If you've heard about Michigan's Home Help program, a Medicaid state-plan entitlement that pays family caregivers $17.13 an hour with no waitlist, and wondered if Tennessee Consumer Direction Medicaid works the same way, the honest answer is: not exactly.
Tennessee does not operate a state-plan personal-care entitlement. Every paid-caregiver pathway in TennCare lives inside one of three long-term-services-and-supports programs: CHOICES (for adults 65+ or adults 21+ with a physical disability), ECF CHOICES (for individuals with intellectual or developmental disabilities), or Katie Beckett (for children under 18 with significant disabilities). Each of those programs has its own enrollment cap, its own waitlist mechanics, and its own version of what's called Consumer Direction (CD), the option that lets a Medicaid recipient hire their own worker (often a family member, neighbor, or friend) instead of using a traditional home-care agency.
This guide walks through how Consumer Direction works across all three programs, who can be hired (and who can't), how Consumer Direct Care Network Tennessee (CDTN) handles payroll and Electronic Visit Verification, what workers earn in 2026, and where TN's Public Chapter 182 of 2025 (the Freedom for Family Caregiving Act) created a separate agency-employed pathway for the relationships CD bars.
What Tennessee Consumer Direction Medicaid Actually Is
Consumer Direction (sometimes called "self-direction" or "participant direction" in federal documentation) is a delivery model, not a separate program. The federal Medicaid statute lets states offer Medicaid recipients the option of hiring their own workers, setting their own schedules, and (within boundaries) setting their own wages, instead of receiving services from a traditional home-care agency.
In Tennessee, CD is governed primarily by Tenn. Comp. R. & Regs. 1200-13-01-.32 for Katie Beckett and parallel sections of TennCare's CHOICES and ECF CHOICES rules. All three programs use the same Fiscal Employer Agent: Consumer Direct Care Network Tennessee (CDTN), a private contractor that handles payroll, tax withholding, EVV, worker enrollment, and the administrative parts of being an employer.
The recipient (or their authorized representative) is the legal employer of record. CDTN is the financial intermediary. The worker is a W-2 employee of the recipient.
Two structural points are worth understanding up front:
- CD is an option, not a default. When a member enrolls in CHOICES or ECF CHOICES, they can choose either the agency-delivered service model or Consumer Direction (or a mix, per service). Katie Beckett families similarly elect CD for specific services.
- CD does not change the underlying program's eligibility, enrollment cap, or service catalog. A family that picks CD still has to be approved for CHOICES (or ECF, or Katie Beckett); they still face the same waitlist; they still get the same authorized hours.
Why Tennessee Doesn't Have an "MI Home Help Equivalent"
This is the question Tennessee families most often ask after reading about Michigan's program: "Does Tennessee have something like Home Help?"
Here's the comparison:
| Feature | MI Home Help | TX Consumer Directed Services (CDS) | TN Consumer Direction |
|---|---|---|---|
| Federal authority | Medicaid state-plan §1905(a) personal care | §1915(c) waivers + STAR+PLUS | §1115 demonstration (TennCare III) |
| Standalone program? | Yes, entitlement | No, option inside other programs | No, option inside CHOICES/ECF/KB |
| Waitlist? | None, entitlement | Depends on the underlying waiver | Yes for Group 2 (HCBS), Group 3, ECF, KB Part A; no for Group 1 (NF entitlement) |
| 2026 individual caregiver rate | $17.13/hr (statewide standard) | Varies by waiver/STAR+PLUS budget | ~$11–$15/hr (member-set within budget) |
| Spouse can be hired? | No | No (CDS), yes via STAR+PLUS Self-Determination | No (CD), yes via PC 182 agency-employed |
| Parents of minor children can be hired? | Limited | Limited | No (CD), yes via PC 182 agency-employed |
| Fiscal Employer Agent | CHAMPS via MDHHS | Various FMS providers | CDTN (Consumer Direct Care Network TN) |
| Coverage scope | ADLs + selected IADLs | Full waiver service array | Full CHOICES/ECF/KB service array |
The single biggest structural difference: MI Home Help is an entitlement, while every TN paid-caregiver pathway lives inside a capped program. A Tennessee family in the same situation as a Michigan family using Home Help may end up on a CHOICES waitlist for HCBS Group 2, even though both families would receive comparable services if the underlying program had open capacity.
