If you're caring for an aging parent, a spouse with dementia, or an adult child with a serious disability, you've probably realized that Tennessee has more help available than anyone told you about. The hard part isn't whether help exists. It's knowing what's there, who runs it, and which one fits your situation.

This guide is the map. It covers every major caregiver program in Tennessee in 2026: the three pathways that can pay a family member as a caregiver, the respite vouchers and grants that can fund a real break, the AAAD network that handles intake, the VA programs for caregivers of veterans, the dementia resources, and how all of this is treated for taxes. Each section is short on its own and points you to the deeper article when one exists.

You don't have to figure this out alone. And you don't have to fund all of it out of your savings.

By Brevy Care Team · Last verified May 2, 2026

In This Guide

Tennessee Caregiver Programs at a Glance

Program What It Offers Who Qualifies Cost to You
TennCare CHOICES Consumer Direction Family hires its own paid caregiver; W-2 payroll through CDTN CHOICES Group 1/2/3 members; cannot hire spouse, conservator, guardian, or POA Free (paid by Medicaid)
TennCare CHOICES Agency-Employed (PC 182) A licensed home-care agency hires a family member (incl. spouses) as a W-2 employee CHOICES, ECF, Katie Beckett A/B, DD waivers, PDN, HHN, HHA Free (paid by Medicaid)
ECF CHOICES Family Caregiver Stipend Flat monthly cash to a family caregiver of a Group 4 ECF member ECF CHOICES Group 4 only Free (paid by Medicaid MCO)
NFCSP grants (via AAADs) $300–$500 supplemental grants, training, support groups Any informal caregiver of an adult 60+ (and other categories) Free; no income test
Family-Directed Respite Voucher Up to $2,500/yr/beneficiary for caregiver-chosen respite Aging or DD recipients via DDA/AAADs Free
OPTIONS for Community Living State-funded homemaker, personal care, home-delivered meals, respite At-risk seniors and adults with disabilities through AAADs Free or sliding scale
Adult Day Services Daytime supervised care at a TDHS-licensed center Most older adults; TennCare CHOICES covers for Group 2/3 $85–$100/day private; free for CHOICES
VA PCAFC Monthly stipend to primary family caregiver; training; counseling Veterans 70%+ service-connected, needing 6+ mo personal care Free; veteran must be VA-enrolled
VA Respite Care Up to 30 days/year of caregiver relief VA-enrolled veterans meeting clinical criteria Up to $97/day copay
Caring for Caregivers Act (pending) Up to $6,000/yr reimbursement for dementia-care expenses Pending governor's signature; ADL ≥2 with dementia diagnosis Free if program activates

A note before we dive in. Tennessee runs Medicaid through a §1115 demonstration called TennCare III rather than the more common state-plan-plus-§1915(c)-waivers structure most other states use. That's why everything here is labeled "CHOICES" or "ECF CHOICES" rather than the usual "HCBS waiver" terminology. The practical effect is the same, long-term care coverage under federal Medicaid authority.

Programs That Pay Family Caregivers

For a deep walkthrough, eligibility, application, hourly rates, the spouse rules, and the difference between the two CHOICES paths, read How to Get Paid as a Family Caregiver in Tennessee. Here is the high-level map.

TennCare CHOICES Consumer Direction (CD)

Consumer Direction lets a CHOICES member hire and supervise their own personal care attendant, in-home respite worker, or companion-care worker. The Fiscal Employer Agent, Consumer Direct Care Network Tennessee (CDTN), handles W-2 payroll, tax withholding, Electronic Visit Verification (EVV), background checks, and biweekly direct deposit. The member is the legal employer of record.

Who can be hired:

  • Adult children, siblings, parents of an adult child, friends, other relatives.

Who cannot:

  • Spouses. This is a hard rule under Consumer Direction and PC 182 did not change it.
  • Court-appointed conservators, legal guardians, or powers of attorney.
  • Anyone serving as the member's CD Representative.

CDTN's CHOICES contact line is 1-888-444-3109. Hourly rates in 2026 fall in roughly the $11–$15/hour range, with the exact ceiling and floor governed by CDTN's current Wage Memo and the budget your MCO Care Coordinator authorizes.

