janet Shouse smiling outside

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

As most of you know, the state of Tennessee rolled out its new waiver program in July, the state’s first waiver program focused on employment and that includes individuals with developmental disabilities who don’t have an intellectual disability. The program is called Employment and Community First CHOICES. Many of us in the disability community have been waiting for years for such a program, so we are eager to hear what’s going on.

But first let’s have a brief recap of what a Medicaid Waiver is. Medicaid provides both medical and non-medical services. The non-medical services are known as “long term services and supports” or (LTSS). Many individuals with developmental disabilities and/or intellectual disabilities need long term services and supports. Years ago, such services were only available if a person lived in an institution, such as a developmental center or nursing home. Waivers allow states to apply to ‘waive’ certain requirements, including the requirement to provide services in institutions. Waivers allow individuals with disabilities to receive home- and community-based services rather than having to move into a nursing home or other institutional setting.

The Employment and Community First CHOICES waiver program offers a range of services. The focus is, of course, on employment, and this program offers 14 employment-related services, including job development, job coaching and benefits counseling to help individuals and families understand how a person can work and still receive vital benefits and services. Other services include such things as independent living skills, transportation, community living supports, personal assistance and assistive technology.

Carrie Brna, the housing and employment specialist in the Division of Long Term Services and Support for TennCare, shared an update with me last week on the new waiver program. The state opened the ECF CHOICES program with 1,700 slots for this first year, which will end on June 30. As of Dec. 5, 2016:

  • 589 individuals with disabilities have been enrolled since July 1.
  • Of those 589, 54% have a diagnosis of developmental disability; 46% have a diagnosis of intellectual disability.
  • Currently, 244 people have been deemed eligible, but the person is still in the process of being enrolled.
  • Group 5, which is called Essential Supports for Employment and Independent Living and targets transition-age youth 18 to 22, leads enrollment, with 363 people from that group enrolled.

The Employment and Community First CHOICES program has three benefit groups:

  • Essential Family Supports, which is primarily for children under 21, but can include adults who are still living with family and is designated as Group 4.
  • Essential Supports for Employment and Independent Living, which is designated as Group 5.
  • Comprehensive Supports for Employment and Community Living, which is for people over age 21 who have more intense needs and is designated as Group 6.

In addition to these three benefit groups, there have been eight “priority categories” created to prioritize enrollment and prevent a flood of enrollees from overwhelming the managed care organizations, which are responsible for providing and contracting for these services.

The priority categories are:

1. Individuals who are currently employed and need supports to keep their job.
2. Transition-age youth ages 18 to 22 who want to work, have a job lined up after they exit school and need supports to be successful in that new job.
3. Individuals who have recently become unemployed and need supports to find and keep a new job.
4. Transition-age youth ages 18 to 22 who want to work, but who do not have job lined up, and will need supports when they find a job.
5. Individuals who are currently unemployed and have a job lined up, but need supports to keep the job. (The majority of people enrolled in ECF CHOICES so far have come in through this Priority Category 5 — 261 individuals.)
6. Individuals in Group 4 (those of working age who live at home) who want to work and need supports to do so.
7. Adults and transition-age youth who are not currently committed to working, but are willing to explore potential employment options if pre-employment supports are available.
8. Individuals age 62 and older who are not interested in pursuing employment, but need supports to actively participate in their communities and sustain integrated community living. (Individuals age 55 and older may be included in this group if they have more significant disabilities or health conditions that significantly impact their ability to work.)

As you can see, the priority categories are focused on keeping those who are employed in their jobs, getting those who want employment into a job, and helping those who are willing to consider a job to explore the options of employment.

Finally, there are “reserved slots.” These slots will go to:

  • Individuals whose caregivers are 75 years old or older.
  • Those in “emergent” situations, such as when an individual’s caregiver has died or become incapacitated or when an individual’s behavior becomes a threat to himself or others.
  • Individuals with multiple, complex health conditions and significant needs for support.

If my calculator serves me correctly, when I subtract the 833 slots for those individuals who are enrolled or deemed eligible from the 1,700 currently funded slots, I get 867 slots to be filled between now and June 30, 2017. I personally believe it is vitally important that these 867 slots be filled by June 2017. For years, many of us in the disability community voiced concerns about lengthy waiting lists for people to get services. I hope that those who have been waiting seize this opportunity to receive the supports and services that they need to enjoy Employment and Community First living.

If you know an individual or a family who could benefit from the services offered by the Employment and Community First CHOICES waiver program, I would encourage you to share information about the program with them. Some brief information and the self-referral form can be found at 

More detailed information about the program can be found in the TennesseeWorks blog archive, starting with the March 29 blog post at

As always, if you have a comment or a question, you can share your concern in the comments below, or you can email me at

My thanks to Carrie Brna for providing the updated numbers and answering my multitude of questions.

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