I/DD Waivers in Tennessee

All states: Medicaid disability services map

Tennessee I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Tennessee?

Two state agencies share the work. The Division of TennCare, Tennessee's Medicaid agency, oversees all I/DD home and community services through its Division of Long-Term Services and Supports (LTSS). The Department of Disability and Aging (DDA) runs the three older 1915(c) waivers day to day under a contract with TennCare. TennCare runs Employment and Community First (ECF) CHOICES, the program where all new I/DD enrollment now goes, through its health plans.

• Division of TennCare: the state Medicaid agency. Its LTSS division oversees the 1915(c) waivers and runs ECF CHOICES through three managed care organizations (MCOs), which are health plans: BlueCare, UnitedHealthcare Community Plan and Wellpoint.
• Department of Disability and Aging (DDA): operates the Statewide, Comprehensive Aggregate Cap and Self-Determination waivers. DDA staff review each Person-Centered Support Plan before DDA authorizes 1915(c) services. DDA also credentials providers and runs the Therap system that 1915(c) providers use for billing and electronic visit verification (EVV). For ECF CHOICES and Katie Beckett, DDA handles intake, assessments and paperwork, and it keeps in touch with people who are waiting for services.
• Front door: people already on TennCare start with their health plan. People without TennCare start with a DDA regional intake office (West 866-372-5709, Middle 800-654-4839, East 888-531-9876).
• Case management: in the Statewide and CAC waivers, Independent Support Coordinators (ISCs) from agencies that DDA contracts with plan and coordinate services. In the Self-Determination waiver and Katie Beckett Part B, DDA case managers do this (some Part B families have an ISC). In ECF CHOICES, the member's health plan provides support coordination and authorizes services based on assessed need.

What Medicaid waivers and programs serve people with I/DD in Tennessee?

Tennessee has three 1915(c) waivers for adults with intellectual disabilities: the Statewide (SW) Waiver, the Comprehensive Aggregate Cap (CAC) Waiver and the Self-Determination (SD) Waiver. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. All three closed to most new enrollment on July 1, 2016. New enrollment now goes to ECF CHOICES, which runs under TennCare's 1115 demonstration (TennCare III), a broader federal approval that lets Tennessee run Medicaid through health plans.

• Employment and Community First (ECF) CHOICES (1115 demonstration): serves people of all ages with intellectual or developmental disabilities who meet financial eligibility and, for most groups, level of care. Members are placed in one of five benefit groups: Group 4 Essential Family Supports (children under 21 living with family, and some adults living with family), Group 5 Essential Supports for Employment and Independent Living (adults 21 and older), Group 6 Comprehensive Supports for Employment and Community Living (adults 21 and older with higher needs), Group 7 Intensive Behavioral Family Supports (children under 21 with severe behavior support needs who live with family) and Group 8 Comprehensive Behavioral Support for Employment and Community Living (adults with severe behavior support needs moving from highly structured settings). Services include employment services (exploration, discovery, job development and job supports), Community Integration Support Services, Community Living Supports, personal assistance, supportive home care, respite, community transportation and enabling technology. Since January 1, 2026 Group 7 also covers supportive home care and respite, with respite capped at 30 days or 216 hours a year.
• Statewide (SW) Waiver (1915(c), control number TN.0128): the oldest (1987) and largest of the three. It serves adults with intellectual disabilities and offers residential services (Residential Habilitation, Supported Living, Family Model Residential and Medical Residential), day and employment services, personal assistance, respite, behavior services and Independent Support Coordination. It is open to new people only through Money Follows the Person (MFP), a program that helps people move out of institutions, for someone leaving an intermediate care facility after a stay of at least 90 days. The waiver has a cost cap.
• Comprehensive Aggregate Cap (CAC) Waiver (1915(c), control number TN.0357): began in 2000 as the Arlington Waiver and was renamed in 2015. It offers the same kinds of services as the Statewide waiver. It serves adults who were class members in the Arlington or Clover Bottom cases, people discharged from the Harold Jordan Center after a stay of at least 90 days, and people moved from the Statewide waiver at its January 1, 2020 renewal because their services went over the Statewide cost cap.
• Self-Determination (SD) Waiver (1915(c), control number TN.0427): started in 2005 for adults with intellectual disabilities who live in their own home, with family or with a non-related caregiver. It has no residential services. It covers day and employment services, personal assistance, respite, individual transportation and behavior services, and DDA case managers coordinate care. It is closed to new enrollment.

