Written & Reviewed by
Last updated: May 4, 2026
Bottom line: Tennessee has a real paid-family-caregiver path for some seniors, but it usually runs through TennCare CHOICES. It is not a simple state check that pays any family member. The most practical paid route is usually CHOICES home care with Consumer Direction or a provider agency that hires a qualified relative. If the senior does not qualify for TennCare long-term care, the next steps are usually OPTIONS services, caregiver respite, PACE in Hamilton County, VA caregiver help, or local support.
For a wider list of help in the state, see our Tennessee senior benefits guide. You can also use our senior help tools to sort through common next steps.
Where to start in Tennessee
| Your situation | Start here | What to ask for |
|---|---|---|
| The senior is not on TennCare now | Call the AAAD at 1-866-836-6678 | Ask for a CHOICES long-term-care screening and other home help while you wait. |
| The senior already has TennCare | Call the TennCare health plan listed on the member card | Ask for CHOICES home services and a care coordinator. |
| You want to hire an adult child or other relative | Ask about Consumer Direction first | Ask if the service can be consumer directed and whether the worker can be approved. |
| The caregiver is a spouse or lives with the senior | Ask about provider-agency hiring | Ask which agencies hire family or household caregivers for the approved service. |
| A denial, delay, or service cut is the problem | Call the LTSS Help Desk | Ask what appeal, complaint, or care-plan step applies. |
Contents
- Where to start in Tennessee
- Emergency help now
- What paid caregiver help looks like
- Quick facts
- Who qualifies
- How much caregivers make
- Best Tennessee options
- How to start
- Checklist of documents
- Tax rules
- Reality checks
- Common mistakes
- Denied or delayed
- Backup options
- Local resources
- Phone scripts
- Rural and Spanish help
- Resumen en español
- FAQ
Emergency help now
- If the older adult is in immediate danger or has a medical emergency, call 911 or go to the nearest emergency room.
- If there is abuse, neglect, self-neglect, or money exploitation, contact Adult Protective Services at 1-888-277-8366.
- If a hospital says discharge is happening now and home care is not set up, call the AAAD line at 1-866-836-6678 and the LTSS Help Desk at 1-877-224-0219 the same day. Ask for urgent long-term-care screening help.
- If the senior is already in CHOICES, ECF CHOICES, Katie Beckett, or a waiver and you need help with rights, complaints, or appeals, call the Beneficiary Support System at 888-723-8193.
What paid caregiver help looks like
In Tennessee, most families do not get a simple monthly caregiver stipend just because an adult child, spouse, or other relative is helping at home. For seniors, the main paid-family-caregiver path is usually CHOICES, Tennessee’s long-term-care Medicaid program for older adults and adults with physical disabilities.
Once a senior qualifies, Tennessee may approve home care instead of nursing-home care. Then the family usually has two possible routes. The senior can use Consumer Direction and hire an approved worker directly through the state’s payroll contractor, or the senior can use a provider agency that employs a qualified relative.
If the senior does not qualify for TennCare long-term care, Tennessee usually offers support services, respite, meals, homemaker help, or adult day services instead of direct wages. That help can still matter. It may lower the number of unpaid care hours the family has to cover.
Quick facts
| Question | Tennessee answer |
|---|---|
| Can a family member get paid to care for a senior? | Yes, sometimes. The main route is TennCare CHOICES home care. |
| Can a spouse be paid? | Not through CHOICES Consumer Direction. The provider-agency route is broader, but it must be confirmed for the exact service. |
| Can an adult child be paid? | Often yes, especially if the adult child does not live with the senior and the service is approved. |
| Does the senior usually need Medicaid? | Yes for the main paid path. Non-Medicaid programs usually offer services, not wages. |
| Is there a broad non-Medicaid state pay program? | No. Tennessee’s main non-Medicaid options are OPTIONS, caregiver support, respite, and local help. |
| Best first phone call | Call AAAD at 1-866-836-6678 if the senior is not already on TennCare. |
Who qualifies
For older adults, the main program to know is CHOICES. It serves seniors age 65 and older and adults age 21 and older with physical disabilities. To get home-based CHOICES, the person must need help with daily activities. Group 2 is for people who meet nursing-home level of care but choose home care instead. Group 3 is for people who do not yet meet nursing-home level of care but are at risk of needing it without help at home.