TennCare CHOICES Agency-Employed (Public Chapter 182 of 2025)

This is the newer path and the one most TN families don't yet know about. The Freedom for Family Caregiving Act, signed by Governor Lee on April 30, 2025 and fully effective July 1, 2025, prohibits TennCare and DDA from blocking provider agencies from hiring a relative as a Direct Support Worker or paid caregiver based on family relationship, shared residence, age of the recipient, parental or spousal status, which TennCare program the recipient is enrolled in, or the family member's concurrent unrelated caregiver employment.

The act amends Tennessee Code Annotated Titles 52 and 71 and applies to 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. The Senate vote was 31-0; the House vote was 94-0.

The pathway runs only through agency employment: a TennCare-contracted home care agency hires the family member as a W-2 employee to deliver the recipient's authorized care hours. Spouses are now allowed through this route, that's the major change. Two limits to know: court-appointed conservators and legal guardians are excluded unless the court order explicitly permits employment, and Consumer Direction rules are unchanged.

The catch: agencies are not required to hire any specific family member. Access still depends on finding a willing TennCare-contracted home care agency. Your MCO Care Coordinator can provide the list of agencies in your county.

ECF CHOICES Family Caregiver Stipend

If you're caring for a child or adult with intellectual or developmental disabilities enrolled in ECF CHOICES Group 4 (Essential Family Supports, children and adults living with family with lower-intensity I/DD support needs), you may qualify for a flat monthly stipend paid by the member's MCO.

  • Up to $500/month when the ECF CHOICES member is a child under 18.
  • Up to $1,000/month when the member is an adult age 18 or older.

The stipend is intended to compensate the family caregiver for extraordinary care provided above what is typical for the recipient's age and needs. It's a flat sum, not an hourly wage, and it does not require enrollment as a Consumer-Directed Worker through CDTN. Available only in Group 4, Groups 5, 6, 7, and 8 do not include this stipend. The stipend cannot duplicate paid Consumer Direction hours or paid agency-employed services for the same time period.

VA PCAFC and VA Veteran-Directed Care

For Tennessee veterans enrolled in VA health care, the Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to a primary family caregiver. The veteran must have a 70 percent or higher service-connected rating and need in-person personal care services for six or more continuous months. PCAFC is now open to all eras (post-9/11 and pre-9/11). The September 29, 2025 final rule extended the legacy participant transition period through September 30, 2028.

VA stipend amounts depend on caregiver tier (Tier 1 or Tier 2) and locally adjusted federal wage rates. The VA Caregiver Support Coordinator (CSC) at your TN VAMC can confirm the current range for your situation.

The Program of General Caregiver Support Services (PGCSS) is open to caregivers of any veteran enrolled in VA health care, regardless of era or service-connection rating. PGCSS provides peer support, training, and self-care resources, but no monthly stipend.

The VA Caregiver Support Line is 1-855-260-3274 (Mon–Fri 8am–10pm ET, Sat 8am–5pm ET). Each TN VAMC has a Caregiver Support Coordinator (CSC), call the facility switchboard and ask for the CSC.

Respite Care Programs

Respite, a real, planned, paid-for break, is one of the most underused benefits in the Tennessee caregiver toolkit. For a complete walkthrough, read Respite Care in Tennessee. The condensed version:

  • TennCare CHOICES respite (Groups 2 and 3): up to 216 hours/year of in-home respite, 9 days of inpatient respite, and 2,080 hours/year of adult day services for Group 2.
  • NFCSP grants through AAADs: typically $300–$500 as supplemental respite grants. No income test.
  • Family-Directed Respite Voucher through DDA/AAADs: up to $2,500/year per beneficiary for in-home care, adult day, or short-term facility respite. The caregiver chooses the provider.
  • VA Respite Care for enrolled veterans: up to 30 days/year (in-home, VA Community Living Center, VA-contracted residential care, or adult day health care). Copay up to $97/day.
  • Hospice respite: caregivers of veterans on VA hospice qualify for hospice-bundled respite (up to 5 days per benefit period). Civilian Medicare hospice also includes a respite benefit; check with the hospice agency for current details.

A quick truth about NFCSP and the Family-Directed Respite Voucher: many AAADs report substantial unspent funds at fiscal year end because families don't apply. If you're caring for someone full-time and have not asked your AAAD about respite funding, the next phone call is 1-866-836-6678.

