For most of the last decade, Tennessee was one of the hardest states in the country to be paid as a family caregiver. That changed in 2025. The Freedom for Family Caregiving Act, signed by Governor Bill Lee on April 30, 2025 and fully in effect since July 1, 2025, created the first legal pathway in Tennessee for a spouse or parent to be hired as a paid caregiver through a TennCare-contracted home care agency.
The change isn't a single check from the state. It's a permission slip that opens up an existing system. Layered on top of TennCare CHOICES Consumer Direction, the ECF CHOICES Family Caregiver Stipend, VA programs, and the new dementia-specific Caring for Caregivers Act grant moving through the legislature, Tennessee families now have seven distinct ways to be compensated for caregiving.
This guide lays out every legitimate pathway in Tennessee for 2026, who can actually be hired under each (spouses, adult children, friends, parents of minor children), what the pay looks like, and how to choose the right program for your family's situation.
The Short Version
If you're an adult child, sibling, niece, nephew, friend, or neighbor of a Medicaid-eligible adult in Tennessee, TennCare CHOICES Consumer Direction is the most direct path to being paid. Your loved one applies for CHOICES through their MCO, gets enrolled in the Consumer Direction option, and hires you as their personal care attendant through CDTN. Pay rates are member-set within the budget, typically around $11–$15 per hour in 2026.
If you're a spouse, Consumer Direction is closed to you. The new pathway under the Freedom for Family Caregiving Act lets you be hired by a TennCare-contracted home care agency to deliver your spouse's authorized care hours as a W-2 employee. The catch: not every agency has updated its hiring policies, so you have to find a willing one.
If you're caring for a child or adult with an intellectual or developmental disability, ECF CHOICES has a Family Caregiver Stipend (Group 4 only), up to $500 per month for child caregivers and up to $1,000 per month for adult caregivers. ECF also offers Consumer Direction for personal assistance and respite.
If your loved one is a wartime veteran, VA programs (Aid & Attendance, Veteran-Directed Care, PCAFC) often pay more than Medicaid-side programs and can stack with them.
If you have enough private assets, a written caregiver agreement with fair-market wages can pay you while reducing your loved one's estate for eventual Medicaid planning. Tennessee's 60-month look-back makes the contract format critical.
The details matter. Below is the full map.
The Recent Change: What Public Chapter 182 of 2025 Actually Did
Tennessee's caregiver-pay landscape has a clear before-and-after at April 30, 2025.
Before that date, TennCare's Consumer Direction option excluded spouses, conservators, powers of attorney, and certain co-resident family members from being paid as the member's worker. That left families with two unhappy choices: either find an outside caregiver to deliver care a spouse was already providing for free, or move the member into a nursing facility. The American Association of Retired Persons (AARP) repeatedly ranked Tennessee near the bottom of its scorecard on family caregiver support.
The Freedom for Family Caregiving Act, Public Chapter 182 of 2025, sponsored by Sen. Raumesh Akbari and Rep. Ronnie Glynn, passed the Senate 31-0 and the House 94-0, and was signed by Governor Bill Lee on April 30, 2025. It became fully operational on July 1, 2025.
The act amends Tennessee Code Annotated, Titles 52 and 71, and prohibits both TennCare and the new Department of Disability and Aging (DDA) from blocking provider agencies from hiring a relative as a Direct Support Worker, personal care attendant, home health aide, private-duty nurse, or other paid caregiver based on:
- The family relationship between the worker and the recipient
- The worker and recipient sharing a home
- The age of the recipient
- The worker being the recipient's parent or spouse
- Which TennCare program (CHOICES, ECF CHOICES, Katie Beckett, etc.) the recipient is enrolled in
- The worker being concurrently employed as a paid caregiver by an unrelated party
What the law does not do. Three things are easy to misread:
- It does not change Consumer Direction. CHOICES CD still bars spouses, court-appointed conservators, legal guardians, powers of attorney, and the member's CD Representative from being the paid worker. The new pathway only opens the agency-employed route.
- It does not require any specific agency to hire any specific family member. It removes the state-level ban; an individual home care agency still sets its own internal hiring policies. Many agencies were quick to update; others have not. Families will need to call agencies in their area to find a willing one.
- It does not cover court-appointed conservators or legal guardians unless the court order itself explicitly permits employment.
