What is the Employment and Community First CHOICES Working Disabled Group?

/ July 18, 2023

By Gary Smith

TennCare’s Employment and Community First CHOICES is a long-term services and supports program funded by Medicaid, as many of you know. ECF CHOICES is for people of all ages who have an intellectual or developmental disability. The intent of the program is to help its members to gain as much independence as possible and to create a “pathway” to employment based on each individual’s specific needs. All services are offered in the home or in community-based settings. In order to qualify for ECF CHOICES, a person must be determined to be both medically and financially eligible. Today we want to highlight the ECF CHOICES Working Disabled Group, which is a relatively new but lesser-known way for individuals to meet the financial eligibility criteria for the program.

To qualify for ECF CHOICES, including the Working Disabled Group, an individual must be determined to qualify medically for what’s called “nursing facility level of care” or to be considered to be “at-risk” of nursing facility level of care. This does not mean that a person needs to actually be living in a nursing facility or even that a nursing facility is being considered, but that the needs of the individual are significant enough to require help.

Another part of the criteria for an individual to meet the Working Disabled Group is that the individual applying must have income from working. There are two income rules looked at for the Working Disabled Group. For the first test, the individual’s net countable income must be at or below 250% of the Federal Poverty Level. The Federal Poverty Level is an income amount that is adjusted and shared every year by the U.S. Department of Health and Human Services. Health and Human Services sets the standards to be used as comparison amounts to help calculate a number of things, including Medicaid eligibility. The Federal Poverty Level amount is different based on family size and changes every year. For 2023, 250% of the FPL for a household of one person is $36,450 per year.

When looking at an applicant’s financial eligibility for the Working Disabled Group’s first test, a process called “deeming” may also be used. Deeming means looking at how other people connected to the applicant may be helping to meet their basic needs of food and shelter. Deeming can be complicated. If an applicant is under the age of 18, sometimes the parent’s income and resources count through something called “parent-to-child deeming rules.”  All of this information is gathered and reviewed as part of completing the first test for the Working Disabled Group.

For the second test for the Working Disabled Group, the applicant’s earned income is subtracted from their net countable income. The resulting amount must be below what is referred to as the “Supplemental Security Income Federal Benefit Rate.” This is the maximum monthly SSI benefit amount for a couple or an individual. For 2023, the Supplemental Security Income Federal Benefit Rate is $914 per month for an eligible individual and $1,371 per month for an eligible couple.

If this all sounds complicated, it is. There are even more steps to this than what is described here. The good news is that applicants don’t need to know all of the details because this is automatically looked at as a part of the application process. But it’s important to understand that the system that processes this financial information is designed to look at every possible eligibility pathway, including for the ECF CHOICES Working Disabled Group.

To learn more about the Employment and Community First CHOICES program, including how to apply, you can go to https://www.tn.gov/tenncare/long-term-services-supports/employment-and-community-first-choices.html.

Or you can do a Google search by typing “Employment and Community First CHOICES TennCare.” If you have specific questions about the program itself, you can contact Gary Smith, the director of Employment and Community First CHOICES and Katie Beckett at Gary.A.Smith@tn.gov or the assistant director, Kati Snow, at Kathryn.R.Snow@tn.gov

My thanks to Gary Smith for his willingness to share information this particular part of the Employment and Community First CHOICES waiver program. Although I know this has been part of the waiver program for years, I have not had a good understanding of it. I appreciate the explanation! I also very much appreciate Gary and Kati Snow being willing to include their email addresses. I think their openness to hearing from individuals with disabilities and their families is huge! As always, if you have questions, you can contact me at janet.shouse@vumc.org. Thanks for reading!

Gary Smith has worked for more than 21 years as a public servant for the state. He is currently the director of Employment and Community First CHOICES and Katie Beckett programs with TennCare. Gary has also served as a director with both the state Department of Education and the Department of Human Services. Gary originally came to Tennessee to work for Tennessee Voices for Children. Gary is an advocate at heart and in each of these roles Gary has had a passion for serving vulnerable populations and for helping families get the support that they need.


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