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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 more cost-effective services 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. This includes people with intellectual disabilities who would otherwise 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. We provide residential services for adults and children who do not live with family but need support where they live. We explore job opportunities for individuals who want to work and assist them through every phase of the employment process. We help them choose positions that match their skills and 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 give them 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, improve skills necessary to reside successfully in a family environment in the home of trained caregivers rather than in the home of actual family members.
  • 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 – Provides individuals with assistance in identifying their strengths and skills as well as what they will 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