ECF-17-1

You may be able to get support

at home and in the community now. If so, you‘ll have TennCare too!

“You” is the person who has an intellectual or developmental disability and wants services.

(It’s not the person helping them apply.)

You are getting this letter because you’re on a list to apply for Employment and Community First

CHOICES. It’s a new program for people who have an intellectual or developmental disability.

This includes people who have significant disabilities.

You may be on the list to apply because:

You filled out a referral form for the new program.

OR, you used to be on a waiting list for one of the home and community based services

(HCBS) waiver programs run by the Department of Intellectual and Developmental Disabilities

(DIDD). New people can’t sign up for those waiver programs anymore.

The green page with this letter tells you about groups that may qualify to enroll and get services

now in Employment and Community First CHOICES. Some of the groups are new! We want to know

if YOU may be in one of these groups.

Look at the green page. Do you think you may qualify in any of these groups? Tell us! Fill out the online form at https://tcreq.tn.gov/tmtrack/ecf/index.htm. Don’t have a computer or

internet? OR, need help to fill out the form? Call <###-###-####>. We can help you fill out the

form. OR, we can fill out the form for you with the facts you give us.

Space is limited, so fill out your form online or call right away! After we get your form, we’ll set a

time to visit you. We’ll see if you may qualify to get services now.

Already fill out a form? It’s ok to fill out a new one. More groups are open now. Be sure to answer

all the questions. Your answers tell us if you may be in a group that could qualify to get services now.

Services in the new program help you live at home or in the community – not in an institution. They

can help your family support you. They also help you do things in the community, build relationships,

and reach your goals. They include residential services for people who need them. To see a list of

services and how they can help you, go to:

http://tn.gov/assets/entities/tenncare/attachments/MemberBenefitTable.pdf.

But there’s more! Employment and Community First CHOICES can help you get ready to work and

find a job. This could be a full-time job. Or it could be a part-time job or self-employment. Working

can help you be more independent, make friends, and play a bigger part in your community.

You don’t have to work to be in Employment and Community First CHOICES.

You may qualify to get services now if you are:

Interested in working, with help from the program, OR

Turn the page over and keep reading.

ECF-17-1

Open to exploring the option of working—even part-time or working for yourself, with help

from the program.

There are more reasons you may qualify to get services now. Be sure to read the green page.

Tell us if you think you’re in one of the groups.

If you don’t fill out the form, you’ll still be on the list for Employment and Community First

CHOICES. But we won’t set a time to come visit you soon. We’ll only set a time to visit soon if you

tell us you’re in one of the groups that may qualify to get services now.

What if you think you can’t work because of your disability? We can help you explore lots of

options. We can help you find a good fit for things you like and are good at. If you have greater

support needs, we can even help find or make a job just for you (called “customized” employment).

We can also help you get ready to work. You can learn new skills to help you be more independent.

What if you’re not old enough to work yet? We can help you get ready to work when you’re old

enough. We can help your family support you in planning for and reaching your goals.

What if you explore employment and decide it’s not for you? OR, you’re old enough to retire?

Other services can help you live in and be part of your community.

Afraid of losing other benefits you receive, like SSI (Supplemental Security Income)? Just signing

up for the program won’t hurt your benefits. What if you get a job? One of the services you can get is

called Benefits Counseling. Someone will help you understand how the money you earn from

working will impact other benefits you get. This includes SSI or Social Security and TennCare. It can

help you decide how much income you can earn from working without losing your benefits.

Is Employment and Community First CHOICES part of TennCare? Yes. But if you don’t have

TennCare, enrolling in Employment and Community First CHOICES may help you qualify for

TennCare. Do you already have TennCare? If so, Employment and Community First CHOICES

offers services you can’t otherwise get from your TennCare health plan.

Do you need help with this letter? Is it because you have a health problem, learning problem or a disability? Or, do you need help in

another language? If so, you have a right to get help and we can help you. Call the Tennessee Health

Connection for free at 1-855-259-0701.

Do you have a mental illness and need help with this letter? The TennCare Advocacy Program can help you.

Call them for free at 1-800-758-1638.

We do not allow unfair treatment in our program. No one is treated in a different way because of race, color, birthplace, religion, language, sex, age, or

disability. Do you think you’ve been treated unfairly? Do you have more questions? Do you need

more help? You can make a free call to the Tennessee Health Connection at 1-855-259-0701.