A related program, Katie Beckett, serves children under 18 with significant disabilities or complex medical needs (not only I/DD) whose families earn too much for Medicaid. Part A gives full Medicaid plus up to $15,000 a year in home and community services. Part B gives up to $10,000 a year in services and is not Medicaid enrollment. Part C keeps Medicaid for a child who would qualify for Part A when no Part A slot is open. Tennessee also has Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), both state-operated and private, as the institutional option that the waivers are an alternative to.

Does Tennessee pay for I/DD services through managed care?

Yes. ECF CHOICES is run by TennCare's three health plans, and since July 1, 2024 those plans also pay claims for the three 1915(c) waivers. DDA still authorizes 1915(c) services and contracts the Independent Support Coordinators, so the waivers are a mix: the state agency approves the plan and the health plan pays the claim.

• ECF CHOICES: the member's health plan authorizes services, coordinates them and pays providers. The three plans are BlueCare (888-747-8955), UnitedHealthcare Community Plan (800-690-1606) and Wellpoint (833-731-2153).
• 1915(c) waivers: for dates of service from July 1, 2024, providers enter claims in DDA's Therap system, and Therap sends them to the member's health plan each week for payment, according to DDA's Therap billing FAQs.
• Exceptions paid by the state: Katie Beckett Part B and state-funded services are also billed in Therap, but the state pays them through its Edison system rather than a health plan. Katie Beckett Part A children are Medicaid members served through their health plan.

Is there a waiting list for I/DD services in Tennessee?

Yes. ECF CHOICES has a limited number of slots, and the state does not publish a count of people waiting. Qualified applicants who cannot be enrolled right away go on a referral list and are enrolled by priority group as slots open. People in the priority groups with the most urgent needs can enroll right away.

• ECF CHOICES referral list: TennCare's ECF CHOICES page says qualified applicants are placed on a referral list when no openings are available. We did not find a full description of the priority groups or a current count on a state source.
• New slots: BlueCare told providers in its fourth quarter 2025 newsletter that TennCare approved 2,500 new ECF CHOICES slots. We did not find a state notice on how fast those slots are being released.
• 1915(c) waivers: closed to new enrollment except the narrow groups described above, so they do not run an open waiting list.
• Katie Beckett: Part A and Part B enrollment is limited by funding, and children who qualify when no slot is open go on a Part A or Part B waiting list. We did not find a published count for either list.

For a person's place on a list, families can ask their DDA regional intake office or the TennCare LTSS Help Desk at 1-877-224-0219.

How do people apply for I/DD services in Tennessee, and how are budgets set?

For ECF CHOICES, a person can fill out an online self-referral form, ask their TennCare health plan for help, or, if they are not on TennCare, call a DDA regional intake office. DDA handles intake and assessment. Services are then authorized by the health plan based on assessed need. Tennessee does not publish the name of the assessment tool it uses to set support levels.

