CHOICES Group 3 Extended
In the past two years we have published a newsletter and several blogs related to changes in who was eligible for what type of care under TennCare/CHOICES. Prior to July 2012, there were two categories (Group 1 and Group 2) of people who qualified for care under CHOICES. Group 1 was for people who received services in a nursing facility; Group 2 was for those who received home and community-based services (HCBS). To qualify for either group, an individual only had to be unable to perform one activity of daily living without assistance.
Beginning in July 2012, CHOICES recipients were divided into three groups: Group 1 for those receiving services in a nursing facility; Group 2 for those receiving comprehensive HCBS; and Group 3 for “at-risk” individuals who could receive HCBS valued at up to $15,000 per year. To qualify for either Group 1 or Group 2, an applicant had to score between 9 and 26 on TennCare’s need acuity assessment. Group 3 was for those who scored below a 9 but who, due to specific types of disabilities, were deemed “at risk” of needing care in a nursing facility if they did not receive extra care in the community. From the beginning, Group 3 was meant to be a temporary measure which would expire at the end of 2013.
In recent months, TennCare has undergone further reform. In 2013, as the scheduled date for ending Group 3 approached, the Center for Medicare and Medicaid Services announced that CHOICES Group 3 enrollment would cease for everyone except SSI recipients effective January 1, 2014. This would have extended enrollment only for people who could qualify for SSI: those with income less than $720 per month who were also A) aged 65 or older or B) permanently and totally disabled according to Social Security. However, TennCare sent a request to CMS for an extension to keep Group 3 open through the end of June 2015. The request was approved on January 1st this year. As a result, open enrollment for CHOICES Group 3 continues and is not limited to only people who are eligible for SSI. It remains to be seen whether Group 3 enrollment will close at the end of June 2015 or be extended for some applicants beyond that time.
New TennCare/CHOICES Application Process
For many years, applying for Medicaid/CHOICES/TennCare has been a 45- day process in which the applicant’s file was submitted to a Department of Human Services (DHS) case worker who would review the file and request additional documentation to support the application during a follow up meeting. However, the Bureau of TennCare is attempting to streamline and standardize the way these applications will now be handled. As of January 1, 2014, we are looking at an entirely new process for applying for TennCare through the newly created Tennessee Health Connection center in Nashville.
The new application, called the Long-Term Services and Supports (LTSS) Application, is filed in a central office in Nashville through a government contractor, Cognosante. The local DHS office will no longer handle applications. The new application is longer than before and requests information about the entire household in which the applicant resides; however, much of this newly requested information is relevant to the decision on the application. All information provided in the application must also be supported by documentation. According to TennCare, specialized LTSS case workers will be assigned to review applications from specific counties, much as DHS case workers used to do. One of these case workers may contact the applicant during the review process to resolve questions or fill gaps in information.
A lot is still unknown about the new process. Among the things we still don’t know are where to file appeals when financial applications are denied (DHS, TennCare, or a contractor). Furthermore, the Medicaid Manual which has served as a guide for DHS case workers and professionals has been removed from the TennCare website. If and when TennCare re-publishes it and provides a written guide for new applications and policy, perhaps some of the mysteries will be solved. Until then, we are finding our way through a network of shared experiences among the elder law community.
The new application process is intended to cut costs. We are hopeful that it will also be a successful gateway for efficient and fair approval of applications. That is yet to be seen. Professionals who are helping clients to apply for TennCare will have to watch closely for updates and announcements related to the change.
Seeking help when confronted with difficult issues related to elder care is one of the most important steps toward reaching emotional stability, financial security, and overall peace of mind. Elder Law of East Tennessee helps all kinds of families to find care solutions that work for them. We provide support not only for our clients, but also for family members and other caregivers. We can also walk our clients through the process of applying for TennCare or other public benefits programs to help them get help financing care. If you have questions about elder care or legal issues, get in touch. We would love to help you find the answers and care tools you need.