Paid Family Caregiver Programs in Tennessee

Last updated: 31 March 2026

Bottom Line: Tennessee does have a real paid-family-caregiver path for some seniors, but it usually runs through TennCare CHOICES, not through a simple state check that pays any family member. The most practical paid route is usually CHOICES home care with the state’s Consumer Direction option or a provider agency willing to hire a qualified relative; if the senior does not qualify for TennCare long-term care, Tennessee’s main backups are AAAD and OPTIONS services, caregiver support and respite, PACE in Hamilton County, or VA caregiver programs.

Emergency help now

1. If the older adult is in immediate danger or has a medical emergency, call 911 or go to the nearest emergency room.
2. If there is abuse, neglect, self-neglect, or financial exploitation, contact Adult Protective Services at 888-277-8366.
3. 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 and ask for urgent long-term-care screening help.

What this help actually looks like in Tennessee

In Tennessee, most families do not get a simple monthly caregiver stipend just because an adult child or spouse is helping at home. For seniors, the main paid-family-caregiver path is usually TennCare 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 goes one of two ways. 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 hires qualified family members. If the senior does not qualify for TennCare long-term care, Tennessee usually offers support services, respite, meals, or homemaker help instead of direct wages.

Quick facts

Question	Tennessee answer
Can a family member get paid to care for a senior?	Yes, sometimes, mainly through TennCare CHOICES.
Can a spouse be paid?	Not through CHOICES Consumer Direction handbook rules. The provider-agency route is more complicated and should be confirmed in writing before you rely on it.
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 in Tennessee usually provide support, not wages.
Is there a broad non-Medicaid state pay program for family caregivers?	No. Tennessee’s main non-Medicaid options are OPTIONS, caregiver support, respite, and local services.
Best first phone 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 you live in does not count, and TennCare looks back five years for gifts or transfers for less than fair value. If income is over the limit, the same page says a Qualifying Income Trust may help.

• The senior must usually need hands-on help or supervision with things like bathing, dressing, eating, moving around, toileting, or communication, as explained in the CHOICES brochure.
• The TennCare health plan must be able to safely meet the person’s needs at home.
• If the senior is applying for Group 3, the public CHOICES page still notes an enrollment target for non-SSI applicants, so ask whether a slot is open.
• 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.

How much do paid family caregivers make in Tennessee?

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 and must fit inside the senior’s approved service budget. TennCare’s contract also says higher rates are allowed only in limited situations.

In the provider-agency model, the employer agency sets the wage. Either way, pay can vary by service type, health plan, approved hours, region, and the agency or worker arrangement. Tennessee’s family caregiver guidance also says payment cannot go beyond the benefits in the senior’s approved care plan. Ask for the expected rate and hours in writing before anyone quits a job.

Best Tennessee options for paid family caregiver help

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 Tennessee seniors. It works best when the senior or a trusted adult child 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, and Tennessee’s current member materials say CHOICES cannot pay relatives for care they would have provided for free anyway. The state also requires electronic visit verification for several services, so workers have to clock in and out correctly.

How to apply or use it: If the senior is not on TennCare, start with the AAAD. If the senior already has TennCare, call the health plan and ask for CHOICES home care and Consumer Direction. After approval, TennCare’s consumer-direction contract says services should begin as soon as possible and no later than 60 days after the referral to the payroll contractor, unless there is a documented outside delay.

What to gather or know first: Know exactly 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	CHOICES Consumer Direction	Important Tennessee rule
Spouse	Usually no	Current member handbook language says a spouse cannot be paid in Consumer Direction.
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 bars people who live with the member from being paid for personal care visits, attendant care, in-home respite, and several other consumer-directed 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 rules are broader than its Consumer Direction rules.

2) CHOICES through 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 other covered long-term-care services and who want the agency to handle payroll, supervision, and employment paperwork.

How it helps: Tennessee’s 2025 family caregiver guidance says provider agencies may hire qualified family members or other household members for CHOICES and other waiver home- and community-based services. That same guidance says agencies may not add extra limits solely because of the family relationship, residence, age of the person served, or even the spousal relationship. The worker still has to meet job qualifications, pass any needed checks, 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 or know first: Be ready for background checks, orientation, training, EVV, and any certification the agency requires. If the family member is also a conservator or court-appointed guardian, TennCare says the court order must specifically 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 ADL and IADL limits. The state says there is no income eligibility requirement, but there is a sliding fee scale.

How it helps: It can provide personal care, homemaker help, home-delivered meals, and some regional add-on services. It is a very 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 or know first: Have a list of daily-care problems, the senior’s income, and the help already being provided by family. The latest public OPTIONS waiting-list report said 6,722 people were waiting statewide as of November 2024, so think of this as a real backup option, but not guaranteed fast help.

4) National Family Caregiver Support Program and Tennessee Caregiver Coalition respite help

What it is: Tennessee offers the National Family Caregiver Support Program through Area Agencies on Aging and Disability. The state also works with the Tennessee Caregiver Coalition’s respite voucher program.

Who can get it or use it: Caregivers of adults age 60 and older, adults with Alzheimer’s disease or related disorders, 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 Tennessee Caregiver Coalition voucher program helps reimburse respite costs. It is not a paycheck for routine daily caregiving.

How to apply or use it: Call the AAAD or the Tennessee Caregiver Coalition.

What to gather or know first: Be ready to explain how many hours of care the family is already providing and what kind of short-term break would help most.

5) PACE in Hamilton County

What it is: Tennessee’s Program of All-Inclusive Care for the Elderly is an all-in-one medical and long-term-care option.

Who can get it or use it: The official Tennessee PACE page says the person must be 55 or older, meet nursing-facility level of care, live in Hamilton County, and still be able to live safely in the community.