Programs the new pathway touches: CHOICES, ECF CHOICES, Katie Beckett (Parts A and B), the three §1915(c) DD waivers (Self-Determination, Statewide, Comprehensive Aggregate Cap), Private Duty Nursing, Home Health Nursing, and Home Health Aide services delivered through TennCare.
The strategic effect for Tennessee families: a previously-impossible category of paid caregivers, spouses, parents of minor children with disabilities, and certain co-resident relatives, now has a legal route. The route runs through agencies, not through the member's own checkbook, but it exists.
The Seven Tennessee Paid Family Caregiver Pathways
1. TennCare CHOICES: Consumer Direction (CD)
Who pays: TennCare, administered by one of three Managed Care Organizations.
Who can be paid: Adult children, siblings, parents of an adult child, friends, neighbors, and most other relatives. Cannot pay: spouses, court-appointed conservators, legal guardians, powers of attorney, or anyone serving as the member's CD Representative.
2026 pay rate: Set by the member within an authorized budget. Typical 2026 personal care attendant rates fall in roughly the $11 to $15 per hour range. The exact floor and ceiling are governed by the current CDTN CHOICES Service Agreement Wage Memo; verify with Consumer Direct Care Network Tennessee at 1-888-444-3109 before locking in a wage.
What it covers: Personal care assistance with ADLs (bathing, dressing, toileting, transferring, eating) and selected IADLs (meal prep, medication reminders, light housekeeping, shopping); in-home respite; companion care.
Eligibility, recipient (2026):
- Age 65+ OR adult age 21+ with a physical disability
- Income up to $2,982/month (300% of the federal SSI Federal Benefit Rate). Above the limit, applicants establish a Qualified Income Trust (QIT) to redirect excess income, Tennessee's functional equivalent of what other states call a Miller Trust
- Countable assets up to $2,000 individual / $3,000 couple
- Home equity up to $752,000 is excluded from countable assets
- Functional: nursing-facility level of care (Group 1 or 2) or At Risk (Group 3)
Eligibility, caregiver: Age 18+, pass background and registry checks, complete TennCare-required training including CPR/first aid and Electronic Visit Verification (EVV), and have a valid Service Agreement on file with CDTN.
Waitlist: Group 1 (nursing facility) is an entitlement, no waitlist. Group 2 (HCBS in lieu of nursing facility) operates under a statewide enrollment cap with possible waitlists. Group 3 (At Risk) is a smaller demonstration population.
How the caregiver gets paid: CDTN serves as the Fiscal Employer Agent, payroll, tax withholding, EVV, biweekly direct deposit. The member is the W-2 employer of record.
Best for: A non-spouse adult relative or close family friend caring for a CHOICES-eligible adult who needs help with ADLs and has been authorized for personal care attendant hours.
2. CHOICES Agency-Employed Pathway (the New PC 182 Route)
Who pays: TennCare, through a TennCare-contracted home care agency or home health agency.
Who can be paid: Anyone the agency is willing to hire, including, for the first time, spouses, parents of minor children, and other co-resident relatives. The agency cannot legally refuse a relative based on the relationship or living arrangement after July 1, 2025.
2026 pay rate: Whatever the agency pays its W-2 caregivers. Tennessee agency wages vary by region and credential level, with skilled or CNA-level work paying meaningfully more than non-medical personal care.
What it covers: The member's authorized CHOICES personal care, home health aide, or skilled nursing hours, delivered by the family member as a W-2 agency employee.
Eligibility, recipient: Same as CHOICES Consumer Direction (financial and functional criteria are program-wide, not pathway-specific).
Eligibility, caregiver: 18+, pass the agency's background check, meet the agency's hiring qualifications, complete the agency's training. The PC 182 protections mean an agency cannot refuse you because you're the spouse or parent or live with the recipient, but the agency still sets the bar for skill, schedule, and credential requirements.
Waitlist: Same as CHOICES generally, Group 2 has the cap.
How the caregiver gets paid: Standard agency employment. W-2 wages, agency handles taxes, scheduling, and supervision. The agency bills TennCare for the hours; the family member receives the agency's wage rate.
Best for: Spouses caring for a CHOICES-eligible spouse; parents caring for an adult child with an I/DD diagnosis; any family member who lives with the recipient and was previously locked out of paid caregiving by the old CD rules.
Important caveat: Not every agency has updated its hiring policies. The Tennessee Disability Coalition has been compiling lists of agencies that are actively hiring family caregivers under the new law; the TennCare provider-agency information page is the official starting point.