This isn't a small policy difference. Tennessee has historically lagged peer states on family-caregiver support, in significant part because of the lack of a Home Help-style entitlement and (until July 2025) the bar on agency-employed family caregivers.
The Freedom for Family Caregiving Act (Public Chapter 182 of 2025, fully effective July 1, 2025) addressed part of that gap, it opened a parallel agency-employed pathway that didn't exist before. But it did not create a state-plan personal-care entitlement, so the underlying access constraint (CHOICES enrollment caps) remains.
How Consumer Direction Works in Each TennCare Program
Each of the three programs has its own version of CD. They share CDTN as the FMS, share the EVV requirement, share most worker rules, but the eligible services and certain restrictions differ.
How Consumer Direction Works in Each Program
- 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: Attendant Care, Companion Care, In-Home Respite, Personal Care Visits, and Non-Medical Transportation.
- Service caps: Attendant Care 1,080 hours/year (or 1,400/year if member also needs homemaker assistance); Personal Care Visits 2,580 hours/year, max 2 visits/day at 4 hours each; In-Home Respite 216 hours/year. Companion Care is CD-only and reserved for 24-hour-coverage scenarios where natural supports are insufficient.
- Cost-neutrality: Group 2 plan of care cannot exceed $107,627.55/year (2026 cost-neutrality cap); Group 3 cannot exceed approximately $18,000/year.
- 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.
- 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).
- CD-eligible services: Personal Assistance, Supportive Home Care, Hourly Respite, and Community Transportation. Other ECF services (Community Integration Support, Independent Living Skills Training, Supported Employment, Behavior Services, Assistive Tech, Minor Home Modifications) are agency-delivered.
- 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.
- Who can be hired: Same as CHOICES, adult children, siblings, in-laws, friends. Cannot: spouses; parents of minor children in the same home generally cannot be the CD worker for that child (the Family Caregiver Stipend in Group 4 is the workaround for parental caregivers); conservators/POAs.
- Enrollment: Through DDA (Department of Disability and Aging). Regional intake numbers: West TN (866) 372-5709; Middle TN (800) 654-4839; East TN (888) 531-9876.
- The Family Caregiver Stipend is a Group 4 ECF benefit ($500/month for a child caregiver, $1,000/month for an adult caregiver) that lets a parent be paid even though parents typically can't be the CD worker for their minor child. It's a separate benefit from CD.
- Programs: Parts A and B (Part C bridge coverage doesn't include CD).
- 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. Co-residents also cannot be reimbursed for Community Transportation. This is the Katie Beckett-specific rule that bars most parents from CD even though parents are otherwise eligible relations.
- 40-hour rule: CD workers in Katie Beckett may not provide more than 40 hours/week without overtime approval (Part A only). Overtime requires advance authorization from the MCO Care Coordinator.
- Enrollment: Through TennCare Connect / DDA, parallel financial and medical eligibility processing.
What Consumer Direct Care Network Tennessee (CDTN) Does
CDTN is the Fiscal Employer Agent for all CD members across CHOICES, ECF CHOICES, and Katie Beckett. The role is administrative, they handle the parts of being an employer that most families wouldn't want to handle themselves.
CDTN's operational scope:
- Worker enrollment. Background checks (criminal history, abuse registry, sex offender registry), Medicare/Medicaid exclusion check, training verification, Service Agreement intake, Form I-9, W-4.
- Payroll and tax withholding. Federal withholding, state withholding (Tennessee has no state income tax, so this is simpler than in most states), Social Security, Medicare, federal unemployment, state unemployment.
- EVV (Electronic Visit Verification). Federally required under the 21st Century Cures Act. Workers clock in and clock out via mobile app or interactive voice response (IVR) at the start and end of each shift. Skipping EVV = no pay; CDTN cannot process the time entry without it.
- Biweekly direct deposit to worker bank accounts.
- Year-end W-2 issuance to workers.
- Member education. CDTN runs orientation sessions for new CD members on the responsibilities of being the employer of record (managing the worker, scheduling, addressing performance issues).
Contact: 1-888-444-3109 or consumerdirecttn.com. CDTN's office hours and member-services contact information are listed on their website.
Worker Requirements: How to Be a CD Worker
If you're an adult child, sibling, in-law, friend, or neighbor of someone enrolled in CHOICES, ECF CHOICES, or Katie Beckett, here's what it takes to be hired as their CD worker.