Attachments: Do You Need Special Help? TN A003 Foreign Language Assistance TN A014

Employment and Community First CHOICES

These are the groups that may qualify to enroll in the program and get services now.

“You” is the person who has an intellectual or developmental disability and wants services.

(It’s not the person helping them apply).

Priority Category

Who may qualify:

A You have a job. You need help to keep your job.

B You’re a young adult (at least 18 years old) and about to finish school. This could be

high school. Or, it could be college or other training after high school. You have a

job offer. But, you can only get the job if you have help on the job.

C You lost your job not long ago, and you want to get a new one. You need help to get

a new job. You may also need help to keep your new job.

D

You’re 18-22 years old and about to finish school. You don’t have a job offer, but

you want to work. You need help to get a job. You may also need help to keep your

new job.

E You don’t have a job, but you want to work. You need help to get a job. You may

also need help to keep your new job.

F

You’re 14-22 years old. You’re still in school. You live at home with your family.

You’re planning to work when you get out of school. But, you need help getting

ready for work. You can’t get the kind of help you need from your school or Voc

Rehab (Vocational Rehabilitation).

G

You’re at least 14 years old but not old enough to retire. You’re open to exploring

the option of working—even part-time or working for yourself, with help from the

program. You agree to receive a service called “Exploration.” It will help you

decide if you want to work and the kinds of jobs you might like and be really good

at by visiting job sites that match your skills and interests. It also helps you (and

your family) understand the benefits of working and helps answer your questions

about work.

H

You’re at least 62 years old. You aren’t interested in working anymore. You need

help to live in and be part of the community.

OR

You’re at least 55 years old. Your health problems make it hard for you to work.

Turn the page over and keep reading.

You need help to live in and be part of the community.

We have limited space for these groups too:

Who may qualify:

Aging Caregiver

(Required by state law)

You have an intellectual disability and your parent or

other unpaid caregiver is age 75 or older.

Emergent Circumstances The person who used to care for you has died. OR,

they can no longer care for you because they have a

physical or mental health problem or disability.

OR, you are being abused, neglected or exploited

where you live now. AND, you don’t have any other

place to go.

OR, you need help to move out of a nursing home

into a new home in the community. This includes

nursing homes for people with intellectual disabilities.

(This is called an intermediate care facility for

individuals with intellectual disabilities or ICF/IID).

OR, you or others are at risk of serious harm or

danger. Other things have been tried but didn’t help.

AND, you need these services to help keep you and

others safe in the community. (It doesn’t matter how

old you are.)

Sustain Family Living Arrangement You live at home with your family. You need a lot of

help with medical or behavioral problems. Your family

needs help caring for you so you can keep living at

home. (It doesn’t matter how old you are.)

Planned Transition You’re at least 21 years old. You live at home with your

family. The person who supports you is in poor health,

and it’s getting worse. They can’t keep caring for you

much longer. You need help to move to a new place soon

to get the support you need.

Multiple Complex Health Conditions You’re an adult. You have two or more big health

problems that make it hard for you to work. You need

help right away to keep living where you do now.

TN A003.15

Rev: 16Dec16

Do You Need Special Help?

Here are some places you can call for help.

All of these numbers are free calls.

Se incluye la versión en español

Do you have questions or need help with TennCare? Or, do you need help because you

have a health, mental health, learning problem or disability?

Call the Tennessee Health Connection at 1-855-259-0701.

Do you have a hearing or speech problem and have questions or need help?

Call the Tennessee Relay Service (TNRS) at 1-800-848-0298. Ask them to

connect you with the Tennessee Health Connection at 1-855-259-0701.

Do you need help with prescription or refills at the drug store?

First, call your doctor. Then, if you still need help call the TennCare

Solutions Unit at 1-800-878-3192.

Do you have questions about Medicare for people over age 65 and for the disabled?

Call Tennessee’s State Health Insurance Assistance Program (SHIP) at

1-877-801-0044.

Do you need help getting health care, mental health care or drug or alcohol treatment?

First, call your health plan. If you still need help call the TennCare Advocacy

Program at 1-800-758-1638.

Then, if you still need help, call the TennCare Solutions Unit at

1-800-878-3192.