Adult Day Services

Adult Day Services (ADS) are TDHS-licensed centers that provide daytime supervised care, meals, social activities, and often health-related services like medication administration and nursing oversight. For most working caregivers, or any caregiver who needs reliable daytime relief, ADS is the most affordable structured option in Tennessee.

  • 2026 private-pay rate: approximately $85–$100/day, well below the national median of $95/day for adult day health care.
  • TennCare CHOICES coverage: covered for Group 2 (up to 2,080 hours/year cap) and Group 3 through the contracted MCOs (BlueCare, UnitedHealthcare Community Plan, Wellpoint).
  • Number of centers: approximately 30+ active licensed adult day centers across Tennessee in 2026, concentrated in Davidson, Knox, Shelby, Hamilton, and Rutherford counties.

A regulatory point that confuses families coming from other states: Tennessee uses a single licensure category, "Adult Day Services Center", under TDHS rules. Centers may offer health-related services (medication administration, nursing oversight) under the same license, so the social-model versus adult-day-health-care distinction familiar from other states is not a regulatory line in TN.

The trade association is the Tennessee Association of Adult Day Services (TAADS) at taads.net. To find a center near you, search the TDHS Licensed Adult Day Services Centers roster (updated periodically; ask for the current list at the Pre-Licensure Unit, ChildCarePrelicensure.DHS@tn.gov).

Support, Training, and Dementia Resources

Caregiver support in Tennessee is well-developed but spread across multiple organizations. The two most important lines for dementia caregivers are different organizations, be careful not to conflate them.

Two Distinct Alzheimer's Organizations

  • Alzheimer's Association, Tennessee Chapter is the Tennessee affiliate of the national Alzheimer's Association (alz.org/tn). Offices in Nashville (1801 West End Ave, Suite 200), Knoxville (6025 Brookvale Lane, Suite 207), Memphis (1661 International Drive, Suite 400), and Chattanooga (PO Box 4501). The older "Mid South Chapter" branding for the Memphis area has been consolidated into the Tennessee Chapter. National 24/7 Helpline: 1-800-272-3900 (English plus 200+ languages).
  • Alzheimer's Tennessee, Inc. is an independent state nonprofit founded in 1983, headquartered in Knoxville. It is not affiliated with the national Alzheimer's Association. Independent helpline: 1-888-326-9888. Operates the Howard Circle of Friends Adult Day Services in Knoxville (1807 Dandridge Ave).

Both organizations are legitimate and run support groups, education programs, and care consultations. Many families work with both. The shared "Alzheimer's" word in their names creates frequent confusion, if a guide or article doesn't distinguish them, treat the source carefully.

State-Level Dementia Coordination

The Tennessee Department of Disability and Aging operates a statewide Dementia Coordinator: Keita Cole, keita.cole@tn.gov, 615-347-6890 (also serves as Nutrition Services Director). Her office coordinates state-level dementia training, certifications, and the Alzheimer's Disease Program Initiative.

The Alzheimer's Disease Program Initiative (ADPI) is a federal Administration for Community Living cooperative grant awarded to DDA in September 2023 and funded through September 2026. ADPI funds statewide Dementia Navigators, live referral specialists who serve as a no-cost first-line resource for families newly facing a dementia diagnosis. The program's continuation past September 2026 should be confirmed before relying on it long-term.

MedicAlert + Safe Return

The historic Alzheimer's Association co-branded wandering-response program ended around 2020. Enrollment for MedicAlert services is now through the MedicAlert Foundation directly at medicalert.org.

Caregiver Training and Support Groups

Beyond the dementia-specific organizations:

  • The 9 AAADs run free caregiver training and support groups under NFCSP. Topics range from dementia behaviors to medication management to self-care. Schedules vary by region, call the statewide line 1-866-836-6678.
  • The Tennessee Disability Coalition (tndisability.org) advocates and educates for caregivers of people with disabilities.
  • 211 Tennessee (dial 211) connects to local support resources, food, transportation, and crisis intervention.

