At a glance
In July 2012, the State implemented new medical eligibility rules for CHOICES, which made it much more difficult to qualify for nursing facility care (Choices 1) or the full array of home and community-based services (Choices 2). At the same time, Choices 3 was created to provide more limited home and community-based services for people who could not meet the stringent rules but who nonetheless were at-risk for institutionalization because of health need. Choices 3 is for people whose disabilities require assistance to perform at least one essential activity of daily living. They don’t yet qualify for nursing home care, but they need a more moderate package of home and community based services to delay or prevent the need for nursing home care. Effective July 1, there will be no assistance for thousands of seniors who, until two years ago, would have qualified for nursing home care. Only individuals who receive SSI (income limit of $753 per month, mostly individuals with disabilities who do not have a significant work history) will be able to qualify for Choices 3. Because Choices 3 is closing soon, it is more important than ever to keep track of when your application for Choices is submitted. The State has 90 days to make a decision on a Choices application. Coverage should begin date of application. People who do not have a decision on July 1, but who have applied before that day should be eligible for Choices 3 if they’re approved. Source: The Tennessee Justice Center
Reba Robers, age 83, is photographed with her son, Doc Rogers, right, and Olivia Haring, left, at Sharon’s Adult Day Center on Thursday, May 28, 2015, in Cleveland, Tenn. Haring is an LPN and is assistant executive director at the center.How to apply
Anyone who might be eligible for Choices 3 should apply now! To apply, call the local Area Agency on Aging and Disability at 1-866-836-6678 If you’re told over the phone you are ineligible, insist on getting a home visit and completing application. Submit Long Term Services and Supports application, available at http://www.tn.gov/tenncare/forms/LTSSMedicaidApplication.pdf Source: Tennessee Justice Center
Changes to the TennCare program could force more people into assisted living facilities or nursing homes because they will no longer qualify for funding for in-home care services.
“It’s a shame … these are people who have worked all their lives and there’re not a lot of options for their care,” said Doc Rogers, who is trying to get his 83-year-old mother, Reba, into TennCare’s Choices 3 before the July 1 deadline.
On that date Choices 3, which once covered working-class and poor people, will only be available to the very poor on Supplemental Security Income. Funding for services that allowed working-class people to remain at home will not be provided. Those services include Meals-on-Wheels, adult day care and in-home personal care such as bathing and housekeeping.
People who might be eligible for Choices 3 should apply now, said John Orzechowski, client advocate with the Tennessee Justice Center, a Nashville-based nonprofit law firm that provides free legal services to vulnerable Tennesseans.
Orzechowski, who led a recent Choices webinar with other health care professionals and social workers, is among several Tennesseeans sounding the alarm about upcoming changes to the program.
TennCare is lowering income standards for people to qualify for home and community-based services in Choices 3 and for Medicaid/TennCare, according to Kelly Gunderson, TennCare’s director of communications.
Monthly income limits to qualify for home care assistance will drop from $2,199 to a maximum of $753 a month.
Currently only a third of the 4,900 people in Choices 3 get SSI. People who already are enrolled in Choices 3, no matter what their income, will be able to keep their benefits.
Rogers pays out of pocket to keep his mother in adult day care while he waits to see if she will be admitted into Choices 3. He was initially told by one agency that the program already had stopped taking new clients, but he kept calling around until the Southeast Tennessee Area Agency on Aging and Disability helped him to apply.
Without Choice 3, his mother, who is prone to falling, would have to go to a nursing home. But she wants to stay at home.
Terry Woods, Choices manager with the Southeaste Tennessee agency on aging, agreed that the coming change likely will increase the risk for some people of going into a nursing home. But she said it’s possible they could still get at-home assistance if there’s a determination that they have safety risks.
Residents must have documentation stating that they need physical assistance with walking, toileting or taking medications. They need to show that they have been to the emergency room or been hospitalized multiple times during the year, that they have lost their caregiver and/or they’ve had cognitive decline due to dementia.
“It’s not all gloom and doom,” said Woods. “It’s just going to be more work. It’s all about the documentation. We’ve got to have the documentation to prove what TennCare is asking for.”
Orzechowski said that people who are denied for Choices 3 can appeal. He encourages them to document when they communicate with the agency on aging, who they talk to, and when they filed paperwork.
Most people want to stay home instead of going to a nursing home, said Sharon Kelly, a local registered nurse and owner of Sharon’s Senior Services.
But the TennCare changes mean that many won’t be able to stay at home and receive the care they need, she said.
Kelly wrote letters to U.S. Sen. Bob Corker and state Rep. JoAnne Favors and is encouraging others who value the program to write, too.
“I think if people raise their voices it can be put on hold, even now,” she said.
TennCare officials say the cost of the program was not sustainable.
TennCare officials proposed cutting at-home care assistance in 2014 after Gov. Bill Haslam told every agency to submit a budget with an overall reduction of 7 percent. The new policy cuts state funding by $3.8 million.
“Because state resources are limited and the population who is aging and who has disabilities is expected to grow exponentially, it is important for the sustainability of the program that we target limited resources to people who need it the most,” Gunderson wrote in an emailed statement this month.
Contact staff writer at yputman@timesfreepress.com or 757-6431.