TN A003.15

Rev: 16Dec16

Do you need help talking with us or reading what we send you? Do you have a disability and need help getting care or taking part in one of our programs or services? Or do you have more questions about your health care? Call us for free at 1-855-259-0701. We can connect you with the free help or service you need. (For TTY call: 1-800-848-0298)

We obey federal and state civil rights laws. We do not treat people in a different way

because of their race, color, birth place, language, age, disability, religion, or sex. Do

you think we did not help you or you were treated differently because of your race,

color, birth place, language, age, disability, religion, or sex? You can file a complaint

by mail, by email, or online. Here are two places where you can file a complaint:

Health Care Finance and Administration Office of Civil Rights Compliance

310 Great Circle Road, Floor 4W

Nashville, Tennessee 37243

Email: HCFA.Fairtreatment@tn.gov

Phone: 1-855-857-1673 (TRS 711)

You can get a complaint form online at:

http://www.tn.gov/hcfa/article/civil-rights-compliance

U.S. Department of Health & Human Services Office for Civil Rights

200 Independence Ave SW, Rm 509F, HHH Bldg

Washington, DC 20201

Phone: 1-800-368-1019

(TDD): 1-800-537-7697

You can get a complaint form online at:

http://www.hhs.gov/ocr/office/file/index.html

Or you can file a complaint online at:

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

TN A003.15

Rev: 16Dec16

¿Necesita ayuda especial?

Estos son algunos lugares a los que puede llamar si necesita ayuda.

Todos estos números de teléfono son llamada gratuita.

English version is included

¿Tiene preguntas o necesita ayuda con TennCare? O ¿acaso necesita ayuda porque

tiene un problema de salud, de salud mental, de aprendizaje o una discapacidad?

Llame a Tennessee Health Connection al 1-855-259-0701.

¿Tiene un problema de audición o del habla y tiene preguntas o necesita ayuda?

Llame a Servicio de Retransmisión de Tennessee (Tennessee Relay Service,

TNRS) al 1-800-848-0298. Pídales que lo conecten con Tennessee Health

Connection en el 1-855-259-0701.

¿Necesita ayuda con recetas médicas o renovaciones en la farmacia?

Primero, llame a su doctor. Luego, si aún necesita ayuda, llame a la Unidad de

Soluciones de TennCare (TennCare Solutions Unit) al 1-800-878-3192.

¿Tiene preguntas sobre Medicare para las personas mayores de 65 años de edad y las

personas discapacitadas?

Llame al Programa de Asistencia con el Seguro Médico Estatal (State

Health Insurance Assistance Program, SHIP) al 1-877-801-0044.

¿Necesita ayuda para conseguir atención médica, atención para la salud mental o

tratamiento para alcoholismo o drogadicción?

Primero, llame a su plan de seguro médico. Si aún necesita ayuda llame al

Programa de Representación y Abogacía de TennCare (TennCare

Advocacy Program) al 1-800-758-1638.

Luego, si aún necesita ayuda, llame a la Unidad de Soluciones de TennCare

(TennCare Solutions Unit) al 1-800-878-3192.

TN A003.15

Rev: 16Dec16

¿Necesita ayuda para hablar con nosotros o para leer lo que le enviamos?

¿Tiene una discapacidad y necesita ayuda para recibir atención o participar en alguno de nuestros programas o servicios?

O, ¿acaso tiene más preguntas sobre su atención médica?

Llámenos gratis al 1-855-259-0701.

Nosotros podemos conectarlo con la ayuda o servicios gratuitos que necesite. (Para TTY llame al: 1-800-848-0298)

Nosotros acatamos las leyes federales y estatales de derechos civiles. No tratamos a las

personas de manera diferente debido a su raza, color de la piel, lugar de nacimiento,

idioma, edad, discapacidad, religión o sexo. ¿Piensa que no le ayudamos o que fue

tratado de manera diferente debido a su raza, color de la piel, lugar de nacimiento,

idioma, edad, discapacidad, religión o sexo? Puede presentar una queja por correo

postal, por correo electrónico o en línea. Estos son dos lugares donde puede presentar

una queja:

Health Care Finance and Administration Office of Civil Rights Compliance

310 Great Circle Road, Floor 4W

Nashville, Tennessee 37243

Correo electrónico: HCFA.Fairtreatment@tn.gov

Teléfono: 1-855-857-1673 (TRS 711)

Puede obtener un formulario de queja en línea en:

http://www.tn.gov/hcfa/article/civil-rights-compliance

U.S. Department of Health & Human Services Office for Civil Rights

200 Independence Ave SW, Rm 509F, HHH Bldg

Washington, DC 20201

Teléfono: 1-800-368-1019

(TDD): 1-800-537-7697

Puede obtener un formulario de queja en línea en:

http://www.hhs.gov/ocr/office/file/index.html

O bien, puede presentar una queja en línea en:

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

TN A014.6

Rev: 10Oct16 1

Do you need free help with this letter?

