Can you get paid to care for your spouse in Tennessee? Through TennCare's main self-directed option the answer is no, but a 2025 state law and two VA pathways can put a spouse on payroll. If you are caring for a husband or wife around the clock, that gap is worth understanding: many families hear a flat "you don't qualify" and stop at the first no, never reaching the U.S. Department of Veterans Affairs benefits or the newer state route that actually pay.

The "no" you keep hearing comes from one specific Medicaid rule, and Tennessee has recently built a real way around it. This guide walks through each option so you spend your phone calls on the routes that pay.

In This Guide

Can You Get Paid to Care for Your Spouse in Tennessee?

Let's start with the honest answer, because it saves you time. Tennessee's main way to pay a family member, TennCare CHOICES Consumer Direction, does not let a member hire their spouse. That is different from the rule for other relatives: an adult child, a sibling, a friend, or a neighbor generally can be hired and paid to provide the same care. The husband or wife is the one relationship that option carves out.

So when a neighbor tells you "Tennessee pays family caregivers" and you call TennCare only to be told you don't qualify, you are not misunderstanding anything. Both things are true. The program does pay family members, and the specific family member it will not pay through Consumer Direction is a spouse.

The reason that old "no" exists, and where Tennessee's newer "yes" lives, both matter, and the sections below walk through each option in turn.

The Medicaid Self-Directed Route

TennCare runs no across-the-board Medicaid personal-care entitlement, so paid family caregiving lives inside its long-term care programs, chiefly CHOICES. Within CHOICES, the option that lets a family member draw a paycheck is called Consumer Direction (CD). Under CD, the member (or their designated representative) becomes the employer of record: they hire, train, and schedule their own workers instead of going through a provider agency, and Consumer Direct Care Network Tennessee (CDTN), the state's Fiscal Employer Agent, handles payroll, tax withholding, and electronic visit verification in the background. A member may hire family members, friends, neighbors, or other acquaintances, and CD wages are set by the member up to a TennCare-approved ceiling: on the current schedule a personal care visit runs $18.31 an hour on average and $19.16 at the maximum, and respite $16.36 and $18.93.

There is one limit that matters for spouses, and it is worth knowing exactly how solid it is. TennCare's own CHOICES page says only that "there may be some limitations" on who a member can hire, and it does not list them. The CMS-approved terms do list them. Attachment F of the TennCare III Special Terms and Conditions, which CHOICES consumer direction is administered under, says members "will have the flexibility to hire persons close to them, including family members but excluding spouses, to serve as their workers." A husband or wife is shut out of Consumer Direction, and that exclusion sits in Tennessee's own CMS-approved demonstration terms, not in something an MCO can waive for you. What those terms do not do is name conservators, guardians or powers of attorney: the separate limit there attaches to serving as the member's designated representative, not to holding a legal title. So ask your MCO Coordinator what applies to your household before you rule anyone out, and treat the agency-employed route below as the spouse pathway that is written down.

The Tennessee exception: the Freedom for Family Caregiving Act

This is where Tennessee is now different from many states. The Freedom for Family Caregiving Act (Public Chapter 182 of 2025, sponsored as SB 1178 / HB 712, signed by Governor Bill Lee on April 30, 2025 and effective July 1, 2025) prohibits TennCare and the Department of Disability and Aging from blocking a provider agency from hiring a relative as a paid caregiver based solely on the family relationship, a shared residence, the age of the recipient, or spousal status. In plain terms, the state can no longer tell an agency "you can't put the spouse on payroll just because they are the spouse."

The mechanics are different from Consumer Direction. This new path runs through the agency-employed route: a TennCare-contracted home care agency hires the family member, including a spouse, as a W-2 employee to deliver the recipient's authorized care hours. The law did not change Consumer Direction's own rules, so CD still bars spouses; the new access comes entirely through the agency, not through CD. Two limits are worth knowing before you count on it. An agency is not required to hire any specific family member, so you still have to find a TennCare-contracted agency willing to employ you. And a court-appointed conservator or guardian sits in a genuine conflict between the two sources: TennCare's implementing guidance says conservators and court-appointed guardians cannot be employed as a family caregiver unless the order of guardianship or conservatorship explicitly permits it, while the statute bars refusing someone over their guardianship or conservatorship status "unless explicitly prohibited in guardianship or conservatorship documents." An agency will apply TennCare's version, so expect to be asked for explicit court permission, and raise the statutory text with the agency or the MCO if you are refused. Parents of minor children by birth or adoption are eligible without court approval.

One tax note if you do become a paid caregiver through a Medicaid program: under IRS Notice 2014-7, qualified Medicaid waiver payments made to a care provider who lives in the same home as the person receiving care can be excluded from gross income, whether or not the provider is related. That exclusion is specific to Medicaid waiver payments and to a live-in caregiver, so confirm how it applies to your situation with a tax professional before you count on it.