3. ECF CHOICES: Consumer Direction and the Family Caregiver Stipend
Who pays: TennCare, with DDA in the oversight role.
Population: Tennesseans of any age with an intellectual or developmental disability (I/DD) who meet ECF financial and functional criteria. Five enrollment groups: Group 4 (Essential Family Supports), Group 5 (Essential Supports for Employment & Independent Living), Group 6 (Comprehensive Supports for Employment & Community Living), Group 7 (children with severe behavior support needs), and Group 8 (adults with severe behavior support needs).
Family Caregiver Stipend (Group 4 only): Up to $500 per month when the ECF member is a child under 18, and up to $1,000 per month when the member is an adult age 18+. The stipend is a flat sum paid by the assigned MCO, not an hourly wage, intended to compensate the family caregiver for the extraordinary care they provide above what is typical for the recipient's age. It does not require enrolling as a Consumer-Directed Worker.
Consumer Direction (all ECF groups): Same FEA (CDTN), same family-relationship rules as CHOICES CD: spouses, conservators, and POAs cannot be the CD worker, and parents of minor children in the same home generally cannot be the CD worker for that child. The stipend is the workaround for that group.
Agency-employed pathway under PC 182: Same as CHOICES, parents of minor children, adult children, and other relatives can now be hired by a Direct Support Provider agency to deliver authorized ECF services.
Eligibility, recipient: I/DD diagnosis recognized by DDA; meets ECF financial criteria (CHOICES income/asset limits) or qualifies under Katie Beckett-style parental income disregards for children.
Eligibility, caregiver: Same general profile, 18+, background check, training, valid Service Agreement.
Waitlist: ECF has historically operated reservation-list dynamics rather than a hard cap; Group 5 emergent slots fill periodically.
Best for: Families of a child or adult with I/DD who want either a flat monthly stipend (Group 4) or paid hourly support delivered by a non-spouse, non-co-resident family worker.
4. TennCare Katie Beckett
Who pays: TennCare, with TennCare Select managing Part A coverage and DDA coordinating Part B.
Population: Tennessee children under age 18 with significant disabilities or complex medical needs whose family income or assets would otherwise disqualify them. Tennessee operates Katie Beckett under its Section 1115 demonstration (NOT a separate §1915(c) waiver) and TCA §71-5-164.
Three components:
- Part A, full TennCare Medicaid coverage plus up to $15,000 per year in HCBS wraparound (in-home respite, supportive home care, home and vehicle modifications, family caregiver education up to $500/year, equipment and supplies). Capped at 300 enrollees statewide; separate waitlist prioritized by Level of Care score.
- Part B, no Medicaid coverage; up to $10,000 per year in flexible HCBS dollars (premium assistance, HSA contributions, respite). Larger enrollment, first-come-first-served waitlist.
- Part C, bridge coverage for children losing Medicaid eligibility while waiting for a Part A slot.
Can parents be paid as caregivers? Historically, the answer was no for Consumer Direction. Per Tenn. Comp. R. & Regs. 1200-13-01-.32, "a family member shall not be reimbursed for a service that he would have otherwise provided without pay," spouses cannot be CD workers, and persons residing with the child cannot deliver Supportive Home Care or hourly respite under Consumer Direction. Part A's $500/year Family Caregiver Education benefit reimburses training and conferences, not direct caregiver wages.
The PC 182 pathway: A parent or other resident relative can now be hired by a TennCare-contracted home health, private-duty-nursing, or home health aide provider agency to deliver authorized medically necessary skilled care or hours that go beyond the parental floor. This is the meaningful change for Katie Beckett families: a parent who needs to be home anyway delivering nursing-level care can now be a paid agency employee for those hours.
Best for: Families of medically complex children where a parent has been delivering full-time skilled nursing or aide-level care without pay.
5. Tennessee Caring for Caregivers Act (Pending Signature)
Status: The Tennessee Caring for Caregivers Act, sponsored by Rep. Renea Jones, passed both chambers of the Tennessee General Assembly in spring 2026 and was signed into law on May 18, 2026 (Public Chapter 940). Verify the application process before applying.
What it does: Establishes a three-year DDA pilot grant program for family caregivers of Tennesseans with Alzheimer's disease or related dementias who are cared for in a private residence.
Grant amount: Up to $6,000 per year to reimburse documented expenses including home modifications (grab bars, ramps, safety upgrades), durable medical equipment, and respite care.
