TennCare Consumer Direction 2026: TN Paid Family Caregiver Guide

• Programs: Group 2 (HCBS in lieu of NF) and Group 3 (At Risk). Group 1 members in nursing facilities don't use CD because services are facility-delivered.
• CD-eligible services: exactly four of the fourteen CHOICES HCBS carry a "Yes" in the rule's Consumer Direction column, Attendant Care, Companion Care (delivered under CBRA), In-Home Respite Care, and Personal Care Visits. Everything else, including Adult Day Care, Minor Home Modifications, PERS, and Short-Term NF Care, is agency-delivered. CHOICES has no consumer-directed transportation benefit; Community Transportation exists only in ECF CHOICES and Katie Beckett.7
• Service caps (Tenn. Comp. R. & Regs. 1200-13-01-.05(8)(l), and they apply across CD and agency hours combined): Attendant Care 1,080 hours per calendar year, or 1,400 if the member also needs Homemaker Services; In-Home Respite Care 216 hours per calendar year; Personal Care Visits are capped by frequency rather than by an annual hour total, at 2 intermittent visits per day, no more than 4 hours per visit, with at least 4 hours between visits.7
• Cost-neutrality: Group 2 plan of care cannot exceed $107,627.55/year (2026 cost-neutrality cap, $294.87/day); Group 3 has an $18,000/year HCBS expenditure cap, excluding Minor Home Modifications.7,4
• Bringing a parent home from a nursing facility skips the Group 2 cap. A member already being served in CHOICES Group 1 who meets the requirements for Group 2 "can enroll in CHOICES Group 2 even though the Enrollment Target has been met," and is served outside the target until a slot becomes available. That, plus CEA enrollment for an SSI-eligible member and the 300 reserved slots, is why the waitlist is the residual rather than the default answer (see the waitlist question in the FAQ below).4
• Who can be hired: Adult children, siblings, in-laws, nieces/nephews, friends, neighbors. Cannot: spouses, court-appointed conservators, legal guardians, powers of attorney, the member's CD Representative. Two service-specific bars sit on top of that. A member cannot employ anyone who lives with them to deliver Personal Care Visits, Attendant Care, or In-Home Respite Care. And Companion Care, the 24-hour service, bars every Immediate Family Member outright (the rule defines that as spouse, parent, grandparent, child, grandchild, sibling, and in-laws, including step and adopted), plus anyone the member lives with now or has lived with in the last five years.
• Enrollment: Member elects CD during care planning with the MCO Care Coordinator; coordinator refers to CDTN; CDTN enrolls the member as employer of record and the worker(s) as W-2 employees.

• Programs: All five ECF Groups (4-8).5
• CD-eligible services: Personal Assistance, Supportive Home Care, Hourly Respite, and Community Transportation. Three of those carry limits worth knowing before you plan a schedule. Personal Assistance is covered only for members enrolled in Group 5 or Group 6, and the 215-hours-per-month limit the rule states applies to Group 6 only (Comprehensive Supports for Employment and Community Living); it is not a Group 5 hour ceiling, and even in Group 6 it is not absolute, because an MCO may authorize services in excess of a benefit limit as a cost-effective alternative to institutional placement. Respite runs to 30 days per calendar year or 216 hours per calendar year, and the member chooses daily or hourly: the two limits cannot be combined in a calendar year, and daily respite is not available through Consumer Direction. Community Transportation is capped at $225 per month for anyone using Consumer Direction. Other ECF services (Community Integration Support, Independent Living Skills Training, Supported Employment, Behavior Services, Assistive Tech, Minor Home Modifications) are agency-delivered.5
• Service caps: Vary by Group. Group 4 has an $18,000/year expenditure cap (Minor Home Modifications excluded); Group 5 has $36,000 + up to $6,000 emergency exception; Group 6 has tiered caps from $54,000 to $108,000+ based on Level of Need; Group 7 caps at $236,450/year; Group 8 caps at $513,625 first year then $236,450 thereafter.5
• Who can be hired: Same as CHOICES, adult children, siblings, in-laws, friends. Cannot: spouses; conservators/POAs; and anyone who lives with the member, who is barred from delivering Personal Assistance, Supportive Home Care, or hourly Respite and cannot be reimbursed for Community Transportation. That co-residence bar is what keeps a parent living with their ECF-enrolled child out of CD (the Family Caregiver Stipend in Group 4 is the route built for parental caregivers).
• Enrollment: Through DDA (Department of Disability and Aging). Anyone can file the online self-referral at perlss.tenncare.tn.gov/externalreferral; a member who already has TennCare can ask their health plan for help with the referral; a member who does not can call the DDA regional office, which will also help with Medicaid enrollment. Regional intake numbers: West TN (866) 372-5709; Middle TN (800) 654-4839; East TN (888) 531-9876.2
• The Family Caregiver Stipend is a Group 4 ECF benefit that lets a family caregiver be paid without enrolling as a CD worker at all. The tier turns on the age of the member receiving care, not the age of the caregiver: up to $500 a month when the ECF member is a child under 18, up to $1,000 a month when the member is 18 or older, with the actual amount set from the individual's assessed needs. It is a flat sum paid by the MCO, not an hourly wage, and it cannot duplicate paid CD hours or paid agency services for the same period. A member also cannot enroll in Group 4 for the stipend alone.8