If you speak a language other than English, help in your language is

available for free. This page tells you how to get help in a language other

than English. It also tells you about other help that’s available.

Spanish: Español

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.

Llame al 1-855-259-0701 (TTY: 1-800-848-0298).

Kurdish: وردی ک

قەسە دەکەیت، خزمەتگوزاریەکانی یارمەتی زمان، بەخۆڕایی، بۆ تۆ بەردەستە. پەیوەندی بە کوردیئاگاداری: ئەگەر بە زمانی

1- 855-259-0701 (TTY (1-800-848-0298 .بکە

Arabic: ية عرب ال

0701-259-855-1 ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم

(.0298-848-800-1هاتف الصم والبكم: )رقم

Chinese: 繁體中文

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-855-259-0701

（TTY 1-800-848-0298）。

Vietnamese: Tiếng Việt

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số

1-855-259-0701 (TTY: 1-800-848-0298).

Korean: 한국어

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

1-855-259-0701 (TTY: 1-800-848-0298)번으로 전화해 주십시오.

French: Français

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés

gratuitement. Appelez le 1-855-259-0701 (ATS : 1-800-848-0298).

Amharic: አማርኛ ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-855-259-0701 (መስማት ለተሳናቸው: 1-800-848-0298).

Gujarati: ગજુરાતી સચુના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-855-259-0701 (TTY: 1-800-848-0298).

Laotian: ພາສາລາວ

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ,

ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-855-259-0701 (TTY: 1-800-848-0298).

German: Deutsch

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen

zur Verfügung. Rufnummer: 1-855-259-0701 (TTY: 1-800-848-0298).

Tagalog: Tagalog

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa

wika nang walang bayad. Tumawag sa 1-855-259-0701 (TTY: 1-800-848-0298).

TN A014.6

Rev: 10Oct16 2

Hindi: ह िंदी ध्यान दें: यदद आप ह िंदी बोलते हैं तो आपके ललए मुफ्त में भाषा सहायता सेवाए ंउपलब्ध हैं। 1-855-259-0701

(TTY: 1-800-848-0298) पर कॉल करें।

Serbo-Croatian: Srpsko-hrvatski

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno.

Nazovite 1-855-259-0701 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom:

1- 800-848-0298).

Russian: Русский

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги

перевода. Звоните 1-855-259-0701 (телетайп: 1-800-848-0298).

Nepali: नेपाली ध्यान दिनुहोस:् तपार्इंले नपेाली बोल्नुहुन्छ भने तपार्इंको ननम्तत भाषा सहायता सेवाहरू ननिःशुल्क रूपमा उपलब्ध छ । फोन गनुहुोस ्1-855-259-0701 (दिदिवार्इ: 1-800-848-0298) ।

Persian:

با. باشدی م فراهم شمای برا گانیرا بصورتی زبان التیتسه د،یکنی م گفتگو فارسی زبان به اگر: توجه1-855-259-0701 (TTY: 1-800-848-0298) دیریبگ تماس.

Do you need help talking with us or reading what we send you?

Do you have a disability and need help getting care or taking part in one of our programs or services?

Or do you have more questions about your health care?

Call us for free at 1-855-259-0701. We can connect you with the free help or service you need. (For TTY call: 1-800-848-0298)

We obey federal and state civil rights laws. We do not treat people in a different way because of their race,

color, birth place, language, age, disability, religion, or sex. Do you think we did not help you or you were

treated differently because of your race, color, birth place, language, age, disability, religion, or sex? You

can file a complaint by mail, by email, or online. Here are two places where you can file a complaint:

Health Care Finance and Administration

Office of Civil Rights Compliance

310 Great Circle Road, Floor 4W

Nashville, Tennessee 37243

Email: HCFA.Fairtreatment@tn.gov

Phone: 1-855-857-1673 (TRS 711)

You can get a complaint form online at:

http://www.tn.gov/hcfa/article/civil-rights-

compliance

U.S. Department of Health & Human Services

Office for Civil Rights

200 Independence Ave SW, Rm 509F, HHH Bldg

Washington, DC 20201

Phone: 1-800-868-1019

(TDD): 1-800-537-7697

You can get a complaint form online at:

http://www.hhs.gov/ocr/office/file/index.html

Or you can file a complaint online at:

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf