2024 Tennessee Disability Scorecard
Tennessee receives a D for its policies, practices, opportunities, and outcomes for residents with disabilities. 

Family Caregiving Support: F

Access to Care: F

Housing: F

Education: D

Aging: C+

Mental Health Access: D-

Employment: C-

Access to Justice: C-

Transportation: C-

Tennessee’s Overall Grade: D


Family Caregiving Support: F
The Problem:
1. Cost: 20% of family caregivers in Tennessee report 14 or more days of poor mental health, and 15% report 14 or more days of poor physical health. 
2. Support: Tennessee ranked 45th nationally in the availability of home health care workers, with only 23 workers per 1,000 residents.
3. Total system failure: In the most recent AARP State Disability Scorecard, Tennessee ranked 51st in the amount of support that it offers to family caregivers.
Tennessee’s Homework:
1. Compensate: Enact a comprehensive, statewide paid family caregiving program and policy.
2. Protect: Fully fund conservatorship and supported decision-making services for Tennessee caregivers with loved ones enrolled in the state’s waiver programs.
3. Support: Repeal state preemption banning local paid family leave policies.


Access to Care: F
The Problem:
1. Underspending: Tennessee ranked 51st in the United States in the amount of spending per Medicaid enrollee, spending less than half of the national average.
2. Playing with fire: TennCare reimbursement rates cover only 75% of the actual cost of hospital care, contributing to 60% of Tennessee hospitals operating at a loss, with 45% at risk of closure.
3. Provider Scarcity: 44% of enrollees in the state’s ECF CHOICES waiver program say they are waiting for services because there are no providers available.
Tennessee’s Homework:
1.Increase transparency: Modify the state’s provider network adequacy reporting standards to more accurately reflect the extent of waiver services enrollees actually receive, how long they wait for them and where and for whom our network gaps exist.
2. Improve Access: Submit a waiver to expand TennCare eligibility to those earning up to 138% of the Federal Poverty Line (FPL).
3. Management: Reconvene the TennCare Oversight Committee within the General Assembly to monitor TennCare’s provider network, 3rd party vendors, and quality of service delivery.


Housing: F
The Problem:
1. Purchase: Zero counties in Tennessee are affordable for a household with a disability to purchase a home, down from 5 in 2023 and 15 in 2022.
2. Support: Tennessee ranks 46th in the US in the percentage of residents with a disability receiving a Housing Choice Voucher.
3. Rental: A household with a disability cannot afford the median rental unit in any county in the state.
Tennessee’s Homework:
1. Protect: Prohibit further exemptions to the state’s anti-institutionalization laws for new segregated and congregate residential facilities.
2. Support: Increase reimbursement rates for residential Community Living Supports providers.
3. Invest: Establish an Accessible Housing Trust Fund to acquire, rehabilitate, and modify homes for Tennesseans with disabilities.


Education: D
The Problem:
1. Noncompliant: The Federal Department of Education classified the state’s special education implementation as “needs assistance for more than two years in a row.”
2. Personnel: 45% of Tennessee teachers say they lack the support personnel to teach students with disabilities.
3. Invest: Tennessee ranks 43rd in per-pupil spending in the US, and 45th in the percent of state revenue dedicated to education.
Tennessee’s Homework:
1. Compliance: Reconstitute the state’s special education compliance division within the Department of Education to focus on special education implementation.
2. Prepare teachers: Create an Academic and Behavioral Specialist (ABS) licensure category for prospective teachers who plan to work with students with behavior needs.
3. Follow the law: Require administrators to formally document ALL removals of students from school for behavior resulting from a disability and enforce IDEA protections.