• Programs: Group Part A and the Medicaid Diversion Group Part B. The Continued Eligibility Group Part C is for children who meet every Part A criterion but for whom no Part A slot is open; the rule says they are not eligible for Part A wraparound HCBS, so there is nothing to consumer-direct there.
• CD-eligible services: Supportive Home Care, Hourly Respite (not daily respite, daily is agency-only), and Community Transportation. Other services (modifications, equipment, therapies) cannot be consumer-directed.
• Co-resident restriction: Persons residing with the child cannot provide Supportive Home Care or Hourly Respite under CD, and cannot be reimbursed for Community Transportation.5 This is what bars most parents from CD even though parents are otherwise eligible relations. It is not a Katie Beckett quirk: CHOICES and ECF CHOICES carry the same co-residence bar on their own core hands-on services.
• 40-hour rule: no CD worker may provide more than 40 hours of support in a week, and the two Katie Beckett parts differ in whether that can be exceeded. For a child in Group Part A, the parent, legal guardian, or CD Representative may decide to go past 40 by paying overtime out of the child's own approved budget; it is the family's call within the budget, not an MCO authorization. For a child in the Medicaid Diversion Group Part B, the 40-hour ceiling is absolute, a worker there may not exceed it at all.
• Enrollment: Through TennCare Connect / DDA, parallel financial and medical eligibility processing.

• Age 18 or older. No upper age limit.
• Pass background checks. Criminal history (Tennessee Bureau of Investigation), Tennessee Abuse Registry, Sex Offender Registry, Office of Inspector General Medicare/Medicaid Exclusion check.
• No conflict-of-relationship status. You cannot be the member's spouse, court-appointed conservator, legal guardian, power of attorney, or designated CD Representative.
• You cannot live with the person you're being paid to care for, for the core hands-on services, in any of the three programs: Personal Care Visits, Attendant Care, and In-Home Respite Care in CHOICES; Personal Assistance, Supportive Home Care, and hourly Respite in ECF CHOICES; Supportive Home Care and hourly Respite in Katie Beckett. Co-residents also cannot be reimbursed for Community Transportation in ECF CHOICES or Katie Beckett. If you have moved in to provide care, confirm this with the Care Coordinator before anything else.
• CHOICES Companion Care is stricter still: no Immediate Family Member (spouse, parent, grandparent, child, grandchild, sibling, or in-law, including step and adopted) may be hired for it, nor anyone the member lives with now or has lived with in the past five years.
• The "would have provided without pay" rule. You cannot be reimbursed for care you would have provided for free anyway. The service must be over and above the typical family relationship, a documentable level of care that wouldn't have happened without compensation.

• Orientation through CDTN, typically online.
• All training TennCare requires for the service you'll deliver. The rule states the requirement as "complete all required training" without naming a fixed list, and the specifics differ by service and program, so ask CDTN and the Care Coordinator which modules and certifications apply to your role rather than assuming a standard set.
• EVV training (how to clock in and out through the CareAttend app).

• Form I-9 (work authorization).
• Form W-4 (tax withholding).
• TennCare provider paperwork. Families are often surprised by this one: the rule requires a CD worker to complete the applications to become a TennCare provider, sign an abbreviated Medicaid agreement, and be assigned a Medicaid provider ID number before delivering services.
• Service Agreement signed by the member (employer) and the worker.
• Valid driver's license if transporting the member.
• Vehicle insurance if transporting the member in your own vehicle.