Eligibility: The care recipient must have an Alzheimer's or related dementia diagnosis and need help with at least two ADLs. Priority is given to very-low-income then low-income households.
Funding: Year-one appropriation of $200,000 (nonrecurring), divided evenly among East, Middle, and West Tennessee.
What it is not: A tax credit (despite the shared name with Oklahoma's Caring for Caregivers tax credit) and not an hourly caregiver wage. It's a reimbursement grant, caregivers must front qualifying expenses and submit documentation.
Best for: Family caregivers of dementia patients with documented home-modification, equipment, or respite expenses to reimburse.
6. VA Programs (PCAFC, Veteran-Directed Care, Aid & Attendance)
Federal VA programs apply in Tennessee with state-specific delivery details.
6a. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Who can be paid: A designated "Primary Family Caregiver", spouse, son, daughter, parent, stepfamily, or extended family member, of an eligible veteran. Up to two Secondary Family Caregivers can also be designated.
2026 stipend: Indexed to the OPM GS-4 Step 1 annual rate, with a tier factor for Level 1 versus Level 2 (the Level 2 caregiver supports a veteran "unable to self-sustain in the community"), and adjusted for the caregiver's geographic locality. In Tennessee, that means different stipend amounts in the Nashville–Davidson–Murfreesboro–Columbia MSA, the Memphis MSA, the Knoxville MSA, and the Rest of US locality (most of East Tennessee). Confirm your specific stipend with your VA Caregiver Support Coordinator before relying on a number.
Veteran eligibility: Service-connected disability rating of 70% or higher (single or combined); needs in-person personal care services for at least 6 continuous months; enrolled in VA health care. Both pre-9/11 and post-9/11 eras qualify under the expanded program.
Other PCAFC benefits: CHAMPVA health insurance for the Primary Family Caregiver if uninsured; at least 30 days/year of respite; mental health counseling; legal and financial planning; travel reimbursement.
How the caregiver gets paid: Direct deposit from the VA after PCAFC application approval. The stipend is federal tax-free.
Best for: Families of eligible veterans who are willing to commit to full-time caregiving and who meet the post-2022 expanded eligibility.
6b. VA Veteran-Directed Care (VDC): Tennessee Status
Who can be paid: Any caregiver the veteran hires, including spouses, adult children, friends, and professional aides. VDC has the most permissive family-hire rules of any program in this guide.
2026 pay rate: The veteran is given a flexible monthly budget set by their VA care team based on assessed need, and sets the worker's hourly rate within that budget.
Tennessee availability: As of 2026, Veteran-Directed Care is offered through the VA Tennessee Valley Healthcare System (Nashville and Alvin C. York/Murfreesboro campuses) in partnership with the Greater Nashville Regional Council, South Central Tennessee, Southeast Tennessee, Upper Cumberland, and Pennyrile (KY) Area Agencies on Aging and Disability, and through the James H. Quillen VAMC (Mountain Home, Johnson City) in partnership with the East Tennessee AAAD. Veterans served by the Lt. Col. Luke Weathers, Jr. VA Medical Center in Memphis should ask their Caregiver Support Coordinator or social worker about VDC referral options, Memphis is not on the published list of VDC referring VAMCs.
Veteran eligibility: Enrolled in VA health care; needs help with ADLs; VDC must be available at the veteran's VAMC.
How the caregiver gets paid: Through a Financial Management Services agency contracted with the VA.
Best for: Tennessee veterans in Middle or East Tennessee with ADL needs who want flexibility in hiring (especially for spousal caregivers).
6c. VA Aid & Attendance Pension
Who is paid: The veteran or surviving spouse directly. Family caregivers are typically paid out of the pension under a private arrangement.
2026 A&A maximums (effective Dec 1, 2025 – Nov 30, 2026): single veteran with A&A receives up to $2,424/month ($29,093/year); veteran with one dependent receives up to $2,874/month ($34,488/year); two married veterans both receiving A&A together receive up to $3,845/month ($46,143/year). Each additional dependent child adds $2,984/year. Confirm current rates on the VA pension rate page before applying.
Net worth limit (2026): $163,699 in combined assets and annual income, excluding the primary residence, one vehicle, and basic household items.
Eligibility: Wartime veteran (90 days active duty including 1+ day during a recognized wartime period) OR surviving spouse; A&A-specific functional criteria (needs help with ADLs, is housebound, is in a nursing facility, or is legally blind).