On the money side, TennCare says Medicaid long-term-care income cannot be more than $2,982 a month in 2026. Countable resources usually cannot be more than $2,000. The home where the person lives does not count. TennCare also looks back five years for gifts or transfers for less than fair value. If income is over the limit, TennCare says a Qualifying Income Trust may help.
- The senior must usually need hands-on help or supervision with bathing, dressing, eating, moving around, toileting, or communication.
- The TennCare health plan must be able to safely meet the person’s needs at home.
- If the senior is applying for Group 3, ask whether a slot is open for non-SSI applicants.
- Married cases can be more complex than the simple $2,000 resource rule, so do not guess. Ask for a full TennCare long-term-care review if the senior has a spouse.
The CHOICES brochure is a good plain-English starting point if you want to understand the program before you call.
How much caregivers make
Tennessee does not publish one statewide hourly wage for family caregivers in CHOICES. In Consumer Direction, the worker pay rate goes into the service agreement and payroll setup. It must fit inside the senior’s approved service budget. Older Consumer Direction materials also say the state sets a range of rates for most services.
In the provider-agency model, the employer agency sets the wage. Pay can vary by service type, health plan, approved hours, region, and the agency or worker setup. Ask for the expected rate, approved hours, and start date in writing before anyone quits a job or turns down other income.
Best Tennessee options
1) TennCare CHOICES and Consumer Direction
What it is: Consumer Direction gives a CHOICES member more control over who provides certain home-care services. The senior, or an authorized representative, acts as the employer. Tennessee uses Consumer Direct Care Network Tennessee as the payroll company, also called the Fiscal Employer Agent.
Who can get it or use it: This is the clearest Medicaid self-direction option for many Tennessee seniors. It works best when the senior or a trusted adult can handle hiring paperwork, worker supervision, time records, and a back-up plan.
How it helps: A relative, friend, or neighbor may be hired for approved services. But the care must be in the senior’s approved plan. Consumer Direction handbook says the worker cannot be the member’s spouse, legal guardian, power of attorney, or Consumer Direction representative. They also say CHOICES does not pay family members for care they would have provided for free anyway.
How to apply or use it: If the senior is not on TennCare, start with AAAD. If the senior already has TennCare, call the health plan and ask for CHOICES home care and Consumer Direction.
What to gather first: Know which relative you hope to hire, whether that person lives with the senior, and whether you have a reliable back-up caregiver if the worker misses a shift.
| Relative or worker | Consumer Direction | Important Tennessee rule |
|---|---|---|
| Spouse | Usually no | Consumer Direction worker rules say the worker cannot be the member’s spouse. |
| Adult child who lives elsewhere | Often yes | The adult child still must be hired for an approved service and follow worker rules. |
| Adult child who lives with the senior | Often no for common services | Tennessee’s contract bars people who live with the member from being paid for personal care visits, attendant care, in-home respite, and several other services. |
| Immediate family for companion care | No | Immediate family, current housemates, and some former housemates cannot be paid for CHOICES companion care. |
| Sibling, friend, or neighbor | Often yes | Best chance when the worker does not live with the senior and the service is approved. |
If a live-in adult child or spouse hits a wall in Consumer Direction, do not stop there. Ask next about the provider-agency route below. Tennessee’s provider-agency guidance is broader than the Consumer Direction worker rules.
2) A provider agency that hires family members
What it is: Instead of the senior acting as the employer, a home-care provider agency can be the employer.
Who can get it or use it: This can work for seniors who are approved for CHOICES or another covered long-term-care service and who want the agency to handle payroll, supervision, and employment paperwork.
How it helps: Tennessee’s provider-agency guidance says provider agencies may hire qualified family members or other household members for CHOICES and other waiver home- and community-based services. Agencies cannot add extra limits only because of the family relationship, residence, age of the person served, parental relationship, or spousal relationship. The worker still has to meet job qualifications, pass needed checks, follow timekeeping rules, and be paid only for services and hours on the approved care plan.
