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Group of happy people with disabilities

Employment and Community First (ECF), is a program TennCare created based on feedback from people and their families regarding which services they felt were most needed. The objective is to provide services and supports more cost-effectively with a long-term goal of serving more people. This includes those on the waiting list and people with other kinds of developmental disabilities, which previously have been unserved through the state’s existing Medicaid waivers. With ECF, Tennessee will become the first state in the country to develop and implement a home and community-based services program. It will allow the state to provide Home and Community Based Services (HCBS) and other Medicaid services more cost-effectively so people who need HCBS can receive them, including people with intellectual disabilities who would otherwise would be on the waiting list or those with other developmental disabilities who previously may not have qualified. Our ECF program is for people of all ages who have an intellectual or developmental disability, including individuals who have significant disabilities. As well as children. Our UCA program allows us to work with DCS and help children with these disabilities since they can not be apart of the foster care system. Our services are to help people with these disabilities gain as much independence as possible while they are supported to live with their families or in the community, instead of an institution. We provide residential services for adults and children who do not live with family but need support where they live. We help explore the possibility of working for the individuals who desire to work in the community by helping them find and maintain employment. We help choose positions that match your employment preferences. It can be part-time, full-time, or self-employment. This program will allow your loved ones to grow in their communities through supported employment and be given the tools and resources they need to successfully fulfill their dreams of living a more independent and fulfilling lifestyle.


  • Family Model Residential Services – Personalized service and support that enables an individual to acquire, retain or improve skills necessary to reside successfully in a family environment in the home of trained caregivers other than in the home of actual family members. Our Unique Care Agreement (UCA) program also allows us to provide this to young individuals under the age of 18 who can not be a part of foster care due to their disability.
  • Supported Employment – is a program for individuals seeking competitive employment but need support because of the nature of their disability. We offer a various amount of services under our supported employment program which are:
    • Exploration – Helps you to decide if you would like to work as well as the kind of work you may enjoy or be good at by visiting job sites that match your skills and interests.
    • Discovery – will provide individuals with assistance in identifying their strengths and skills as well as what they will be need to be successful.
    • Situational Observation – Allows the individual to try out various jobs identifying their specific needs in preparation for the job field of their choice.
    • Job Development – Assists the individual with creating their personalized plan for growth inside their job or to develop their own business.
    • Job Coaching – A coach will be provided to the individual to support them with their job until they can perform the job on their own or with the help of their co-workers. A coach will also be provided to an individual trying to start their own business until they are capable of running the business on their own.
    • Benefits Counseling – Provides assistance to help the individual better understand how the income earned will impact other benefits received.
    • Integrated Employment – Time-limited training to prepare and equip individuals for work in the community.
elderly woman and a woman smiling