Your Local Area Agency on Aging and Disability

The Area Agencies on Aging and Disability (AAADs) are Tennessee's ground-level intake, assessment, and service-coordination network for older adults and adults with disabilities. They handle NFCSP, OPTIONS for Community Living, the Family-Directed Respite Voucher, the Long-Term Care Ombudsman program, SHIP/SHIBA Medicare counseling, and a host of other services. The federal authority is the Older Americans Act; the state authority sits with the Tennessee Department of Disability and Aging (DDA), formed July 1, 2024 by merger of the former Tennessee Commission on Aging and Disability and the Department of Intellectual and Developmental Disabilities.

Statewide intake line: 1-866-836-6678.

District Region Headquarters
First Tennessee AAAD Northeast TN Johnson City
East Tennessee AAAD East TN Knoxville
Southeast Tennessee AAAD Southeast TN Chattanooga
Upper Cumberland AAAD Upper Cumberland Cookeville
Greater Nashville Regional Council AAAD Middle TN (Greater Nashville) Nashville
South Central Tennessee AAAD South Central TN Lewisburg / Mount Pleasant
Northwest Tennessee AAAD Northwest TN Martin
Southwest Tennessee AAAD Southwest TN Jackson
Memphis Delta (MIFA) Memphis Delta Memphis

If you're not sure which district covers your county, call 1-866-836-6678 and ask. The intake specialist routes you to the right office.

VA Caregiver Benefits in Tennessee

If the person you're caring for is a veteran enrolled in VA health care, the federal VA system runs a parallel benefit stack that often pays more than TennCare or NFCSP.

Three Tennessee VA Health Care Systems

  • VA Memphis Healthcare System, main 901-523-8990; serves West TN.
  • VA Tennessee Valley Healthcare System, Nashville campus 615-327-4751; Alvin C. York campus in Murfreesboro 615-867-6000; serves Middle TN.
  • VA Mountain Home Healthcare System, Johnson City 423-926-1171; serves East TN.

Tennessee veterans in border counties may also use VA systems in Kentucky (Lexington), Virginia, North Carolina (Asheville/Salisbury), Georgia, and Alabama. Each TN VAMC has a Caregiver Support Coordinator (CSC). Direct CSC phone numbers are not always published; call the facility switchboard and ask for the CSC, or use the CSP Team Locator at caregiver.va.gov/support/New_CSC_Page.asp.

Three Federal VA Caregiver Programs

  • PCAFC (Program of Comprehensive Assistance for Family Caregivers), monthly stipend, training, counseling, mental health services. All eras. Veteran must be 70%+ service-connected and need 6+ months of personal care services. Tier 1 or Tier 2 stipend depending on care needs.
  • PGCSS (Program of General Caregiver Support Services), peer support, training, self-care resources. No stipend. Open to caregivers of any VA-enrolled veteran.
  • VA Respite Care, up to 30 days/year of caregiver relief through in-home, VA Community Living Center, VA-contracted residential care, or adult day health care. Copay up to $97/day depending on Priority Group.

National contact: VA Caregiver Support Line 1-855-260-3274, Mon–Fri 8am–10pm ET, Sat 8am–5pm ET.

For the deeper walkthrough of VA benefits in Tennessee, including Aid and Attendance for non-service-connected wartime veterans needing assistance with ADLs, see our forthcoming guide.

**Trying to figure out if you can be paid?** Read [How to Get Paid as a Family Caregiver in Tennessee](/caregiver/tennessee/how-to-get-paid-family-caregiver) for the side-by-side breakdown of Consumer Direction, agency-employed (PC 182), the ECF CHOICES stipend, and VA programs. Includes the spouse rules, the application sequence, and what to ask the MCO Care Coordinator.

Tennessee Caregiver Programs and the Caring for Caregivers Act (Pending)

The Tennessee Caring for Caregivers Act, sponsored by Rep. Renea Jones, passed both chambers of the General Assembly in spring 2026. As of May 2, 2026, the bill is awaiting Governor Bill Lee's signature.

If signed, the act would establish a three-year pilot grant program administered by DDA to support family caregivers of people with Alzheimer's disease or related dementias cared for in a private residence. Eligible caregivers may apply for up to $6,000/year to reimburse documented expenses including home modifications (grab bars, ramps, safety upgrades), durable medical equipment, and respite care. The care recipient must have an Alzheimer's or related dementia diagnosis and need help with at least two activities of daily living (ADLs). Priority goes to very-low-income then low-income households.