How to apply or use it: Ask the care coordinator for agencies in your area that hire family caregivers. Then ask each agency the same question: “Will you hire my family member for the exact service hours on this approved plan?” Get the answer in writing if you can.
What to gather first: Be ready for background checks, orientation, training, electronic visit verification, and any certification the agency requires. If the family member is also a conservator or court-appointed guardian, the court order must clearly allow the job.
This is the Tennessee path to ask about when a spouse or live-in adult child cannot be paid through Consumer Direction. It may work better, but it is still not automatic.
3) OPTIONS for Community Living
What it is: OPTIONS for Community Living is Tennessee’s state-funded in-home program for adults who need help but do not qualify for Medicaid long-term care.
Who can get it or use it: Tennessee residents age 18 or older who meet activities of daily living and instrumental activities of daily living limits. The state says there is no income eligibility requirement, but there is a sliding fee scale based on income.
How it helps: It can provide personal care, homemaker help, home-delivered meals, and some regional services. It is a useful backup when a senior is over income for TennCare or does not meet CHOICES rules. But it is not a regular wage program for a family caregiver.
How to apply or use it: Call the AAAD line at 1-866-836-6678 and ask for an OPTIONS screening.
What to gather first: Have a list of daily-care problems, the senior’s income, and the help already being provided by family. Services are based on need and available funds, so ask what can start now and what may require waiting.
4) Caregiver support and respite
What it is: Tennessee offers the caregiver support page through Area Agencies on Aging and Disability. The state also works with the respite voucher program through the Tennessee Caregiver Coalition.
Who can get it or use it: Caregivers of adults age 60 and older, adults with Alzheimer’s disease or a related disorder, and some older relative caregivers.
How it helps: These programs can offer counseling, support groups, training, respite, personal care, homemaker services, and adult day care, depending on the area. The voucher program may help reimburse respite costs. It is not a paycheck for routine daily caregiving.
How to apply or use it: Call AAAD or contact the Tennessee Caregiver Coalition. Be ready to explain how many hours of care the family is already providing and what kind of short break would help most.
5) PACE in Hamilton County
What it is: Tennessee’s Tennessee PACE page describes PACE as an all-in-one medical and long-term-care option.
Who can get it or use it: The person must be 55 or older, meet nursing-facility level of care, live in Hamilton County, and be able to live safely in the community.
How it helps: PACE does not directly pay a family caregiver. It may reduce the family’s care load by bundling adult day care, home care, medical care, transportation, medicines, and care coordination.
How to apply or use it: Contact Alexian PACE in Chattanooga. The main public line is 423-698-0802, and Alexian lists an intake line at 423-495-9114.
What to gather first: Have Medicare, TennCare, medication, doctor, and hospital information ready.
6) VA caregiver programs
What it is: The VA offers caregiver support programs for eligible veterans and their caregivers. Some families may qualify for a stipend through the Program of Comprehensive Assistance for Family Caregivers. Others may get training, coaching, or help finding in-home services.
Who can get it or use it: The veteran must generally be enrolled in VA health care. These rules are separate from TennCare.
How it helps: This can be the best non-Medicaid paid-caregiver option for some Tennessee families. Start with the VA caregiver page, or ask the local VA caregiver team for help.
How to apply or use it: Call the VA Caregiver Support Line at 1-855-260-3274. Ask whether the veteran may fit the VA stipend rules and what local in-home supports are available.
What to gather first: Have the veteran’s DD214, VA enrollment information, disability rating records if available, and a list of daily care needs. Families caring for veterans may also want our guide to senior veterans in Tennessee.
How to start
- Start at the right door. If the senior is not already on TennCare, call AAAD. If the senior already has TennCare, call the plan and ask for CHOICES.
- Use the right words. Say: “I need a CHOICES long-term-care screening for home services, and I want to discuss Consumer Direction or a provider agency that can hire a family caregiver.”
- Describe hands-on needs. Mention bathing, dressing, toileting, transfers, meals, medication help, wandering, dementia supervision, falls, and whether nursing-home placement is a risk.