Where the Tennessee No Actually Comes From

If you want to understand why the spouse exclusion keeps showing up, the federal backdrop is worth knowing, but the decision that closes CHOICES Consumer Direction to spouses is Tennessee's own.

Start with the backdrop, which is narrower than it is usually described. Under the Medicaid state plan personal care services benefit, those services must be provided by someone "who is not a member of the individual's family," and for that benefit a family member means a "legally responsible relative." Whether a spouse is one is a question of state law rather than a settled federal fact, and the exclusion does not carry over automatically to a 1915(c) waiver, because a state may define family differently for its own waiver. So there is no single federal yes or no here, and no categorical federal bar.

Self-direction is more permissive again. The federal self-directed personal assistance regulation (section 1915(j)) defines "legally liable relatives" as people who have a duty under state law to care for another person, and says the category may include a spouse rather than that it always does. At the election of the state, a participant may hire any individual capable of the assigned tasks, legally liable relatives included. In other words, federal law gives each state a choice about whether to pay spouses through self-direction, and states land in different places. Tennessee, through its CHOICES Consumer Direction option, has not opened that door to spouses, and instead built its spouse pathway through the agency-employed route described above. Because this is state policy, it can keep evolving, so it is always worth asking your TennCare care coordinator whether any program you qualify for can pay a spouse today.

The VA Route: PCAFC and Veteran-Directed Care

If your husband or wife is a veteran, the picture changes completely, because the VA's caregiver programs were built to pay family, including spouses.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

PCAFC pays a tax-free monthly stipend to a veteran's approved Primary Family Caregiver, and a spouse can serve in that role. To qualify, the veteran generally needs a VA disability rating (individual or combined) of 70% or higher, must need at least six months of continuous, in-person personal care, and must be enrolled in VA health care.,

The stipend is not a flat national figure. It is calculated from the federal Office of Personnel Management (OPM) General Schedule grade 4, step 1 annual salary for the locality where the veteran lives, divided by 12, then multiplied by one of the four factors set in 38 CFR 71.40(c)(4)(i). Which factor applies depends on how the household came into the program, and there are two different schedules. Under the current program (38 CFR 71.20(a)) the factor is 0.625, or 1.00 when the VA determines the veteran is "unable to self-sustain in the community." For a legacy participant or legacy applicant (38 CFR 71.20(b) or (c)), meaning a household carried over from the program as it stood before October 2020, the factor comes instead from the sum of the veteran's 2019 clinical ratings: 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12. On that legacy route no self-sustain determination is required at all, so a legacy household rated 21 or higher reaches the full 1.00 on the rating sum alone.

A veteran who meets both routes is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, as long as the veteran stays at the address the VA has on record. The legacy schedule runs eight years from October 1, 2020 and lapses October 1, 2028. Because the rate follows the veteran's locality, the amount in Nashville, Memphis, or a rural county will differ, so check the current OPM GS-4 step-1 locality rate before you count on any specific figure, and ask your Caregiver Support Coordinator which route your household is on before you assume the lower number. Beyond the stipend, a Primary Family Caregiver can also receive caregiver education and training, mental health counseling, at least 30 days of respite care a year, and CHAMPVA health coverage if not otherwise insured.

Veteran-Directed Care (VDC)

Veteran-Directed Care is a separate VA program, run through the VA's Geriatrics and Extended Care services. It gives an enrolled veteran a flexible budget to hire and supervise their own workers so they can keep living at home. Veterans in VDC may hire family, friends, or neighbors. On the spouse question specifically, VA's page is silent rather than permissive, and it neither allows nor bars it, so put that question to the VA medical center serving you before you plan around it. That is a different posture from the VA pension and Aid and Attendance, which pay the veteran rather than the caregiver. A veteran works with an options counselor at an Aging and Disability Network Agency (often an Area Agency on Aging), and a financial management services provider handles the employer paperwork.

Aid and Attendance for a Veteran or Surviving Spouse

Aid and Attendance (A&A) is worth understanding, but it works differently from the two programs above, so it is easy to misread.

A&A is not a paycheck written to the caregiving spouse. It is an increased monthly VA pension for a qualifying wartime veteran or surviving spouse who needs another person's help with daily activities such as bathing, dressing, and eating. The money goes to the veteran or the surviving spouse, and the household can then spend it on care, including care a spouse provides. It requires that the person qualify for a VA pension, which is income- and net-worth-tested; the 2026 net worth limit is $163,699, counting income as well as assets.

The dollar amounts show the scale. For 2026 (rates effective December 1, 2025 through November 30, 2026), a veteran with no dependents who qualifies for Aid and Attendance can receive up to $29,093 a year, and a veteran with one dependent up to $34,488 a year. VA pays each claimant that ceiling minus their countable income. Eligibility also requires qualifying wartime service and a demonstrated need for aid and attendance under the VA's criteria. If the goal is putting a spouse on payroll, PCAFC is usually the more direct route; A&A is best thought of as extra pension income the family can put toward the cost of that care.