The initial year-one appropriation is $600,000, divided evenly among the state's three regions (East, Middle, West Tennessee). The grant is a reimbursement, not a tax credit and not an hourly caregiver wage; caregivers must front qualifying expenses and submit documentation.

Watch for gubernatorial signature and DDA's implementation guidance for application opening dates.

A Quick Note on Taxes

Tennessee has no state-level personal income tax on wages, so CHOICES, agency-employed, ECF stipend, and VA caregiver wages are not subject to Tennessee state income tax. Federal tax treatment of caregiver wages and stipends is more nuanced: live-in Medicaid waiver caregivers, PCAFC stipend recipients, and dependents-of-record may qualify for specific federal exclusions, credits, or deductions. Talk to a tax preparer familiar with Medicaid waiver caregiver compensation before filing. Federal rules update regularly; do not rely on a state guide for federal tax positions.

Frequently Asked Questions

Through Consumer Direction, no. Spouses are barred from Consumer Direction across CHOICES, ECF CHOICES, and Katie Beckett. Through the agency-employed pathway under PC 182 of 2025, yes, a TennCare-contracted home care agency may now hire a spouse as a W-2 employee. The agency, not Consumer Direction's CDTN, runs payroll. Access depends on finding a willing agency in your county; ask your MCO Care Coordinator for the list.

Yes, through either Consumer Direction (your parent hires you directly via CDTN) or the agency-employed pathway. Both routes pay W-2 wages with full payroll tax withholding. Parents-as-caregivers cannot duplicate paid hours with the ECF Family Caregiver Stipend for the same time period.

DDA (Department of Disability and Aging) is the state-level agency that oversees Tennessee's aging and disability services, formed July 1, 2024 by merger of TCAD and DIDD. The 9 AAADs are the regional service-delivery network, they run NFCSP, OPTIONS for Community Living, the Long-Term Care Ombudsman, SHIP/SHIBA, and many other programs at the local level. You usually contact the AAAD first; complex policy questions or escalations go to DDA.

Yes. PC 182 of 2025 explicitly applies to Katie Beckett Parts A and B and to all ECF CHOICES groups, opening the agency-employed pathway. ECF CHOICES Group 4 also offers the Family Caregiver Stipend ($500/mo for children, $1,000/mo for adults), a flat monthly cash benefit separate from hourly Consumer Direction or agency-employed wages.

Several. NFCSP grants through your AAAD have no income test and don't require Medicaid. OPTIONS for Community Living is state-funded and serves at-risk seniors and adults with disabilities through the AAADs. VA programs apply if the loved one is a veteran enrolled in VA health care. The pending Caring for Caregivers Act (if signed) does not require Medicaid. The Family-Directed Respite Voucher works for both Medicaid and non-Medicaid families through DDA/AAADs.

Start with your MCO Care Coordinator (BlueCare, UnitedHealthcare Community Plan, or Wellpoint). They have the in-network agency list for your county. Call multiple agencies. Some will hire family caregivers under PC 182; others will not. Ask specifically: "Do you currently hire family members as direct support workers under Public Chapter 182?"

Three calls in this order. (1) Your AAAD via 1-866-836-6678 to ask about NFCSP, the Family-Directed Respite Voucher, and the OPTIONS program. (2) The Alzheimer's Association 24/7 Helpline at 1-800-272-3900 for care consultations and support groups. (3) DDA's Statewide Dementia Coordinator Keita Cole at 615-347-6890 for ADPI Dementia Navigator referrals. If your loved one is on TennCare CHOICES, also ask the MCO Care Coordinator about authorized respite hours.

At the state level, no. Tennessee does not currently offer a state caregiver tax credit, and there is no state income tax on caregiver wages either way. The pending Caring for Caregivers Act is a reimbursement grant, not a tax credit. Federal tax treatment of caregiver wages and stipends is nuanced and changes from year to year; talk to a tax preparer familiar with Medicaid waiver caregiver compensation before filing.

First: please read Caregiver Burnout, Signs and Support. Burnout is common, predictable, and treatable. Second: call your AAAD at 1-866-836-6678 and ask about respite funding and a caregiver support group in your area. Third: call 211 for local crisis and behavioral health resources. You're not the first person in Tennessee to feel this way, and you don't have to figure out the way out alone.

Find personalized help mapping Tennessee caregiver programs to your family's situation at brevy.com.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.