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Tennessee home care payment guide
Last updated: September 13, 2026
If you need help at home in Tennessee, the best way to pay depends on the kind of care you need. TennCare CHOICES is the main public route for ongoing Medicaid-funded personal care. Medicare is much narrower and mainly pays for qualifying skilled home health. Tennessee also has aging-network services, a Hamilton County PACE program, veteran benefits, caregiver options, and private-pay choices.
Bottom Line
Start with the right door. If you need ongoing help with bathing, dressing, meals, transfers, or staying safely at home, call Tennessee’s Area Agency on Aging and Disability network at 1-866-836-6678. It can screen people who are not already on TennCare for CHOICES and connect older adults with other home-based services. If you already have TennCare, call the health plan listed on your TennCare card and ask for a CHOICES long-term services and supports screening.
Do not assume Medicare will pay for long-term personal care. It normally requires a homebound status and a need for part-time or intermittent skilled care. For a wider map of help beyond home care, use the Tennessee benefits guide.
Need Help Right Now?
Call 911 for an immediate medical or safety emergency. If an older or disabled adult may be abused, neglected, exploited, or unable to protect themselves, Tennessee Adult Protective Services takes reports 24 hours a day at 1-888-277-8366. For urgent bills, shelter, food, or utility problems that are not a 911 emergency, see the Tennessee emergency help guide.
Start Here
- If you are not on TennCare: call 1-866-836-6678. Tennessee’s AAAD directory routes callers to one of nine regional Area Agencies on Aging and Disability. Ask for a CHOICES screening and other in-home services that may fit.
- If you already have TennCare: call the member-services number on your health-plan card. Tennessee’s CHOICES application steps direct current members to their plan for screening.
- If the need followed an illness or hospital stay: ask the doctor whether you meet Medicare’s rules for skilled home health. If Medicare coverage is confusing, Tennessee SHIP can give free, unbiased counseling.
For more help finding the correct regional aging office, see the GFS Tennessee AAAD guide.
Quick Routes to Paying for Home Care
| Need | Best first route | What to know |
|---|---|---|
| Ongoing personal care at home | TennCare CHOICES | Requires a care-needs review and Medicaid financial eligibility for the applicable group. |
| Skilled nursing or therapy after illness | Medicare home health | The person generally must be homebound and need part-time or intermittent skilled services. |
| Some help at home, meals, or homemaker support | OPTIONS / aging network | Services depend on need, local capacity, and funding. A sliding fee can apply. |
| Coordinated medical and home support in Hamilton County | PACE | Limited to qualified adults age 55+ who live in Hamilton County. |
| Veteran home-care support | VA / county VSO | Eligibility and local availability vary by VA benefit and clinical need. |
| No public program fits now | Insurance / private pay | Compare covered hours, minimum shifts, worker screening, taxes, and cancellation rules before signing. |
Home Care and Home Health Are Different
Home care usually means ongoing help with daily tasks such as bathing, dressing, toileting, transfers, meals, housekeeping, reminders, and supervision. Home health usually means medical or therapy services ordered after an illness, injury, or change in condition.
The difference matters because Medicare can pay for qualifying skilled home health but is not a general long-term personal-care benefit. TennCare CHOICES is the main public route when the need is ongoing help with daily activities.
TennCare CHOICES Is the Main Long-Term Route
TennCare CHOICES provides long-term services and supports for adults age 65 or older and adults age 21 or older with physical disabilities. Depending on need, it can support nursing-facility care or home and community-based services.
Who may fit CHOICES
Group 1 is nursing-facility care. Group 2 is for people who meet nursing-facility level-of-care rules but choose qualified home and community services. Group 3 is for people who do not meet nursing-facility level of care but are at risk of needing it and meet the program’s other rules.
An assessment looks at help needed with bathing, dressing, eating, transfers, toileting, and other daily tasks. A diagnosis alone does not guarantee a particular number of care hours.
Group 3 capacity note: The current CHOICES page still carries a dated October 1, 2022 note about an enrollment target of 1,750 for non-SSI Group 3 recipients. TennCare does not label that note as a 2026 statewide waitlist count. Ask the AAAD or health plan whether current enrollment capacity affects your case.