Worker Eligibility and Pay
- 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.
- For Katie Beckett: You cannot reside with the child if you're providing Supportive Home Care or Hourly Respite.
- 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.
- CPR and First Aid certification required for most CHOICES and ECF roles; KB requirements vary by service.
- EVV training (how to clock in/out via mobile app or IVR).
- Service-specific training for behavior services, transportation, or specialized procedures depending on the role.
- Form I-9 (work authorization).
- Form W-4 (tax withholding).
- 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: $11–$15/hour typical for personal care attendant work, set by the member within an authorized budget per the current CDTN CHOICES Service Agreement Wage Memo. ECF and Katie Beckett wage memos may run slightly different ranges. Verify current rates with CDTN before starting.
- Frequency: Biweekly direct deposit.
- Tax treatment: W-2 employee. Federal withholding, Social Security, Medicare. Tennessee has no state income tax, so no state withholding.
- Overtime: Generally not authorized for routine schedules; requires advance approval from MCO Care Coordinator. Katie Beckett Part A explicitly caps CD workers at 40 hours/week without overtime approval.
- 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.
CD-Eligible Services: A Cross-Program View
What's actually CD-eligible varies by program. The table below summarizes:
| Service | CHOICES | ECF CHOICES | Katie Beckett |
|---|---|---|---|
| Personal / Attendant Care | ✅ Attendant Care | ✅ Personal Assistance | ✅ Supportive Home Care |
| Companion Care | ✅ (CD-only, 24-hr coverage scenarios) | not CD-eligible | not CD-eligible |
| In-Home Respite (Hourly) | ✅ (216 hrs/yr) | ✅ Hourly Respite | ✅ Hourly only (daily is agency) |
| Personal Care Visits | ✅ (2,580 hrs/yr) | not CD-eligible | not CD-eligible |
| Non-Medical / Community Transportation | ✅ | ✅ | ✅ |
| Community Integration Support, ILST, Supported Employment, Behavior Services | not CD-eligible | ❌ Agency-delivered | not CD-eligible |
| Modifications, equipment, therapies | ❌ Agency only | ❌ Agency only | ❌ Agency only |
If a service isn't CD-eligible, the member receives it through a TennCare-contracted agency. A member can mix CD and agency services, for example, using CD for personal care attendants and an agency for skilled nursing or environmental modifications.
When CD Doesn't Fit: The PC 182 Agency-Employed Pathway
Public Chapter 182 of 2025, the Freedom for Family Caregiving Act, signed by Governor Bill Lee in April 2025 and fully effective July 1, 2025, opened a parallel pathway for relationships that CD bars. Under PC 182:
- TennCare-contracted licensed home-care agencies can hire family members (including spouses, parents of minor children, and household members) as paid Direct Support Workers
- The worker is a W-2 employee of the agency, not the member
- The agency, not CDTN, handles payroll, tax withholding, training, and EVV
- The agency cannot refuse to hire based on family relation, residence, age of member, parental/spousal relationship, waiver program, or concurrent unrelated caregivers
- Hard limits: court-appointed legal guardians/conservators cannot be employed unless explicitly permitted in the order; compensation cannot exceed PCSP-authorized benefits
Important: PC 182 does NOT change CD restrictions. Spouses still cannot be CD workers. The agency-employed route is a separate, parallel option for the relationships CD bars.
For a spouse caregiver, the agency-employed pathway is the only TennCare-paid route. For a parent of a minor Katie Beckett or ECF Group 4 child living in the same home, the agency route or (in ECF Group 4) the Family Caregiver Stipend are the alternatives to CD.
The catch: not every TennCare-contracted agency has updated its hiring policies to take advantage of PC 182. As of early 2026, families looking to use this pathway should expect to call multiple agencies before finding one willing to hire under the new authority. TennCare maintains a list of contracted agencies; your MCO Care Coordinator can help identify ones that have implemented PC 182 hiring.
For more detail on the seven Tennessee paid-caregiver pathways (CD plus six others), see our how-to-get-paid family caregiver guide.
Want to know if you qualify to be paid as a caregiver in Tennessee?
