Tennessee Medicaid Waiver Guide

Tennessee delivers intellectual and developmental disability services through TennCare managed care, with the Department of Disability and Aging — formerly DIDD — handling intake. The main program is Employment and Community First CHOICES, organized into numbered benefit groups rather than separate waivers. Separately, Katie Beckett serves children under 18 with significant disabilities or complex medical needs who are otherwise ineligible for Medicaid because of their parents' income or assets. Katie Beckett splits into Part A and Part B, and the difference between them is the most consequential thing for a Tennessee family to understand.

For ECF CHOICES you must have an intellectual or developmental disability — intellectual disability beginning before age 18, or a developmental disability before age 22 — and meet financial thresholds. As of January 2026, income limits run from roughly $1,995 to $3,325 per month depending on circumstances, with a $2,000 resource limit; confirm current figures, since they change annually. Katie Beckett uses a different route entirely: it exists specifically for children whose parents' income or assets would otherwise disqualify them.

Because annual funding is limited, qualified ECF CHOICES applicants join a referral list and enroll based on priority groupings and slot availability. Katie Beckett works differently: everyone who applied for Part A and qualified is currently being served, while Part B needed a waiting list starting June 2023, with an additional 1,000 slots approved in August 2023.

Type

Referral list with priority groupings; Katie Beckett Part A currently has none

Typical timeline

ECF CHOICES timing depends on your priority grouping and available slots. For a child with the most significant disabilities or complex medical needs, Part A of Katie Beckett has been enrolling everyone who qualifies — which makes establishing whether a child meets Part A criteria rather than Part B a high-value question.

How to check status

If you have TennCare, call your health plan — the number is on your TennCare card. If you do not have TennCare, contact your Area Agency on Aging and Disability free at 1-866-836-6678. They can also tell you about other programs if you do not qualify for Medicaid.

1. Start with intake at the Department of Disability and Aging

   DDA conducts intake for ECF CHOICES, Katie Beckett, and other programs. This is the single entry point for I/DD programs in Tennessee.

   Open link
2. If you have TennCare, call your health plan

   For CHOICES or ECF CHOICES, call the managed care organization on your TennCare card. If you do not have TennCare, call your Area Agency on Aging and Disability free at 1-866-836-6678.

3. Submit the ECF CHOICES self-referral form

   You can complete a self-referral form online, or get help from your managed care plan or a regional disability office.

   Open link
4. For a child, ask about Katie Beckett Part A specifically

   Part A provides full Medicaid benefits to children with the most significant disabilities or complex medical needs, and everyone who has applied and qualified is currently being served. Part B is a capped $10,000-per-year flexible package with a waiting list. Establishing which part a child qualifies for is the difference between waiting and not.

5. Identify your ECF CHOICES group

   Groups 4 through 8 differ by age, living situation, and level of need — including two groups built around behavioral supports. Ask which group fits, because it determines what services are on the table.

• The person's age, diagnosis, and county of residence.
• Medicaid status or whether you still need to apply.
• Current supports, urgent needs, and living situation.
• School, medical, evaluation, or eligibility documents.
• Questions about waitlists, timelines, and next steps.

Exact covered services depend on the waiver, assessed need, Medicaid rules, funding, and state program requirements. Confirm services, availability, and payment acceptance with the state, support coordinator, and provider.

ECF CHOICES includes consumer direction, letting participants hire and manage their own workers for certain services rather than using only agency staff. Ask your support coordinator through your managed care plan which services can be consumer-directed in your benefit group.

1. Early childhood

   Tennessee's early intervention system serves infants and toddlers. Katie Beckett can provide a Medicaid route for a child whose family income would otherwise be disqualifying.

2. Under 18 — Katie Beckett

   Katie Beckett serves children under 18. Because Part A has been enrolling everyone who qualifies while Part B carries a waiting list, determining which part fits is time-sensitive.

3. Under 21 — ECF CHOICES Group 4

   Group 4 supports families caring for a child under 21 with I/DD living at home with family, not a foster family. Some adults 21 and older living with family may also qualify.

4. 18 to 21 and beyond

   Groups 5 and 6 serve adults 21 and older, and people 18 to 21 who cannot live with family. Group 8 supports adults transitioning out of hospitals or nursing homes. Ask which group you would move into well before the transition.

If eligibility or a service is denied, reduced, or ended, you have the right to appeal within the deadline printed on your notice. Because services run through a TennCare managed care organization, there is usually a plan-level appeal as well — ask for both in writing. Disability Rights Tennessee is the state's protection and advocacy agency, serving all 95 counties free of charge; note that submitting an intake request does not guarantee representation.

DDA

Department of Disability and Aging — Tennessee's agency conducting intake for I/DD programs, formerly DIDD.

TennCare

Tennessee's Medicaid program, delivered through managed care organizations.

ECF CHOICES

Employment and Community First CHOICES — the main I/DD program, organized into numbered benefit groups rather than separate waivers.

Benefit group

The numbered ECF CHOICES categories (4 through 8) that determine eligibility and available services based on age, living situation, and need.

Katie Beckett Part A

Full Medicaid benefits for children under 18 with the most significant disabilities or complex medical needs. Currently serving everyone who qualifies.

Katie Beckett Part B

A capped package of flexible services up to $10,000 annually, with a waiting list established in June 2023.

AAAD

Area Agency on Aging and Disability — free help applying, especially if you do not have TennCare.