2026 financial rules
TennCare’s 2026 eligibility guide lists an individual monthly income limit of $2,982 and a countable-resource limit of $2,000 for Institutional Medicaid and long-term services and supports. The home where the applicant lives generally does not count toward that resource limit.
A person over the income limit may still have a Qualifying Income Trust route. Married applicants have separate spouse protections. Tennessee’s January 2026 spouse resource policy is summarized below. Ask TennCare to review the household before moving money or property.
| Rule | 2026 point | Why it matters |
|---|---|---|
| Individual income | $2,982 per month | Some people over this amount may still have a QIT route. |
| Applicant resources | $2,000 countable resources | Spouse protections and exempt assets can change the result. |
| Asset transfers | 5-year review period | Giving assets away can create a Medicaid penalty. |
| Community spouse | $32,532 to $162,660 | The protected amount depends on combined countable resources and other rules. |
These are screening points, not an eligibility decision. Care level, income, resources, spouse rules, trusts, and transfers can change the result.
How to apply
If you are not on TennCare, call the Area Agency on Aging and Disability at 1-866-836-6678. If you already have TennCare, call the health plan on your card. The GFS benefits portals guide can help you tell state portals apart.
Do not give assets away first. TennCare applies a five-year transfer review for long-term care eligibility. A gift or below-market transfer can create a penalty. Get qualified advice before transferring property or money.
Estate recovery can matter. Tennessee’s estate recovery rules can seek repayment from a member’s estate for certain TennCare long-term services received at age 55 or older, including CHOICES home and community-based care. Family members are not personally responsible. Protections and hardship waivers can apply.
OPTIONS and Aging Services Can Fill Gaps
Tennessee’s OPTIONS program is a state-funded home and community-based services program. It can provide homemaker help, personal care, and home-delivered meals. Some regions offer other supports.
The state says OPTIONS has no income eligibility requirement, but a sliding fee based on income can apply. A person still must meet functional rules, and service depends on need, local capacity, and funding. Adults age 60 or older may also receive certain Older Americans Act in-home services through the aging network.
The caregiver support program may offer respite, counseling, training, homemaker help, personal care, or adult day services. Tennessee’s aging nutrition program provides home-delivered meals to qualifying older adults. Call 1-866-836-6678 for local availability.
Medicare Can Cover Skilled Home Health
Medicare home health can cover qualifying part-time or intermittent skilled nursing, therapy, medical social services, and some home health aide care. The person generally must be homebound, need skilled services, and use a Medicare-certified home health agency under an eligible clinician’s order.
Medicare does not become long-term custodial coverage when personal care, cooking, housekeeping, or supervision is the only need. Home health aide care is covered only when skilled care is also being provided.
For free Medicare counseling, call TN SHIP at 1-877-801-0044. The GFS Tennessee MSP guide explains programs that may lower Medicare costs and free household income for uncovered care.
PACE Is a Hamilton County Option
Tennessee’s PACE program combines medical care, social services, therapies, transportation, adult day services, equipment, prescriptions, and in-home personal care for qualified participants.
PACE is not statewide. As of September 13, 2026, the Tennessee program serves Hamilton County. A person must be at least 55, meet Tennessee’s nursing-facility level-of-care standard, live in the service area, and be able to live safely in the community at enrollment.
For current enrollment information, Tennessee directs applicants to Alexian PACE at 423-698-0802. Ask the intake coordinator to explain covered services and any costs that could apply before enrolling.
Can a Family Member Be Paid?
Sometimes. CHOICES consumer direction can let an approved member hire certain family members, friends, neighbors, or other workers, subject to program rules and the approved plan of care. Tennessee also publishes family caregiver guidance for provider agencies.
Rules can depend on the relationship, service, worker qualifications, and delivery model. Do not assume a spouse, guardian, or other relative can automatically be paid. See the GFS Tennessee caregiver pay guide. The disability help guide lists related supports.
