How Tennessee pays for disability services

Waiver inventory

Tennessee operates no 1915(i) state plan HCBS benefit and no 1915(k) Community First Choice benefit. CHOICES (1115) is excluded here as the aging and physical disability vehicle. Waiver application downloads: medicaid.gov .../TN0357.zip, .../TN0427.zip

State-only funded programs

Family Support Program. Established 1992, funded entirely with state dollars. Pays for respite, day care, home modifications, equipment, personal assistance, transportation, homemaker services, housing costs, health-related needs, nursing, and counseling for people with severe disabilities and their families. Maximum award $6,000 per person per year, often less depending on available funds and Local Council priorities. Administered by the Department of Disability and Aging (DDA) through regional offices and a network of county-level contracted Family Support agencies, with Local and District Councils setting priorities. tn.gov

Annual appropriation: not separately published. Checked the FY2026-2027 Budget Document Volume 1 (line-item narratives, cost increases, and program summaries) and Volume 3 (expenditures by object and funding by source); the only "Family Support" budget line in the state budget is 359.20 Family Support Services in the Department of Children's Services, which is a child welfare program and unrelated. The DDA Family Support Program sits inside allotment code 344.02 Community Intellectual Disabilities Services, which totals $65,878,600 for FY2026-2027 ($62,200,600 state appropriations, $3,678,000 other), of which $62,300,900 is in the Grants and Subsidies object. tn.gov and tn.gov

State-funded billing codes on the DDA fee schedule (marked "STATE FUNDS," no federal match): Hospital Attendant (ST-0000) $6.59 per quarter hour; Independent Support Coordination for Katie Beckett Part B (ST-T2022-01) $251.23 per month, half rate $125.61; ISC Transition to ICF (ST-0002) and ISC Transition to Waiver Services (ST-0007) $251.23 per month. tn.gov

County / regional / local funding

None identified. Tennessee has no county levy, county board, or local mill levy mechanism for IDD services. DDA operates three regional offices (East, Middle, West Tennessee) but they are state-funded administrative units, not fiscal authorities. The Family Support Program is delivered through county-level contracted agencies with local and district councils, but the money is entirely state appropriation flowing through DDA. Checked the DDA organizational pages, the FY2026-2027 budget documents, and the TennCare LTSS documents library.

Funding scale

• Intellectual Disabilities Services (allotment 318.71, covering the three 1915(c) waivers plus ICF/IID plus Katie Beckett): FY2024-2025 actual $1,202,285,300 ($432,833,700 state, $769,449,400 federal, $2,200 other). FY2025-2026 estimated $1,233,370,400. FY2026-2027 recommended $1,203,376,300 ($448,398,500 state, $754,912,800 federal). tn.gov
• ECF CHOICES: SFY27 projected $510,044,788. tn.gov
• TennCare total: approximately $18.5 billion annual budget FY2025; Intellectual Disability Services (ICF/IID and HCBS waivers) reported at $1,202,285,300; Managed Care Payments (medical, behavioral, LTSS) $11,717,506,000. tn.gov
• Department of Disability and Aging (allotment 344.00) FY2026-2027 recommended: $491,434,200 total ($186,985,400 state, $44,940,000 federal, $259,508,800 other).
• FMAP: 64.16% FFY2026 (https://public-inspection.federalregister.gov/2024-27910.pdf); 63.34% FFY2027 (https://www.govinfo.gov/content/pkg/FR-2025-11-28/pdf/2025-21351.pdf). The state budget uses a blended state-fiscal-year rate declining from 64.323% to 63.545%.
• Spending per participant, from the CMS-approved cost-neutrality demonstrations (Waiver Year 1, amendments effective 11/01/2025): SW $169,646.79 per participant per year (Factor D waiver services $163,276.24 plus Factor D' $6,370.55) against an ICF/IID comparison cost of $312,864.10. CAC $293,835.41 ($283,193.56 waiver services) against $532,794.85. SD $40,187.79 ($34,725.52 waiver services) against $257,460.75.
• People served: ECF CHOICES 6,034 (June 30, 2025); three 1915(c) waivers 5,758 combined approved unduplicated participants in Waiver Year 1. CHOICES nursing facility 13,676 and CHOICES HCBS 12,381 for comparison.
• Waiting list: the FY2026-2027 budget appropriates $54,997,700 non-recurring to add 2,500 enrollees to ECF CHOICES from the waiting list, with those slots closing through attrition, plus $30,131,200 recurring to add approximately 300 enrollees in crisis (ECF CHOICES Mandatory Population). This is the state's own confirmation that a list exists, against TennCare's public framing of reserve capacity rather than a waitlist. The three 1915(c) waivers are closed to new enrollment except for narrow exceptions, with approved participant counts declining every year of the five-year cycle.

Residential funding detail

Legacy 1915(c) waivers (SW and CAC only; SD excludes residential). Four residential service lines, all per diem:

• Residential Habilitation (T2016), provider-owned or operated homes. Priced by acuity Level 1 or Level 2 and by the number of people sharing the home: Level 1 individual $311.36, 2 people $172.50, 3 people $121.94, 4 people $98.16, 5 to 7 people $96.21, 8+ people $78.15. Level 2 individual $450.21, 2 people $247.12, 3 people $218.49, 4 people $144.06, 8+ people $100.95.
• Supported Living (T2033, shift-staffed; T2031, individual/companion) in the person's own home. Level 1 individual/shift $311.36, 2 people $172.50, 3 people $121.94. Level 2 individual/shift $450.21, 2 people $247.12, 3 people $218.49. Individual/companion model Level 1 $213.46, Level 2 $260.77.
• Family Model Residential (T2012), host family. Five tiers: $49.55, $56.84, $76.74, $144.40, $309.39 per day.
• Flexible Residential Support Model ("Flex Support Rates," V1 base, V2 incentive, V3 transitional) layered onto Level 2 Residential Habilitation and Supported Living. Example: Level 2 for 2 people, flex base $164.43 per day plus incentive $10.73 per day, transitional $247.12 per day. tn.gov
• Special Needs Adjustments: residential add-ons of $35.00 per day for homes of 4 or fewer, $20.00 per day for 5 or more; homebound quarter-hour adjustments at $4.00, $5.79, and $8.05 by level.