How it works for caregivers: The pension goes to the veteran. Family caregivers are paid from it under a written caregiver agreement. The Tennessee Department of Veterans Services and county Veterans Service Officers can help file at no cost, avoid for-profit pension consultants who charge a percentage.
Best for: Wartime veterans (or surviving spouses) with countable income and assets under the limits who need help with ADLs.
7. Private Caregiver Agreements (Personal Services Contracts)
Who can be paid: Anyone other than a spouse, adult children, parents, friends, neighbors, professional caregivers, under a written contract.
2026 pay rate: Fair market rate for the geographic area and service type. In Tennessee, 2026 private-pay rates run roughly $14 to $22 per hour for companion or non-medical personal care, with skilled nursing care priced substantially higher (commonly $35 to $50 per hour).
What it is: A written, arms-length contract between the care recipient (or their legal representative) and the family caregiver, executed before services begin. Required elements:
- Date services begin
- Specific services to be performed (personal care, transportation, meal prep, etc.)
- Hours per week and schedule
- Reasonable and customary hourly rate, documented against 2–3 local agency quotes
- Payment terms (frequency, method)
- Caregiver keeps daily logs of duties and hours
- Caregiver reports income on their tax return
Why it matters for Medicaid planning: Tennessee enforces a 60-month Medicaid look-back. Without a written contract, payments from an aging parent to an adult child for caregiving are presumed to be uncompensated transfers (gifts) and trigger a penalty period. The 2026 Tennessee transfer-penalty divisor is approximately $295.87 per day, each $295.87 of unprotected transfer creates roughly one day of Medicaid ineligibility. A properly structured personal services contract converts the payment into a legitimate exchange of value, preserving the estate and avoiding penalties.
Spousal limitation: Spouses cannot be paid under a personal services contract for Medicaid look-back purposes, transfers between spouses are generally disregarded by Medicaid under Social Security Act §1917(d)(3)(A).
Best for: Families with enough assets to private-pay a caregiver who want to preserve the estate for future Medicaid planning. Always work with a Tennessee elder-law attorney to draft the contract, TennCare scrutinizes informal arrangements.
Comparison Table
| Pathway | Pay spouses? | Pay parents of minor? | 2026 typical pay | Waitlist? | Functional threshold |
|---|---|---|---|---|---|
| CHOICES Consumer Direction | No | N/A | $11–$15/hr (member-set) | Group 2: yes; Group 1: no | NF level of care (Group 1/2) |
| CHOICES Agency-Employed (PC 182) | Yes | N/A | Agency-set hourly wage | Same as CD | NF level of care |
| ECF CHOICES Family Caregiver Stipend (Group 4) | Yes | Yes | Up to $500/mo (child) or $1,000/mo (adult) | Reservation list | I/DD diagnosis |
| ECF CHOICES Consumer Direction | No | No (in-home parent) | Member-set within budget | Reservation list | I/DD diagnosis |
| Katie Beckett (PC 182 agency route) | N/A | Yes (medically necessary skilled hours) | Agency wage | Yes (Part A 300-cap) | Institutional level of care |
| Caring for Caregivers Act grant (signed; pilot launching) | Yes | Yes | Up to $6,000/yr lump grant | Pilot, capped | Dementia + 2 ADLs |
| VA PCAFC | Yes | Yes | GS-4 indexed, locality-adjusted | None | VA Tier 1 criteria |
| VA Veteran-Directed Care | Yes | N/A | Vet-set within VA budget | Varies by VAMC | ADL needs |
| VA Aid & Attendance | Pension paid to vet, vet pays anyone | Same | Up to $2,424–$3,845/mo to vet | None | A&A criteria |
| Personal Services Contract | No | Yes | $14–$22/hr companion; $35–$50 skilled | None | Family choice |
How to Choose a Tennessee Paid Family Caregiver Program
Start with the care recipient's situation:
- Veteran or surviving spouse? Check the VA pathways first. PCAFC stipends in higher-cost Tennessee localities can compete with or exceed what CHOICES Consumer Direction pays hourly, and Aid & Attendance can stack with a Medicaid pathway. Connect with your county Veterans Service Officer through TDVS before applying, it's free help.
- Already on TennCare or likely to qualify? If the caregiver will be a non-spouse family member, start with CHOICES Consumer Direction (the fastest, most flexible route). If the caregiver is a spouse, parent of a minor, or court-appointed guardian, you need the new agency-employed pathway under PC 182, start by calling TennCare LTSS at 1-877-224-0219 to find contracted agencies in your area that hire family.