• 2026 pay rate: the member sets each worker's wage from a range TennCare approves, service by service. On the TennCare-approved CDTN CHOICES Services and Rates schedule (Rev. 07/30/2025), Personal Care Visit work (T1019 UC) runs $18.31/hour average with a $19.16 maximum, and Respite (S5150 UC) runs $16.36 average with an $18.93 maximum. Companion Care is paid as a daily rate rather than hourly, $158.97 average and $163.33 maximum per 24-hour day. What comes out of the member's budget is higher than the wage, because employer taxes ride on top (about $20.17 for an $18.31 Personal Care wage). ECF CHOICES and Katie Beckett rate schedules run their own ranges. Confirm the current schedule with CDTN before you start.4
• Frequency: Biweekly direct deposit.
• Tax treatment: W-2 employee. Federal withholding, Social Security, Medicare. Tennessee has no state income tax, so no state withholding. If you are the member's child, parent, or spouse, the IRS FICA/FUTA exemption applies to your wages, so your deductions will not look like an unrelated worker's; CDTN codes this at enrollment.4
• Overtime: not part of a routine schedule. In Katie Beckett Group Part A the parent, guardian, or CD Representative may pay overtime past 40 hours a week out of the child's approved budget; in the Medicaid Diversion Group Part B a worker may not exceed 40 hours at all. In CHOICES and ECF CHOICES, hours are bounded by the authorized plan of care and the service limits rather than by a separate overtime rule, so talk to the Care Coordinator before scheduling past the authorization.
• Benefits: Generally none from the recipient (no health insurance, no retirement, no PTO). CDTN does not provide benefits to CD workers, the recipient is the employer, and most members can't afford to provide benefits.

Not exactly. Michigan Home Help is a Medicaid state-plan personal-care entitlement with no waitlist. Tennessee does not operate a state-plan personal-care entitlement. The closest analog in Tennessee is Consumer Direction, which is an option within CHOICES (for seniors and adults with physical disabilities), ECF CHOICES (for people with I/DD), or Katie Beckett (for children with significant disabilities). All three programs have enrollment caps, so access is more constrained than under MI Home Help.

Not under Consumer Direction, CD bars spouses. Under Public Chapter 182 of 2025 (effective 7/1/2025), licensed TennCare-contracted home-care agencies can hire spouses as W-2 Direct Support Workers in a parallel agency-employed pathway. You'll need to find a TennCare-contracted agency that has updated its policies to use PC 182, your MCO Care Coordinator can help identify one.

Often yes, but one condition decides it: you cannot be living with them. The CHOICES rule bars a member from employing anyone who resides with them to deliver Personal Care Visits, Attendant Care, or In-Home Respite Care, which are the services an adult child would normally be hired for. So if your parent is enrolled in CHOICES Group 2 or 3, elects Consumer Direction, and you keep a separate address, you can be their CD worker once you are 18 or older, pass the background checks, complete training, and have a signed Service Agreement on file with CDTN. If you have moved in with them, CD is closed for those services and the PC 182 agency-employed pathway is the route to ask about instead. Either way the "would have provided without pay" rule still applies, the care must be over and above what a typical family relationship would provide for free.4

Generally not as a CD worker, because you live with the child and the co-residence bar in each program blocks a household member from delivering the hands-on services. The alternatives: (a) the ECF CHOICES Family Caregiver Stipend, Group 4 only, up to $500 a month when the enrolled member is a child under 18 and up to $1,000 a month when the member is 18 or older, with the amount set from assessed need; (b) the agency-employed pathway under PC 182, where you'd be hired by a TennCare-contracted home-care agency and paid as a W-2 employee.8

CDTN is Consumer Direct Care Network Tennessee, the Fiscal Employer Agent that handles payroll, EVV, worker enrollment, and tax withholding for all CD members across CHOICES, ECF CHOICES, and Katie Beckett. Its member line is routed by health plan, so call the one matching the member's plan: UnitedHealthcare 1-888-444-3109, Wellpoint 1-888-398-0664, or BlueCare Tennessee 1-888-450-3240. More at consumerdirecttn.com.4