- Ask three direct questions. Which CHOICES group fits? Can the approved services be consumer directed? If not, is there a provider agency that will hire my family member?
- Use TennCare Connect. Upload papers there and check messages often.
- Do not quit a job too soon. Wait until the senior is approved, the service is authorized, the worker is hired, and you know the hours and pay rate.
Checklist of documents
These papers can save time, even if TennCare does not ask for every item on day one:
- Photo ID, Social Security card, and Medicare card
- Social Security award letter, pension statements, pay stubs, or other proof of monthly income
- Recent bank statements and information on assets and property
- Information about gifts, transfers, or property sales from the last five years
- Other health insurance cards
- Medication list, doctor list, diagnoses, and recent hospital or rehab discharge papers
- Guardianship, conservatorship, power-of-attorney, or health-care proxy papers if any
- The name of the relative you hope to hire and whether that person lives with the senior
Tax rules
Tennessee revenue page says Tennessee has no state income tax on earned income and no state withholding requirement for earned income. Federal tax rules still matter.
If the caregiver is paid through Consumer Direct Care Network Tennessee or through a provider agency, the caregiver will usually receive normal payroll paperwork. Ask the payroll company or agency whether the caregiver will get a W-2 and what taxes are being withheld.
The IRS guidance says some Medicaid waiver payments may be excluded from federal income under Notice 2014-7 when they meet federal rules, including care provided in the caregiver’s home. Do not assume your Tennessee caregiver pay qualifies. Consumer Direction blocks many live-in caregiver situations for common CHOICES services, so this federal tax break is not automatic here.
Reality checks
- Tennessee is not a “fill out one form and get paid to care for Mom” state.
- The main paid path usually requires TennCare CHOICES. Medicare alone is not enough.
- A spouse is blocked in CHOICES Consumer Direction, and live-in relatives face extra limits for several services.
- Tennessee does not post one universal family-caregiver pay rate.
- Provider shortages and local agency practices can still slow things down, even after approval.
- Estate recovery can apply after death for TennCare long-term care received at age 55 or older, though Tennessee lists waivers and hardship protections.
Common mistakes
- Confusing Medicare with Medicaid/TennCare
- Asking only, “How do I get paid?” instead of asking for a CHOICES screening
- Assuming a live-in adult child can always be paid
- Assuming a spouse can be paid through Consumer Direction
- Quitting work before written approval, hiring, and start date
- Ignoring mail from TennCare or missing document deadlines
- Forgetting about electronic visit verification, time sheets, and back-up plans
Best options by need
| If your need is… | Best Tennessee move | What to say first |
|---|---|---|
| You want an adult child paid to care for a parent at home | CHOICES plus Consumer Direction | “I want a CHOICES home-care screening and I want to ask about Consumer Direction.” |
| The caregiver lives with the senior or is the spouse | Provider-agency family hiring | “Consumer Direction may not work for us. Which agencies hire family caregivers for this service?” |
| The senior is not Medicaid-eligible | OPTIONS plus respite | “Please screen us for OPTIONS and caregiver-support services.” |
| The senior lives in Hamilton County and has heavy medical needs | PACE | “Could PACE replace some home-care and medical-care needs?” |
| The senior is a veteran | VA caregiver support | “Could this veteran qualify for a caregiver stipend or other in-home support?” |
Denied, delayed, or waitlisted
If the problem is financial eligibility, a coverage denial, or no decision after too long, use Tennessee’s eligibility appeal process. TennCare says you can ask for a delayed hearing if you have waited more than 90 days on a long-term-care application. You can file through TennCare Connect or call 1-855-259-0701.
If the problem is a service denial, reduced hours, or another medical coverage issue, use Tennessee’s medical appeal process. TennCare says medical appeals are usually decided within 90 days, and an emergency appeal may be faster if waiting could put health or safety at risk. You can call Medical Appeals at 1-800-878-3192.
- If you want an advocate, call the Beneficiary Support System at 888-723-8193. It helps with complaints, grievances, appeals, and CHOICES application problems.