Brevy's care navigators help Tennessee families work through Consumer Direction, the new PC 182 agency-employed pathway, the ECF Family Caregiver Stipend, and the various VA programs every day. Whether you're an adult child trying to figure out CD, a spouse navigating the new agency pathway, or a family caregiver just starting to explore TennCare, we can walk you through your specific situation. Free, no obligation.
How to Enroll in Consumer Direction
If your family member is already enrolled in CHOICES, ECF CHOICES, or Katie Beckett, the path to CD is internal to that program, there's no separate CD application.
- Talk to your MCO Care Coordinator (CHOICES) or DDA Care Coordinator (ECF/Katie Beckett). Tell them you want to use Consumer Direction. The coordinator will explain which services are CD-eligible for your member's situation and approximate pay rates within the authorized budget.
- Choose your worker. It's the member's choice (or their representative's). Common picks: adult children, siblings, longtime friends, neighbors.
- Worker applies through CDTN. CDTN runs the background checks, verifies training, and processes the W-4/I-9. This typically takes 2-4 weeks.
- Service Agreement signed. The member (employer) and the worker (employee) both sign the Service Agreement that locks in the wage, schedule, and duties.
- EVV setup. The worker downloads the EVV mobile app or learns the IVR call-in process.
- First shift starts. Worker clocks in via EVV at start; clocks out at end. Direct deposit follows on the next biweekly pay date.
If your family member is not yet enrolled in CHOICES, ECF, or Katie Beckett, the program enrollment is the first step. CD is the delivery model, not the entry point. See our HCBS waivers guide for an overview of the three programs and their application doors.
Frequently Asked Questions
Frequently Asked Questions
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.
Yes, if your parent or grandparent is enrolled in CHOICES Group 2 or 3 and elects Consumer Direction. You'll need to be 18+, pass background checks, complete training, and have a signed Service Agreement on file with CDTN. 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.
Generally not as a CD worker. Parents of minor children typically cannot be the CD worker for their child under CHOICES, ECF CHOICES, or Katie Beckett. The alternatives: (a) the ECF CHOICES Family Caregiver Stipend (Group 4 only, $500/month for child caregivers, $1,000/month for adult caregivers); (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.
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. Contact them at 1-888-444-3109 or consumerdirecttn.com.
Personal care attendant work typically pays $11–$15/hour in 2026, set by the member within an authorized budget per the current CDTN CHOICES Service Agreement Wage Memo. Some specialized services may pay slightly higher. Verify current rates with CDTN before starting work.
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 via mobile app or IVR call-in. The system captures the start time, end time, location, services delivered, and member identity. Without EVV, CDTN cannot process the time entry, meaning no pay. EVV is non-negotiable.
For Katie Beckett Part A, CD workers are explicitly capped at 40 hours/week without overtime approval. For CHOICES and ECF, schedules are governed by the authorized service plan and the CDTN wage memo; overtime generally requires advance approval from the MCO or DDA Care Coordinator.
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 caps. When the program is at cap, applicants are added to a waitlist and prioritized by acuity. 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.
Bottom Line
Consumer Direction is Tennessee's most flexible paid-caregiver model, but it has structural constraints that families coming from Michigan or other states should know about up front:
- CD is an option, not a program. The underlying program (CHOICES, ECF, or Katie Beckett) has to admit you first.
- All three underlying programs have enrollment caps. Group 1 of CHOICES (nursing facility) is the only entitlement; everything else can have a waitlist.
- CDTN is the FMS for all three programs. Payroll, EVV, taxes, worker enrollment all run through them.
- CD bars certain relationships. Spouses, conservators, POAs, and (in Katie Beckett) co-residents cannot be CD workers. The PC 182 agency-employed pathway is the alternative for some of those.
- Tennessee has no state income tax, which makes the worker payroll math simpler than in most states. Federal withholding, Social Security, and Medicare are the only deductions from a CD wage.
- Pay rates are member-set within authorized budgets, typically $11–$15/hour for personal care attendant work in 2026.
If you're a Tennessee family weighing CD against other options, the right starting point is usually a conversation with your MCO Care Coordinator (CHOICES) or DDA Care Coordinator (ECF/KB). They can run the numbers for your authorized budget, explain the trade-offs vs agency-delivered services, and walk you through CDTN enrollment. From there, the heavy lifting is logistical: background checks, training, EVV setup, and the Service Agreement.
Find personalized help applying for TennCare Consumer Direction at brevy.com.