• ECF CHOICES eligibility: an intellectual or developmental disability, Medicaid financial eligibility (income and asset limits, with a Qualifying Income Trust option for people whose income is over the limit) and a place in a benefit group with an open slot.
• 1915(c) eligibility: for the few people who can still enter, ICF/IID level of care, a Pre-Admission Evaluation (PAE) approved by TennCare and an intellectual disability that appeared before age 18. MFP applicants for the Statewide waiver contact their health plan.
• Katie Beckett: families apply through a self-referral in a TennCare Connect account. TennCare decides financial eligibility. DDA decides medical eligibility for Part B, and Maximus, a state contractor, decides level of care for Part A.
• Levels of need: 1915(c) day and residential rates are tiered by the person's assigned level of need, Levels 1 to 6. ECF CHOICES Community Living Supports use levels 1a, 1b, 2, 3, 4 Medical and 4 Behavioral. We did not find the name of the tool that assigns these levels. Ask DDA or the member's health plan.
• Limits on services: in the 1915(c) waivers, each Person-Centered Support Plan is reviewed by DDA before services are authorized, and day and employment services together are capped at 240 quarter hours per 14-day billing period and 5,832 a year. Katie Beckett Part A is capped at $15,000 a year in home and community services and Part B at $10,000.

What day and residential services can I/DD providers offer in Tennessee?

In the 1915(c) waivers, providers can offer four day and employment services and four residential services, all credentialed by DDA and paid at rates tiered by level of need. ECF CHOICES adds Community Living Supports, a shared home service authorized by the health plan. DDA licenses adult day facilities and residential homes under Tennessee's rules in Chapter 0465-02.

Day and employment services (1915(c) waivers)

• Community Participation Supports: a day service delivered in the community, billed in 15-minute units ($4.32 for Levels 1 to 3 as of July 1, 2026). The provider must be credentialed by DDA. We did not find a published staff ratio.
• Facility-Based Day Supports: a day service delivered in a facility, billed in 15-minute units from $2.10 (Level 1) to $8.19 (Level 6). DDA licenses these as adult habilitation day facilities. The licensing rule requires two direct support staff for the first 20 people supported and one more for each additional 20.
• Intermittent Employment and Community Participation Wraparound Supports: day support for people who work part of the day, billed in 15-minute units ($4.02 for Levels 1 to 3), capped at 160 quarter hours per 14-day period and 3,888 a year within the overall day cap. We did not find a published staff ratio.
• Job coaching and small group supported employment: billed in 15-minute units. Job coach rates ($7.51 to $13.33) step down by months on the job and by the share of hours the person works without the coach. In ECF CHOICES, employment services are paid through the health plan using outcome-based reports. We did not find a published staff ratio.

All 1915(c) day and employment services share one cap of 240 quarter hours per 14-day static billing period and 5,832 a year. A licensed adult habilitation day facility can also serve TennCare CHOICES members (older adults and adults with physical disabilities) as an Adult Day Care provider, under TennCare's rule.

Residential services

• Residential Habilitation (SW and CAC, also used for ECF CHOICES Community Living Supports): the agency owns or rents the home and chooses housemates and staff. The home is licensed by DDA, with no more than 4 people supported per home. Paid daily by level of need and household size.
• Supported Living and Semi-Independent Living (SW and CAC, also used for ECF CHOICES Community Living Supports): the people supported own or rent their home, pay their own bills and have a say in housemates and staff. The agency is licensed by DDA, the home passes a DDA housing inspection, and no more than 3 people live in each home.
• Family Model Residential (SW and CAC) and Community Living Supports Family Model (ECF CHOICES): a host home arrangement in the home of trained family caregivers. In the 1915(c) waivers it is paid daily at Levels 1 to 5 ($49.55 to $309.39). In ECF CHOICES the caregivers must complete a DDA home study, and a Family Model home cannot also receive respite.
• Medical Residential (SW and CAC): residential service with nursing for people with significant medical needs, paid daily by household size (for example $884.05 a day at Level 5 with 2 people).
• Community Living Supports (ECF CHOICES): shared home supports authorized by the health plan at levels 1a, 1b, 2, 3, 4 Medical and 4 Behavioral. Enhanced levels are open to providers that hold a DDA Supported Living or Residential Habilitation license, according to BlueCare's Community Living Supports manual.

How are I/DD provider rates set and how do agencies enroll in Tennessee?