- If you want free legal help, Tennessee’s appeal page points families to Memphis Area Legal Services, West Tennessee Legal Services, Legal Aid Society, and Legal Aid of East Tennessee.
- If OPTIONS is waitlisted, ask AAAD to note any decline in the senior’s condition. Ask for re-screening if needs get worse.
- Keep copies of every notice, upload confirmation, and fax receipt.
Backup options
If Tennessee does not have a clean paid-family-caregiver path for your situation, build a backup plan right away.
- Ask AAAD about meals, homemaker help, respite, transportation, and caregiver support while you wait. Our Tennessee AAAD guide can help you find the right office.
- If the senior is over the CHOICES income limit, ask about a Qualifying Income Trust.
- If bills are the immediate problem, check Tennessee emergency help, housing help in Tennessee, and utility bill help.
- If food or health costs are adding stress, review food help for seniors and Medicare Savings Programs.
- If property taxes are adding pressure, see Tennessee property tax relief.
- If the family is paying privately, use a written caregiver agreement and get legal advice before large payments are made, especially if TennCare may be needed later.
Local resources
- Area Agencies on Aging and Disability: county routing line at 1-866-836-6678
- LTSS Help Desk: long-term-care help at 1-877-224-0219
- TennCare Connect: apply, upload documents, and check status online or call 1-855-259-0701
- BlueCare CHOICES: call 888-747-8955
- UnitedHealthcare CHOICES: call 800-690-1606
- Wellpoint CHOICES: call 833-731-2153
- Disability Rights Tennessee: Beneficiary Support System at 888-723-8193
- Adult Protective Services: report abuse, neglect, or exploitation at 888-277-8366
- Tennessee Caregiver Coalition: respite voucher help through its program page
Phone scripts you can use
Calling AAAD for the first time
“Hi, I care for an older adult in Tennessee. They need help with bathing, dressing, meals, and staying safe at home. I want to ask for a CHOICES long-term-care screening. If CHOICES does not fit, please also screen us for OPTIONS, meals, respite, and caregiver support.”
Calling a TennCare health plan
“Hi, this member already has TennCare. I need to speak with a care coordinator about CHOICES home services. We want to ask about Consumer Direction and whether a family member can be hired for approved care hours.”
Calling a provider agency
“Hi, we have an approved care plan or are working on one. Do you hire qualified family members or household members as caregivers for CHOICES services? If yes, what training, checks, paperwork, and start time should we expect?”
Calling about a delay or denial
“Hi, I need help with a CHOICES delay or denial. Please tell me whether this is an eligibility appeal, a medical appeal, or a complaint. I also need help keeping copies of notices and meeting the deadline.”
Rural and Spanish help
If you live in a rural county, start with the statewide AAAD line instead of hunting for the right office on your own. The line routes you by county, and services can vary by region.
If your family prefers Spanish or needs language help, TennCare offers free language help upon request. Ask for an interpreter when you call TennCare Connect, the health plan, AAAD, or the Beneficiary Support System.
Resumen en español
En Tennessee, sí existe una forma real para que un familiar reciba pago por cuidar a un adulto mayor, pero casi siempre pasa por TennCare CHOICES. No hay un programa estatal simple que mande dinero a cualquier hijo, hija o cónyuge por cuidar a una persona mayor en casa.
La opción más clara es Consumer Direction dentro de CHOICES, o una agencia proveedora que pueda contratar a un familiar calificado. Un hijo adulto a veces puede recibir pago. Un cónyuge no puede recibir pago en Consumer Direction. Si el familiar vive en la misma casa, hay más límites para varios servicios.
El mejor primer paso suele ser llamar a la Area Agency on Aging and Disability al 1-866-836-6678 si la persona mayor no tiene TennCare. Si ya tiene TennCare, llame al plan de salud y pida una evaluación de CHOICES. Si el caso tarda demasiado o es negado, pregunte por una apelación y llame a Disability Rights Tennessee al 888-723-8193.
También puede buscar ayuda con comida, renta, servicios públicos, Medicare y apoyo local mientras espera. No deje un trabajo antes de tener aprobación por escrito, horas aprobadas, fecha de inicio y una tarifa de pago clara.