Aging: C+
The Problem:
1. Crisis: Tennessee has the 10th highest poverty rate among residents 65+ in the United States.
2. Housing: 44.7% of Tennessee renters aged 65+ are housing cost-burdened, ranking 23rd in the United States.
3. Support: Tennessee ranks 37th in the percent of residents 65+ who receive food stamps or SNAP benefits. 
Tennessee’s Homework:
1. Protect: Expand spousal impoverishment protections beyond the federal minimum standards.
2. No wrong doors: Enact “no wrong door” policy to increase knowledge of and access to long-term supports and services, financial support, and community living options.
3. Waiting for help: Provide funds to draw down the OPTIONS and CHOICES Group 3 waitlists and improve provider network adequacy to ensure receipt of services.


Mental Health Access: D-
The Problem:
1. Access: Tennessee ranks 46th in the availability of trained/licensed mental health providers.
2. Increase capacity: The state ranked 38th in the number of psychiatric beds per 100,000 residents.
3. Cost: Tennessee ranks 40th in the percent of adults with mental health need who are insured.
4. Youth Access: Tennessee ranks 39th in the percent of youth with major depression who received care, at 62%.
Tennessee’s Homework:
1. Prevention: Increase funding for the TN START crisis intervention program to expand access statewide, recruit more providers, and develop additional crisis respite homes.
2. Communicate: Require the state’s psychiatric facilities to update their occupancy status daily in a statewide bed registry to ensure that Tennesseans aren’t retained in inappropriate settings during a mental health crisis.
3. Remove barriers: Streamline the process by which Tennessee school districts are able to bill TennCare for behavioral health services provided in the school setting.
4. Prepare: Develop training for mental health providers on working with individuals with intellectual and developmental disabilities.


Employment: C-
The Problem:
1. Access: Tennessee ranked 41st in the United States in the rate of employment for people with disabilities.
2. Training: The state’s Vocational Rehabilitation (VR) system ranked last in spending for job training for people with disabilities.
3. Preparation: Only 7.4% of Individualized Education Plans for Tennessee students with disabilities had compliant post-secondary transition plans.
Tennessee’s Homework:
1. Prepare Workers: Fund the reopening of a Training Center for the Blind to ensure that Tennesseans with vision-related disabilities have access to their communities and gainful employment.
2. Support Workers: End the policy of automatic fading of job coaching for workers with disabilities participating in supported employment through the state’s Medicaid waiver programs.
3. Increase Capacity: Dedicate recurring state supplemental funds for Vocational Rehabilitation to increase access to job coaching, career services, and job placement.


Access to Justice: C-
The Problem:
1. Youth Jails: The state of Tennessee is currently the subject of a lawsuit over their mistreatment of children with disabilities in the state’s “Youth Development Centers.”
2. Disability Access: Tennessee ranks 16th in the composite “Disability Access” rankings by the National Center for Access to Justice.
3. Institutionalization: The Tennessee General Assembly passed a law permitting people with intellectual disabilities who have not been convicted of a violent crime to be remanded indefinitely to a state institution.
Tennessee’s Homework:
1. Common Sense: Increase protections for students with disabilities from being charged with felonies resulting from “threats of mass violence.”
2. Protect liberty: Limit the application of “Jillian’s Law” to only violent felonies.
3. Appropriate Placements: Prohibit administrative transfers of justice-involved youth to the adult criminal justice system.


Transportation: C-
The Problem:
1. Capacity: Tennessee ranks 39th in the United States in the number of demand-response (paratransit) rides per person with a disability, due to low capacity and investment. 
2. Quality: The 2023 AARP State Disability Scorecard ranked Tennessee 47th in composite “Transportation Livability Index.”
3. Safety: In 2023, Tennessee had the 13th most pedestrian traffic fatalities per capita.
Tennessee’s Homework:
1. Public-Private: Require ride-share companies to maintain a certain percentage of vehicles as accessible to folding and non-folding wheelchairs.
2. Mobility: Permit paratransit vehicles and disability plate, placard and decal holders to use the state’s new “Choice Lanes” free of charge.
3. Protect: Fine corporate ride-shares for each instance of driver refusal to permit a licensed service animal on a ride.


The Tennessee Disability Coalition is an alliance of organizations and individuals across Tennessee who work together to improve the lives of Tennesseans with disabilities. 

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