DDA publishes a fee schedule for the 1915(c) waivers, with each service's rate by billing code and unit (quarter hour, day or month). The current schedule is dated July 1, 2026, the start of state fiscal year 2027. TennCare sets ECF CHOICES Community Living Supports rates by level of need, shares them with the health plans, and aligns them with similar 1915(c) rates. Agencies become 1915(c) providers by applying to DDA for credentialing.

• Rate schedule: DDA's Service Details and Rates lists rates tiered by level of need (Levels 1 to 6 for day and residential services) and, for residential services, by the number of people in the home. Examples as of July 1, 2026: Community Participation Supports $4.32 per quarter hour for Levels 1 to 3, and Independent Support Coordination $251.23 per month.
• Credentialing with DDA: agencies send a credentialing application with labeled supporting documents to DDA.Provider.Application@tn.gov, with the organization name and the region they want to serve in the subject line. DDA confirms receipt within two business days and asks applicants to wait 30 days before checking status. DDA holds quarterly virtual credentialing forums. Details are on DDA's become a credentialed provider page, which also lists which services need a DDA license.
• ECF CHOICES: services are authorized and paid by the three health plans. We did not find a single state enrollment path for ECF CHOICES providers, so agencies should also ask each plan about joining its network.
• EVV in the 1915(c) waivers: agencies must use DDA's Therap system for EVV on Personal Assistance and in-home Respite. Therap EVV has been required since January 1, 2022, and claims have been matched to EVV visits since January 1, 2023, according to DDA's Therap page. Agencies cannot use their own EVV system for these services.
• EVV in ECF CHOICES: since August 1, 2025, agencies can use the free CareBridge system or their own EVV system that sends data to CareBridge, which collects EVV data for all three health plans. Consumer-directed workers use the CareAttend app through the fiscal employer agent.

What is changing next for I/DD services in Tennessee?

As of October 23, 2026, we did not find a confirmed change with a set date for Tennessee's I/DD services. TennCare does list two planned procurements that could affect I/DD providers and families. Both are plans, not final decisions, and the state treats its procurement dates as estimates.

• Fiscal employer agent for consumer direction: TennCare's upcoming procurements page lists a single statewide fiscal employer agent contract (procurement 31865-00673) for consumer direction across its home and community programs, including ECF CHOICES and the 1915(c) waivers. Release is projected for the second quarter of 2027. Consumer Direct Care Network Tennessee is the fiscal employer agent today, and no change of vendor has been announced.
• Workforce registry: the same page lists a procurement (31865-00658) for a web-based registry of direct care and support workers and employers. We did not find when it will be released or how providers would use it.

Two recent changes are already in place: ECF CHOICES Group 7 gained supportive home care and respite on January 1, 2026, and BlueCare reported in late 2025 that TennCare approved 2,500 new ECF CHOICES slots. For news on 1915(c) waiver amendments or renewals, check TennCare's waiver public notices or ask DDA.

Tennessee I/DD sources

• TennCare: Employment and Community First CHOICES
• TennCare: Persons with intellectual disabilities receiving services in the 1915(c) HCBS waivers
• Tennessee Department of Disability and Aging: ECF CHOICES
• Tennessee Department of Disability and Aging: Intake for DDA programs
• Tennessee Department of Disability and Aging: FY 2027 1915(c) Service Details and Rates (as of July 1, 2026)
• Tennessee Department of Disability and Aging: Therap billing FAQs
• Tennessee Department of Disability and Aging: Become a credentialed provider
• TennCare: Katie Beckett program
• Tenn. Comp. R. and Regs. 0465-02-07-.03 (adult habilitation day facility staffing)
• TennCare: Upcoming procurements

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Tennessee EVV requirements

Other states that use managed care for I/DD services

Arizona, Arkansas, Iowa, Kansas, Michigan, North Carolina. See every state on the I/DD services map.

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.