Veterans May Have Additional Home-Care Routes
Veterans who use VA health care should ask a VA social worker about home-based services before paying privately. VA home aide care can help with daily activities when clinical and eligibility rules are met.
Veteran-Directed Care can give eligible veterans a flexible service budget and more control over workers, including some family or neighbors. Local availability varies. Qualified pension recipients may also receive a higher pension through Aid and Attendance.
Use Tennessee’s county VSO finder for local claims help. The GFS Tennessee veterans guide explains additional routes.
Long-Term Care Insurance and Private Pay
If public programs do not cover enough hours, families may combine benefits with private resources. Before hiring an agency, ask for the hourly rate, minimum shift, weekend rate, cancellation policy, transportation charges, worker screening, and backup-worker policy.
If the person has long-term care insurance, ask the insurer whether home care is covered, what triggers benefits, whether there is an elimination period, and what records are required. If hiring a worker directly, use a written care agreement and ask a qualified professional about payroll, tax, or legal duties.
Protect Medicaid eligibility. Do not gift, transfer, or retitle major assets just to pay for care or qualify for TennCare without understanding the five-year transfer rule and spouse protections.
How to Start Without Wasting Time
- List the care needed. Note what the person cannot safely do alone: bathing, dressing, toileting, eating, transfers, walking, medications, meals, shopping, or supervision.
- Call the payer first. Use TennCare/AAAD for long-term help, Medicare for qualifying skilled home health, VA for veterans, and PACE for eligible Hamilton County residents.
- Ask for a screening. Describe the actual tasks that need another person’s help.
- Gather documents. Keep identity, coverage, income, asset, spouse, and medical records together.
- Keep written notices. A denial or service reduction should explain the reason and appeal rights.
| Item | Why it helps |
|---|---|
| ID and Social Security number | Identifies the applicant. |
| Coverage cards | Shows TennCare, Medicare, and other insurance. |
| Income proof | Shows Social Security, pension, wages, and other regular income. |
| Asset records | Medicaid LTSS may review accounts, property, and other resources. |
| Spouse information | Married applicants can have special protections. |
| Care and medical notes | Shows diagnoses, medicines, and the daily tasks that require help. |
If groceries are straining the budget, the Tennessee SNAP guide can help reduce another household cost while care is arranged.
Reality Checks Before You Make a Plan
Approval is not instant staffing. Assessment, authorization, worker shortages, and provider capacity can delay service. Ask what can start now and what is still pending.
- Medicare is narrow. It generally will not fund an ongoing caregiver when personal care is the only need.
- CHOICES is not cash. Services are authorized through TennCare and its health plans.
- OPTIONS can be limited. No income eligibility rule does not mean immediate service.
- PACE is local. As of September 13, 2026, Tennessee’s program serves Hamilton County.
- Family pay has limits. The worker and service must fit program rules.
- Estate recovery matters. Ask about it before making inheritance or property assumptions.
Common Mistakes to Avoid
- Waiting for a crisis. Start screening before the current care plan fails.
- Using only a diagnosis. Explain which daily tasks are unsafe without help.
- Assuming over-income means no path. Ask about QIT and spouse rules.
- Giving assets away. TennCare’s transfer review can create a penalty.
- Paying relatives informally. Use an approved program route or clear private agreement.
- Ignoring notices. Denial and reduction letters can contain appeal deadlines.
Denied, Delayed, or Overwhelmed
If CHOICES is denied, reduced, or delayed, ask for the written notice and the exact reason. Tennessee’s Beneficiary Support System, operated with Disability Rights Tennessee, provides free help to CHOICES applicants and members. Call 1-888-723-8193. The TennCare Long-Term Services and Supports Help Desk is 1-877-224-0219.
While an appeal or assessment is pending, ask the AAAD about OPTIONS, caregiver respite, meals, transportation, and other local supports. If the family is struggling with several costs at once, use the GFS state guide linked above to check housing, utilities, food, and health-cost programs that can free money for care.
Tennessee Contacts Worth Saving
- AAAD statewide: 1-866-836-6678 — CHOICES screening for people not already on TennCare and aging/disability services.
- LTSS Help Desk: 1-877-224-0219 — TennCare long-term services and supports questions.