The member sets the wage from a TennCare-approved range that varies by service. On the CDTN CHOICES Services and Rates schedule (Rev. 07/30/2025), Personal Care Visit work averages $18.31 an hour with a $19.16 maximum, and Respite averages $16.36 with an $18.93 maximum; Companion Care is paid daily rather than hourly, at $158.97 average and $163.33 maximum per 24-hour day. Verify the current schedule with CDTN before starting work, and note that the amount charged against the member's budget is higher than the wage because employer taxes are included.4

EVV is a federal requirement under the 21st Century Cures Act for all Medicaid personal care services. Workers must clock in at the start of a shift and clock out at the end, in Tennessee through CDTN's CareAttend mobile app. Without EVV, CDTN cannot process the time entry, meaning no pay. EVV is non-negotiable.4

It depends on the program. In Katie Beckett, no CD worker may provide more than 40 hours of support a week, and only a Group Part A family can go past that, by choosing to pay overtime out of the child's own approved budget; for a child in the Medicaid Diversion Group Part B the 40-hour ceiling cannot be exceeded at all. In CHOICES and ECF CHOICES, hours are bounded by the authorized plan of care and the per-service limits rather than a separate overtime rule, so the practical answer comes from your MCO or DDA Care Coordinator, who authorizes the plan.5

W-2 employees of the member, not of CDTN. CDTN is the Fiscal Employer Agent, they handle the payroll mechanics on behalf of the member. The member is the employer of record, which means they have employer-side responsibilities (managing the worker, addressing performance issues, scheduling).

Generally no. CDTN does not provide benefits, and most CHOICES/ECF/KB members cannot afford to provide them either. If health coverage matters, look at TennCare (if income-eligible), CoverTN small-employer coverage, or Marketplace plans.

Group 2 (HCBS) and Group 3 (At Risk) operate under enrollment targets. Group 2's is set by rule at 12,500 enrolled at any one time, measured including the reserved slots described below; Group 3's is discretionary, and TennCare has published a target of 1,750 for non-SSI recipients. The Waiting List is the residual, not the default. It takes the applicant who qualifies but meets neither the rule's specified exceptions nor its Reserve Capacity criteria. Four routes let someone enroll in Group 2 even when the target has been met:

• Moving home from a nursing facility. A member being served in CHOICES Group 1 who meets the requirements to enroll in Group 2 "can enroll in CHOICES Group 2 even though the Enrollment Target has been met," and is served outside the target until a slot becomes available.
• CEA enrollment for an SSI-eligible member. Where an SSI-eligible recipient meets all other Group 2 criteria but cannot enroll because the target is full, the MCO has the option, at its sole discretion, of offering HCBS as a cost-effective alternative; on satisfactory documentation from the MCO, the Bureau "will enroll the person into CHOICES Group 2, regardless of the Enrollment Target."
• The 300 reserved slots. The Bureau reserves 300 slots inside the Group 2 target, available only once the unreserved slots are filled and only to two groups: applicants being discharged from a nursing facility, and applicants being discharged from an acute care setting who are at imminent risk of nursing facility placement absent HCBS.
• Priority for anyone already enrolled over the target. Persons enrolled in excess of the target "must receive the first available slots," and only after all of them have been moved under the target can additional persons be enrolled.

A denial for lack of capacity is not the end of it either: if enrollment into Group 2 or into a reserved slot is denied because the target has been reached, TennCare must provide notice, including the right to request a fair hearing on any valid factual dispute. So tell your Care Coordinator which of these situations you are in rather than assuming the waitlist is the only answer.4 ECF CHOICES publishes its reserve-capacity groups: an aging caregiver (a custodial parent or caregiver at least 75 for a person with an intellectual disability, or at least 80 for a developmental disability), a primary caregiver who recently died with no one else available, and enrollment needed to move someone out of a nursing facility or ICF/IID.2 While you wait: explore the VA paid caregiver pathways (PCAFC, Veteran-Directed Care, Aid & Attendance) if the member is a veteran; explore agency Home Health under Medicare if the member is homebound and needs intermittent skilled care; consider the private caregiver agreement route while waiting.

See our how-to-get-paid family caregiver guide for the full seven-pathway overview: CHOICES Consumer Direction (this guide), CHOICES PC 182 agency-employed, ECF CHOICES (CD + Family Caregiver Stipend), Katie Beckett, the pending Caring for Caregivers Act dementia grant, the three VA programs (PCAFC, Veteran-Directed Care, Aid & Attendance), and private caregiver agreements.