Tennessee Medicaid Resources:

• State Medicaid Website: Tennessee
• Tennessee Council on Developmental Disabilities Website
• The Arc of Tennessee

Tennessee Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 296,200 people with disabilities covered by Medicaid in Tennessee. Tennessee spent $10,226 for each Medicaid recipient with a disability in 2007.

21% percent of all people covered by Medicaid in Tennessee have a disability, which is much higher than the national percentage of Medicaid recipient who have a disability (15%).

The state spends 44% of all of the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

TennCare II:

The TennCare II Health plan covers adults and children with disabilities including some who are also eligible for Medicare. Some people are also excluded from certain services because of age; for example, dental services are available only to children. However, this plan does offer coverage to people with disabilities living in institutions. This plan has separate parts (and different coverage and payment rules) for mental health/substance abuse, dental, pharmacy, inpatient, and basic coverage.

• Community: community health services, transportation
• Health: bariatric surgery, chiropractic, disease management, durable medical equipment, early and periodic screening, treatment, and diagnosis, family planning, hearing, hospice, immunization, laboratory, occupational therapy, organ and tissue transplants, physical therapy, physician services, podiatry, private duty nursing, psychiatry, speech therapy, vision, x-ray
• Home: home health care
• Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to a PACE center to be eligible.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy speech therapy, recreation therapy, prescription drugs
• Home: home care, home and environmental modifications
• Social Services: case management

HCBS waiver for persons with MR and Developmental Disabilities:

This waiver provides services to people with developmental disabilities and related conditions of all ages, as an alternative to moving into a facility for people with I/DD.

Level of Care: intermediate

• Community: day services, individual transportation, transitional case management
• Health: nursing, nutrition services, occupational and physical therapy, specialized medical equipment and supplies, assistive technology, speech language and hearing therapy, dental, behavioral services including respite, orientation and mobility services for people with visual disabilities, personal emergency response systems
• Home: residential habilitation, respite care, environmental accessibility modifications, family model residential support, in-home medical services, personal assistance, supported living
• Social Services: support coordination

Statewide HCBS Elderly and Disabled waiver:

This waiver applies to people with physical disabilities who need nursing care. Instead of moving into a nursing facility, this waiver will provide appropriate services at home or in other community settings.

Ages: 18 and older for people with disabilities, 65 and older for people with or without disabilities

Level of Care: nursing

• Home: homemaker services, personal care, respite, home delivered meals
• Social Services: support coordination

Tennessee Self-Determination waiver program:

This waiver applies to people with intellectual and developmental disabilities of all ages who want to take an active role in planning and directing their own care.

Option for Self-Direction: This waiver is designed to promote self-determination and independent living.

• Community: day services, transportation, orientation and mobility services for people with visual disabilities
• Health: nursing, nutrition services, occupational and physical therapy, specialized medical equipment and supplies, assistive technology, speech, language and hearing therapy, dental, behavioral services, emergency assistance
• Home: respite, accessibility modifications