How to Get Paid to Care for Your Spouse in Tennessee: How to Apply and Who to Call

There is no single application for "paying a spouse," because the answer runs through different agencies. Work down this list in order and you will land in the right place.

1
Step 1

If your spouse is a veteran, start with the VA

This is often the clearest path to paying a spouse. Call the national VA Caregiver Support Line at 1-855-260-3274 to ask about PCAFC, and ask your Tennessee VA Medical Center's Caregiver Support Coordinator whether Veteran-Directed Care is available in your area.,

2
Step 2

Ask your TennCare health plan about the Freedom for Family Caregiving Act route

Because a spouse cannot be hired through Consumer Direction, ask your TennCare managed care organization's care coordinator specifically about the agency-employed pathway, and whether a TennCare-contracted provider agency in your area will hire you as a W-2 employee.,

3
Step 3

Call Tennessee's aging network

Your Area Agency on Aging and Disability (AAAD) can help you sort caregiver support, respite, and program options; the statewide referral line for caregiver support and OPTIONS for Community Living is 1-866-836-6678. Nationally, you can find your local agency through the Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov.

4
Step 4

If a spouse still cannot be paid, look at other relatives

If none of the above fits, remember that TennCare CHOICES Consumer Direction will pay an adult child, a sibling, a friend, or a neighbor for the same care. That may mean a different family member goes on payroll while you keep providing hands-on care. Our Tennessee family caregiver pay guide covers that route in full.

One practical note: when you call, say plainly that you are the spouse and you want to be paid. The programs that exclude a spouse will tell you quickly, which saves weeks of paperwork, and the routes that allow it (the agency-employed pathway and the VA benefits) will point you to the right intake person.

Frequently Asked Questions

Can I get paid to care for my husband or wife in Tennessee?

Not through TennCare CHOICES Consumer Direction, which does not allow a member to hire their spouse as the paid worker. Since July 1, 2025, though, the Freedom for Family Caregiving Act lets a TennCare-contracted provider agency employ a spouse as the paid caregiver, and the VA's PCAFC pays a spouse if your husband or wife is a veteran.,

Why can other relatives get paid but not a spouse through Consumer Direction?

Because of a federal Medicaid rule. Federal regulations treat a spouse as a "legally responsible relative" with a state-law duty of care, so many Medicaid benefits exclude a husband or wife as a paid provider even though they allow an adult child, a sibling, or a friend., Tennessee's answer was to open a separate agency-employed pathway where a spouse can be paid.

What is the Freedom for Family Caregiving Act?

It is a Tennessee law (Public Chapter 182 of 2025, effective July 1, 2025) that bars TennCare and the Department of Disability and Aging from blocking a provider agency from hiring a relative, including a spouse, based on the family relationship, a shared home, or spousal status. The family member is hired by a TennCare-contracted agency as a W-2 employee. It did not change Consumer Direction's own rules, and agencies are not required to hire any specific person.

How much does the VA pay a spouse caregiver?

Through PCAFC, the monthly stipend is the federal GS-4, step 1 annual salary for the veteran's locality divided by 12, then multiplied by one of four factors under 38 CFR 71.40(c)(4)(i). Under the current program that factor is 0.625, or 1.00 when the VA finds the veteran unable to self-sustain in the community. For a legacy participant or legacy applicant the factor comes from the sum of the veteran's 2019 clinical ratings instead: 1.00 at 21 or higher, 0.625 at 13 to 20, and 0.25 at 1 to 12, with no self-sustain determination needed. A household that qualifies both ways is paid the higher of the two amounts. Because it follows the veteran's locality, the dollar amount in Tennessee depends on where the veteran lives, so check the current OPM GS-4 step-1 rate before relying on a figure.

Is Aid and Attendance a paycheck for the caregiving spouse?

No. Aid and Attendance is an increased VA pension paid to a qualifying veteran or surviving spouse who needs help with daily activities, not a wage paid to the caregiver. The household can use that pension income toward care, including care a spouse provides. To pay a spouse directly, PCAFC is the more direct route.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in TennesseeSeven Tennessee programs that pay family caregivers in 2026, including the new Freedom for Family Caregiving Act pathway. Who qualifies and how to apply. CaregiverHow to Get Paid to Care for Your Spouse: The National GuideCan you get paid to care for your spouse? Spouses are often excluded from Medicaid pay, but some states, the VA PCAFC program, and Aid and Attendance do. CaregiverHow to Get Paid as a Family Caregiver: The 50-State GuideHow to get paid to care for a family member in 2026: Medicaid self-direction, VA caregiver programs, personal care agreements, plus all 50 state guides.

Find personalized help figuring out whether you can get paid to care for your spouse at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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