- Caring for a child or adult with I/DD? ECF CHOICES Group 4 has the only flat monthly stipend in this guide ($500 for child caregivers, $1,000 for adult caregivers). Apply through TennCare ECF.
- Caring for a dementia patient with documented expenses? Watch the Caring for Caregivers Act, once Gov. Lee signs and DDA stands up the application portal, the $6,000/year grant becomes available for home modifications, equipment, and respite reimbursement.
- Private-pay with substantial assets? Talk to a Tennessee elder-law attorney about a personal services contract, both to generate caregiver income now and to protect the estate from the 60-month look-back when Medicaid eventually becomes necessary.
- None of the above? Contact your local Area Agency on Aging and Disability through the statewide line at 1-866-836-6678. Tennessee's nine AAADs deliver National Family Caregiver Support Program respite, training, and small grants, not hourly caregiver pay, but real support.
Not sure which Tennessee program fits your family? Chat with Brevy's care navigator for a side-by-side comparison based on your specific situation: veteran status, TennCare eligibility, whether you're a spouse or non-spouse caregiver, and the recipient's care needs.
Tax Considerations
All Tennessee paid-caregiver programs generate reportable income, with one important federal exclusion.
- CHOICES Consumer Direction pays W-2 wages through CDTN as the Fiscal Employer Agent.
- CHOICES Agency-Employed pathway (PC 182) pays W-2 wages from the home care agency.
- ECF CHOICES Consumer Direction also pays W-2 wages through CDTN.
- ECF Family Caregiver Stipend, tax treatment is administered by the assigned MCO; consult the MCO and a tax preparer for the current year's classification.
- VA PCAFC stipend is federal tax-free income; not reported on a W-2.
- VA Veteran-Directed Care pays W-2 wages through the FMS agency.
- VA Aid & Attendance pension is paid to the veteran (tax-free for the veteran); when used to pay a family caregiver, the caregiver receives ordinary taxable income.
- Personal caregiver agreements pay W-2 wages if the caregiver is treated as an employee, or 1099 income if truly independent (be careful, misclassification is the #1 audit risk in this area).
IRS Notice 2014-7: If the Medicaid-paid caregiver lives in the same home as the care recipient and provides care to that person, the wages may be excluded from federal gross income. This applies to many Tennessee CHOICES Consumer Direction and PC 182 agency-employed scenarios. The exclusion is a common and valuable benefit. Talk to a tax preparer familiar with the rule before filing.
Tennessee state income tax: Tennessee has no state income tax on wages, so the federal classification is the entire tax story for Tennessee residents.
Common Misconceptions
"My spouse can't be paid in Tennessee at all." That was true before July 1, 2025. Today, your spouse can be hired by a TennCare-contracted home care agency under the Freedom for Family Caregiving Act (PC 182 of 2025) to deliver your authorized CHOICES, ECF, Katie Beckett, or related TennCare service hours. Consumer Direction is still closed to spouses; the agency-employed pathway is the way in.
"If my mother has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. Medicare only pays for short-term skilled home health through certified agencies. Family caregiver pay in Tennessee comes through TennCare, the VA, or private arrangements.
"PC 182 means TennCare will hire me directly." No. The law removes a state-level barrier; you still have to find a TennCare-contracted home care agency willing to hire you. The Tennessee Disability Coalition tracks agencies that have updated their hiring policies; the TennCare provider-agency information page is the official starting point.
"I can pay myself out of my parent's Social Security check." Not without a written contract. An informal transfer of a parent's Social Security to a family member without a personal services contract is treated as a gift under TennCare's 60-month look-back, and triggers a penalty calculated at roughly $295.87 per day of disqualification for every $295.87 transferred.
"I need a CNA license to be paid as a family caregiver in Tennessee." Not for CHOICES Consumer Direction, the PC 182 agency pathway (in most cases), or VDC. Caregivers typically need to be 18+, pass a background check, and complete program-specific training. A CNA license expands what skilled tasks you can perform but is not a baseline requirement.
"If I start getting paid, my family loses TennCare." Paying a family caregiver out of TennCare-authorized hours does not jeopardize the recipient's TennCare. The hours come out of the recipient's authorized service plan, not their personal income or assets.
Frequently Asked Questions
Can I get paid to take care of my spouse in Tennessee?