- Beneficiary Support: 1-888-723-8193 — free help with CHOICES concerns, complaints, and appeals.
- TN SHIP: 1-877-801-0044 — Medicare counseling.
- Alexian PACE: 423-698-0802 — Hamilton County PACE enrollment information.
Phone Scripts You Can Use
Calling the AAAD
“I am helping someone who needs regular help with bathing, dressing, meals, or moving safely. Can you screen us for CHOICES and tell me what OPTIONS or other in-home services are available here?”
Calling a TennCare plan
“I am a TennCare member and need more help to stay safely at home. I want a CHOICES screening. What assessment do I need and what records should I prepare?”
Calling PACE
“I live in Hamilton County and am 55 or older. Can you explain the PACE screening, what coverage changes if I enroll, and what costs could apply?”
Calling the VA
“I need help with daily activities at home. Please check whether VA home aide care, Veteran-Directed Care, respite, or another home service is available to me here.”
Backup Options When Hours Are Not Enough
Many families combine smaller supports. Meals can reduce meal-prep hours. Medicare Savings Programs and SNAP can lower other bills. Respite can cover short breaks. Veteran benefits may add another payer. Private care can then fill only the uncovered hours.
Write a weekly schedule showing which hours each program covers and where the gaps remain.
Resumen en Español
Para ayuda continua en casa, empiece por la vía correcta. TennCare CHOICES es la principal opción de Medicaid para servicios de largo plazo. Si la persona no tiene TennCare, llame al 1-866-836-6678. Si ya tiene TennCare, llame al plan de salud de la tarjeta.
Para 2026, TennCare publica un límite individual de ingresos de $2,982 al mes y $2,000 en recursos contables. Hay reglas especiales para cónyuges y algunas personas pueden usar un fideicomiso de ingresos calificado. No transfiera bienes antes de pedir orientación.
Medicare puede cubrir atención médica en el hogar, pero normalmente no cuidado personal continuo por sí solo. OPTIONS no tiene requisito de ingresos, aunque puede cobrar según ingresos y depende de disponibilidad. Al 13 de septiembre de 2026, PACE sirve al condado de Hamilton. Para ayuda con CHOICES, llame al 1-888-723-8193.
Frequently Asked Questions
Does Medicare pay for ongoing home care in Tennessee?
Usually not when the only need is long-term help with bathing, dressing, meals, supervision, or housekeeping. Medicare can cover qualifying home health when a person is homebound, needs part-time or intermittent skilled care, and has an eligible clinician’s order. Home health aide care is covered only when skilled care is also being provided.
What Tennessee program is the main Medicaid route for long-term home care?
TennCare CHOICES is Tennessee’s main Medicaid long-term services and supports route for older adults and adults with physical disabilities. Eligibility depends on care needs and financial rules. People not already on TennCare can start with the AAAD at 1-866-836-6678.
What are the 2026 TennCare long-term care financial limits?
TennCare lists an individual monthly income limit of $2,982 and a $2,000 countable-resource limit for Institutional Medicaid and long-term services and supports. Married applicants can have special spouse protections, and some people over the income limit may have a Qualifying Income Trust route.
Can a family member be paid to provide home care in Tennessee?
Sometimes. CHOICES consumer direction can allow certain family members, friends, neighbors, or other workers, subject to program rules and the approved plan of care. The program or health plan must approve the arrangement.
Does Tennessee OPTIONS have an income limit?
The state says OPTIONS for Community Living has no income eligibility requirement, but a sliding fee based on income can apply. Services also depend on assessed need, local capacity, and funding.
Is PACE available everywhere in Tennessee?
No. As of September 13, 2026, Tennessee’s PACE program serves Hamilton County. A person must be at least 55, meet nursing-facility level-of-care rules, and be able to live safely in the community at enrollment.
Can TennCare recover home-care costs from an estate?
It can in some cases for certain TennCare long-term services received at age 55 or older, including CHOICES home and community-based care. Family members are not personally responsible, and protections or hardship waivers can apply.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: September 13, 2026 · Next review: December 13, 2026
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