How it helps: PACE does not directly pay a family caregiver, but it can sharply reduce family caregiving load by bundling adult day care, home care, medical care, transportation, and care coordination.

How to apply or use it: The state’s PACE page directs families to Alexian PACE or to call 423-698-0802.

What to gather or know first: Have Medicare, TennCare, medication, and doctor information ready.

6) VA caregiver programs for Tennessee veterans and their families

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, while 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 Support Line, or contact the local caregiver teams at VA Tennessee Valley Health Care or VA Memphis Health Care.

How to apply or use it: Call the VA Caregiver Support Line at 1-855-260-3274. Ask whether the veteran may fit the caregiver stipend program and what local in-home supports are available.

What to gather or know first: Have the veteran’s DD214, VA enrollment information, disability rating records if available, and a list of daily care needs.

How to apply or use it without wasting time

1. Start at the right door. If the senior is not already on TennCare, call the AAAD. If the senior already has TennCare, call the plan and ask for CHOICES.
2. 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.”
3. Describe hands-on needs clearly. Mention bathing, dressing, toileting, transfers, meals, medication help, wandering, dementia supervision, falls, and whether nursing-home placement is a risk.
4. 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?
5. Use TennCare Connect. Upload papers there and check messages often.
6. Do not quit a job too soon. Wait until the senior is approved, the service is authorized, the worker is actually hired, and you know the hours and pay rate.

Checklist of documents or proof

These papers usually 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, because TennCare looks back five years for LTSS eligibility
• 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 that may apply

Tennessee does not have state income tax on earned income. But 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 says some Medicaid waiver payments may be excluded from federal income under Notice 2014-7 when they meet the federal rules, including care provided in the caregiver’s home. Do not assume your Tennessee caregiver pay qualifies. Tennessee’s CHOICES rules often block payment to people who live with the member for several common 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 shortage 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, although Tennessee lists important waivers and hardship protections.

Common mistakes to avoid

• 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
• Quitting work before written approval, hiring, and start date
• Ignoring mail from TennCare or missing document deadlines
• Forgetting about EVV, time sheets, and back-up plans in Consumer Direction

Best options by need

If your need is…	Best Tennessee move	What to say on the first call
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 caregiver support and 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?”

What to do if denied, delayed, blocked, 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 you usually have 60 days from when you learn about the problem, and 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 of Middle Tennessee and the Cumberlands, and Legal Aid of East Tennessee.
• If OPTIONS is waitlisted, ask the AAAD to note any decline in the senior’s condition and ask for re-screening if needs get worse.
• Keep copies of every notice, every upload confirmation, and every fax receipt.

Plan B / backup options

If Tennessee does not have a clean paid-family-caregiver path for your situation, build a backup plan right away.

• Ask the AAAD about meals, homemaker help, respite, transportation, and caregiver support while you wait.
• If the senior is over the CHOICES income limit, ask about a Qualifying Income Trust.
• If the senior is a veteran, call the VA Caregiver Support Line.
• 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 map and statewide routing line at 1-866-836-6678
• LTSS Help Desk: TennCare long-term-care contacts at 1-877-224-0219
• TennCare Connect: apply, upload documents, and check status or call 1-855-259-0701
• 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 program

For rural families and families who prefer Spanish

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 a lot by region.

If your family prefers Spanish or needs language help, TennCare Connect offers free language assistance, and Disability Rights Tennessee says interpreter and translation services are available through the Beneficiary Support System.

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. The current member handbook language says a spouse cannot be paid in that model.

The provider-agency route is more nuanced. Tennessee’s 2025 provider guidance is broader and says agencies may not add extra restrictions solely because of a spousal relationship. But that still does not guarantee 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, in-home respite, and some others. Tennessee also blocks immediate family and certain housemates from paid companion care.

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 family 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. Tennessee’s OPTIONS program and caregiver support programs 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’s CHOICES page says a Qualifying Income Trust may help if the person is over the monthly income limit for Medicaid long-term care.

Also, married cases can be more complicated than they look, and some families focus on the wrong number. If the parent is close to the line, ask the AAAD, TennCare, or an elder-law attorney to review the full situation instead of self-denying.

I found ECF CHOICES Family Caregiver Stipend information online. Is that the same thing for my older parent?

Usually no. Employment and Community First CHOICES is mainly for people with intellectual or developmental disabilities. Many search results mix that program together with senior programs, which causes confusion.

For most Tennessee seniors, start with CHOICES, not ECF CHOICES. If your older parent does not have an I/DD-related 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. TennCare says 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.

Resumen breve 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 o cónyuge por cuidar a un padre o madre mayor en casa. En general, el adulto mayor tiene que calificar para Medicaid de cuidado a largo plazo.

La opción más clara es Consumer Direction dentro de CHOICES, o una agencia proveedora que quiera contratar a un familiar calificado. Un hijo adulto a veces sí puede recibir pago. Un cónyuge no puede recibir pago en Consumer Direction, y 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, o llamar al plan de TennCare y pedir una evaluación de CHOICES si ya lo tiene. Si el caso es negado o tarda demasiado, todavía puede apelar y pedir ayuda a Disability Rights Tennessee.

About This Guide

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 and keeps national background short on purpose.

Verification: Program rules, contact points, and eligibility details in this guide were checked against official Tennessee, IRS, and VA sources available through March 2026. Because caregiver pay rules can change, confirm the current service, hours, and worker rules before relying on them.

Corrections: If you spot a change, please send it through the GrantsForSeniors.org contact page so this guide can be reviewed and updated.

Disclaimer: This article is for general education only. It is not legal advice, tax advice, or individualized Medicaid planning advice.