Yes, as of July 1, 2025. Before that date, spouses were excluded from every Medicaid-side caregiver pay program in Tennessee. The Freedom for Family Caregiving Act (PC 182 of 2025) opened a new pathway: a TennCare-contracted home care agency may now hire you as a W-2 employee to deliver your spouse's authorized CHOICES, ECF, or Katie Beckett service hours. Note that CHOICES Consumer Direction (the route where the member directly hires their own worker through CDTN) still does NOT allow spouses, the new pathway is specifically the agency-employed route. VA programs (PCAFC and Veteran-Directed Care) also allow spouses to be paid for caring for an eligible veteran.
What does CHOICES Consumer Direction pay in 2026?
Tennessee CHOICES Consumer Direction pay rates are set by the member within an authorized budget, typically falling in the $11 to $15 per hour range in 2026. Exact floor and ceiling are governed by the current Consumer Direct Care Network Tennessee (CDTN) CHOICES Service Agreement Wage Memo. Verify with CDTN at 1-888-444-3109 before locking in a wage. Caregivers are paid as W-2 employees with the member as the legal employer of record and CDTN as the Fiscal Employer Agent.
Do I need to be a CNA to be a paid family caregiver in Tennessee?
Not for most Tennessee pathways. CHOICES Consumer Direction, the PC 182 agency-employed pathway, ECF CHOICES Consumer Direction, and VDC require the caregiver to be 18+, pass a criminal background and registry check, and complete program-specific training (CPR/first aid, EVV, agency orientation). A CNA license expands what skilled tasks you can perform, useful for Katie Beckett private-duty-nursing scenarios, but is not a baseline requirement.
Will getting paid as a caregiver affect my family member's TennCare eligibility?
No. Payments through CHOICES Consumer Direction, the PC 182 agency-employed pathway, or ECF CHOICES come out of the recipient's TennCare-authorized service hours, not their personal budget. The recipient's Medicaid eligibility is unaffected. What can jeopardize TennCare is paying a family member informally from private funds, without a written caregiver agreement, which Tennessee's 60-month look-back can treat as a disqualifying gift.
Can I stack VA benefits and TennCare caregiver pay?
Often yes. For example, a veteran receiving VA Aid & Attendance can also have a non-spouse adult child paid through CHOICES Consumer Direction. A veteran's family caregiver may receive a PCAFC stipend while the veteran simultaneously receives Aid & Attendance pension. Veteran-Directed Care can also be combined with most Medicaid pathways. The rules get complex, talk to your VA Caregiver Support Coordinator and a Tennessee elder-law attorney before layering programs.
How long does it take to get on CHOICES?
Group 1 (nursing facility) is a Medicaid entitlement, once eligible, enrollment is immediate. Group 2 (HCBS in lieu of nursing facility) operates under a statewide enrollment cap with possible waitlists; current wait times vary by region and acuity. Initial CHOICES financial application processing typically takes several weeks to a few months. If your loved one is in a hospital being discharged to a nursing facility, request a "fast-track" CHOICES screening through hospital discharge planning.
Related Terms
- Consumer Directed Services (CDS): The national term for self-directed programs like TennCare CHOICES Consumer Direction. Tennessee's version operates under §1115 demonstration authority (functionally equivalent to §1915(j) Cash & Counseling).
- HCBS waiver: The federal authority for community-based long-term services. Note: TennCare CHOICES is operated under §1115 demonstration authority, not a §1915(c) waiver, a TennCare-specific structural choice.
- Activities of Daily Living (ADLs): The functional basis for personal care attendant authorization across all CHOICES pathways.
- Nursing Facility Level of Care (NFLOC): The clinical threshold for CHOICES Group 1 and Group 2.
- Miller Trust / Qualified Income Trust (QIT): Tennessee uses the QIT terminology for the income-redirection trust used by CHOICES applicants over the 300% SSI income limit.
- Medicaid spend-down: Tennessee does not use the spend-down model the way some states do; the QIT is the primary income-correction mechanism.
Learn More
- How to Get Paid as a Family Caregiver: The 50-State Guide
- Tennessee Caregivers: The Complete Guide
- TennCare Consumer Direction: How Tennessee Pays Family and Friends
- Caregiver Programs in Tennessee: A Complete Directory
- How to Find Respite Care in Tennessee
- Caregiver Burnout: Signs, Stages, and How to Get Support
- Medicaid Planning Strategies (National)
Find personalized help navigating Tennessee paid family caregiver programs 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.