FAQ
Can Tennessee pay me to care for my elderly parent?
Sometimes, yes. The main path is TennCare CHOICES. If your parent qualifies medically and financially, Tennessee may approve home-care services and allow a relative to be paid through Consumer Direction or through a provider agency that hires family caregivers.
But Tennessee does not have a broad statewide program that simply pays any adult child or spouse who helps an older parent at home. If your parent does not qualify for TennCare long-term care, the state’s non-Medicaid programs usually offer support services, not wages.
Can a spouse get paid to care for a husband or wife in Tennessee?
In CHOICES Consumer Direction, the answer is no. Current Consumer Direction worker rules say a spouse cannot be paid in that model.
The provider-agency route is broader. Tennessee’s provider-agency guidance says agencies may not add extra restrictions only because of a spousal relationship. But that still does not mean every spouse will be hired for every service. Ask the agency and care coordinator to confirm the exact service in writing before you count on spousal pay.
Can an adult child who lives with the parent get paid?
Sometimes, but this is where many families get tripped up. Under Tennessee’s consumer-direction rules, a person who lives with the member cannot be paid for several common services, including personal care visits, attendant care, personal assistance, in-home respite, and community transportation.
That does not always end the conversation. A live-in adult child may have a better chance through a provider agency that hires family caregivers. This is why families should ask about both Consumer Direction and provider-agency hiring.
Does my parent need TennCare Medicaid for paid caregiver help?
Usually yes. For seniors in Tennessee, the main paid-family-caregiver path is CHOICES, and CHOICES is part of TennCare.
The main exceptions are non-Medicaid programs outside TennCare, such as VA caregiver support for eligible veterans or private-pay arrangements. OPTIONS and caregiver support can help without Medicaid, but they are usually not direct wages.
How much will Tennessee pay a family caregiver?
There is no single statewide number posted by Tennessee. In Consumer Direction, pay must fit within the senior’s approved service budget and service agreement. In the provider-agency model, the agency sets the wage.
The safest move is to ask for the expected hourly rate, approved hours, and start date in writing. Do that before anyone leaves work or turns down other income.
What if my parent’s income is a little too high?
Do not assume the case is dead. Tennessee says a Qualifying Income Trust may help if the person is over the monthly income limit for Medicaid long-term care.
Married cases can also be more complex than they look. If the parent is close to the line, ask AAAD, TennCare, or an elder-law attorney to review the full situation instead of self-denying.
I found ECF CHOICES stipend information online. Is that the same thing?
Usually no. Employment and Community First CHOICES is mainly for people with intellectual or developmental disabilities. The ECF Family Caregiver Stipend is only for certain ECF CHOICES Group 4 members. It is not the usual senior CHOICES path.
For most Tennessee seniors, start with CHOICES, not ECF CHOICES. If your older parent does not have an intellectual or developmental disability eligibility path, ECF is usually not the right program.
What if TennCare takes too long or says no?
If the problem is eligibility, income, resources, or no decision after too long, use the eligibility appeal process. Long-term-care applicants can ask for a delayed hearing after more than 90 days.
If the problem is a service denial or reduced care, use the medical appeal process. For extra help, call Disability Rights Tennessee’s Beneficiary Support System or one of the state’s legal-aid programs.
About this guide
We check this guide against official government, local agency, and trusted nonprofit sources. GrantsForSeniors.org is independent and is not a government agency.
Program rules, funding, and eligibility can change. Always confirm details with the official program before you apply.
See something wrong or outdated? Email info@grantsforseniors.org.
Editorial note: This guide was written for Tennessee seniors, caregivers, and adult children trying to solve a real home-care problem. It focuses on official Tennessee and federal sources first.
Verification: Last verified May 4, 2026. Next review September 4, 2026.
Corrections: Please email info@grantsforseniors.org with corrections. We review update requests and fix confirmed errors.
Disclaimer: This article is for general education only. It is not legal advice, tax advice, medical advice, or individualized Medicaid planning advice. Program rules, funding, and local availability can change. Confirm details with the official program before you act.
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