ECF CHOICES. Community Living Supports (CLS) daily tiers: CLS 1a $49.25, CLS 1b $106.19, CLS 2 $218.49, CLS 3 $308.61, CLS 4 $428.34. Monthly options: CLS 1a $1,497.77, CLS 1b $3,185.81. CLS-Family Model daily: 1a $49.56, 1b $70.00, 2 $115.00, 3 $155.00, 4 $309.39; monthly 1a $1,516.59, 1b $2,142. Transitional CLS: Community Stabilization and Transition $428.34 per day, Behavioral Health CST 2a $652.97 and 2b $548.78 per day, Emergency Placement CST $428.34 per day.

ICF/IID remains funded within allotment 318.71 and is the institutional comparison basis for all three 1915(c) waivers.

Room and board. Not paid by the waiver. The approved Statewide Waiver application states that, per 42 CFR 441.310(a)(2), federal financial participation is not claimed for room and board except when provided as part of respite in a state-approved non-private-residence facility, or as the portion of rent and food reasonably attributed to an unrelated caregiver living in the same household. The service definitions repeat that reimbursement for Residential Habilitation, Medical Residential, and Family Model Residential Services "shall not be made for room and board or for the cost of maintenance of the dwelling." Room and board falls to the person's own income, principally SSI. TennCare separately publishes annual maximum room and board charges for assisted care living facilities: tn.gov

Rate structure basis. Rates are built on an average hourly DSP wage embedded in the rate methodology, raised to $15.68 effective July 1, 2025 from $15.37. tn.gov

Comparable service rates

Official rate schedule links

• DDA Service Details and Rates (all three 1915(c) waivers plus state-funded codes), as of 07/01/2025: tn.gov
• DSP wage increase memo with full CHOICES and ECF CHOICES service and rate charts effective 07/01/2025: tn.gov
• ECF CHOICES expenditure caps and institutional cost limit, effective 01/01/2026: tn.gov
• 2026 assisted care living facility room and board maximums: tn.gov
• Approved 1915(c) waiver amendments (CMS approval 10/24/2025, effective 11/01/2025): tn.gov | .../cac-1915c-hcbs-waiver-amendment-application-approved-by-cms-10.24.25-accessible.pdf | .../sd-1915c-hcbs-waiver-amendment-application-approved%20by-cms-10.24.25-accessible.pdf
• DDA Office of Business Services rate page: tn.gov

Notable features and flags

• June 9, 2025 / effective July 1, 2025. Average hourly DSP wage in the rate methodology raised to $15.68 from $15.37, with explicit legislative intent that providers pass it through and document it for TennCare, DDA, or the Comptroller.
• October 24, 2025, effective November 1, 2025. CMS approved amendments to all three legacy 1915(c) waivers. All three project declining approved enrollment across the five-year cycle (SW 3,721 to 3,296; CAC 1,190 to 1,057; SD 847 to 761), confirming the legacy waivers as a closing book with ECF CHOICES as the growth vehicle.
• January 1, 2026. New ECF CHOICES expenditure caps: Group 6 intellectual disability with exceptional needs $236,450 per year; developmental disability with exceptional needs $158,989; DD with tracheal suctioning $208,264.10; DD with chronic ventilator care $301,339.10; Group 7 children $236,450; Group 8 adults first year $513,625, second year and beyond $236,450.
• FY2026-2027 budget (enacted for the year beginning July 1, 2026). $54,997,700 non-recurring from TennCare Shared Savings to add 2,500 ECF CHOICES enrollees from the waiting list, slots closing through attrition; $30,131,200 recurring for approximately 300 crisis enrollees; $10,000,000 for LTSS workforce recruitment and retention incentives across CHOICES, ECF CHOICES, 1915(c) waiver, and OPTIONS providers.
• July 1, 2024. DIDD merged with the Commission on Aging and Disability to form the Department of Disability and Aging under the Tennessee Disability and Aging Act of April 11, 2024. Documents and URLs still carry both names.
• Rate schedule vintage flag. The DDA Service Details and Rates PDF posted at the Office of Business Services URL is dated "as of 07/01/2025." No 07/01/2026 replacement was posted at that location as of August 29, 2026.

Confidence

Solid: waiver structure, waiver numbers and amendment identifiers, approved participant counts, the full DDA and ECF CHOICES fee schedules, ECF CHOICES enrollment, the 318.71 and 344.00 budget lines with state and federal split, per-participant cost-neutrality figures, FMAP, and the FY2027 waiting list appropriations. Estimated or derived: the hourly equivalents of quarter-hour rates, and the characterization of ECF CHOICES residential services as "limited" since CLS is defined by tier rather than by setting type. Could not find: a published Family Support Program appropriation or count of families served (it is not broken out in either budget volume and is not on the program page); a current published ECF CHOICES enrollment figure later than June 30, 2025; a published count of the ECF CHOICES referral list independent of the 2,500-slot budget line; separate expenditure figures by individual 1915(c) waiver; and confirmation of whether a July 1, 2026 rate update exists but is unposted.