Tennessee has three pathways that can pay a family member as a caregiver, plus respite vouchers, grants, and VA benefits that most families are never told about. If you're caring for an aging parent, a spouse with dementia, or an adult child with a serious disability, 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 Tennessee caregiver program in 2026: the pathways that can pay a family member, the respite vouchers and grants that fund a real break, the AAAD network that handles intake, the VA programs for caregivers of veterans, the dementia resources, and how all of it is taxed. Each section 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.

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 services (via AAADs) Respite, counseling, training, support groups, limited supplemental help Any informal caregiver of an adult 60+ (and other categories) Free; no income test
Family-Directed Respite Voucher Up to $600/yr/household for caregiver-chosen respite Caregivers statewide; apply April 1–June 30 Free; no income test
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 $70–$95/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 (2026 law) Up to $6,000/yr reimbursement for dementia-care expenses Dementia diagnosis + help with ≥2 ADLs; DDA pilot standing up Free reimbursement grant

One naming note: Tennessee runs Medicaid through a §1115 demonstration called TennCare III, not the state-plan-plus-§1915(c)-waivers structure most states use. That is why everything here is labeled "CHOICES" or "ECF CHOICES" rather than "HCBS waiver." The practical effect is the same: long-term care coverage under federal Medicaid authority.

Which Programs Pay Family Caregivers in Tennessee?

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 Consumer Direction contact line is plan-specific: 1-888-444-3109 (UnitedHealthcare), 1-888-398-0664 (Wellpoint), or 1-888-450-3240 (BlueCare Tennessee). Worker wages in 2026 are set by the member up to a TennCare-approved maximum that varies by service, roughly $16 to $19 an hour for personal care and respite under CDTN's current approved rate schedule, and the budget your MCO Care Coordinator authorizes governs the exact ceiling.

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.

One important limit: agencies are not required to hire any specific family member, so access depends on finding a willing TennCare-contracted agency. Your MCO Care Coordinator has the list for 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.

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. It is available only in Group 4; the other ECF CHOICES groups do not include this stipend. The stipend cannot duplicate paid Consumer Direction hours or paid agency-employed services for the same time period.

VA Caregiver Programs

If the person you care for is a veteran enrolled in VA health care, the Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to a primary family caregiver, and it is now open to veterans of all eras. It is a fourth paid-caregiver pathway on top of the three TennCare routes above. The full VA benefit stack, the three Tennessee VA health care systems, PCAFC and PGCSS eligibility, respite, and the support line, is laid out in Caring for a Veteran? VA Caregiver Benefits below.

How Do Tennessee Caregivers Get Respite?

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): covers in-home and inpatient respite plus adult day care; the specific annual hour limits are set in the TennCare CHOICES Member Benefit Table and authorized through your MCO care plan.
  • NFCSP through AAADs: funds respite, counseling, training, and limited supplemental services for informal caregivers. No income test.
  • Family-Directed Respite Voucher: reimburses up to $600/year per household for respite of the caregiver's choosing, administered by the Tennessee Caregiver Coalition with the state, no income limit, applied for during an April 1 to June 30 window.
  • 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 for overnight respite.

Many AAADs report unspent NFCSP and respite-voucher funds at year end simply because families don't apply. If you care for someone full-time and haven't asked your AAAD about respite funding, call 1-866-836-6678.

What Does Adult Day Care Cost in Tennessee?

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.

A regulatory point that confuses families coming from other states: Tennessee uses a single licensure category, "Adult Day Services Center", under TDHS rules. Any center caring for five or more adults must hold this TDHS license. 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 Tennessee.

To find a center near you, ask your AAAD at 1-866-836-6678 or search the TDHS public roster of licensed Adult Day Services centers, which TDHS updates through the year.

Support, Training, and Dementia Resources

Caregiver support in Tennessee is well-developed but spread across many organizations. The two biggest dementia lines belong to different groups, so don't 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), and Memphis (1661 International Drive, Suite 400). National 24/7 Helpline: 1-800-272-3900 (available around the clock in more than 200 languages).
  • Alzheimer's Tennessee, Inc. is an independent, Knoxville-based state nonprofit. It is not affiliated with the national Alzheimer's Association. Independent helpline: 1-888-326-9888.

Both run support groups, education, and care consultations, and many families use both. The shared "Alzheimer's" in their names causes frequent confusion, so confirm which one you are calling.

State-Level Dementia Coordination

The Tennessee Department of Disability and Aging (DDA) has a statewide Dementia Program Manager: Jackie Moment, jackie.moment@tn.gov, 615-854-9610. That 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 (ACL) 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.

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
Aging Commission of the Mid-South Memphis / Shelby area 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.

Caring for a Veteran? VA Caregiver Benefits

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.

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.

Three Federal VA Caregiver Programs

  • PCAFC (Program of Comprehensive Assistance for Family Caregivers), monthly stipend, training, counseling, mental health services. Open to caregivers of veterans of any service era. Veteran must be 70%+ service-connected and need 6+ months of personal care services. The stipend is the OPM GS-4 Step 1 annual rate for the veteran's locality divided by 12, then multiplied by one of four factors set at 38 CFR 71.40(c)(4)(i), not two: 0.625 or 1.00 in the current program, where 1.00 requires a VA "unable to self-sustain in the community" determination, or 1.00 / 0.625 / 0.25 on the legacy schedule, set by the sum of the veteran's 2019 clinical ratings at 21 or higher, 13 to 20, and 1 to 12 respectively.
  • 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 for overnight respite (and up to $15/day for in-home or adult day respite), depending on the veteran's service-connected status.

Two things that schedule decides for a Tennessee family. A legacy participant or applicant reaches the full 1.00 factor on the 2019 rating sum alone, with no self-sustain determination, so a household told that determination is the only road to the top rate is understating what it can claim by 1.6 times. And a veteran who qualifies on both routes is paid whichever amount is higher, while a legacy participant's caregiver cannot fall below what they were eligible for the day before October 1, 2020, so long as the veteran stays at the address VA has on record. The legacy apparatus lapses October 1, 2028. Ask your Caregiver Support Coordinator in writing which schedule you are on.

National contact: VA Caregiver Support Line 1-855-260-3274, Monday to Friday, 8am to 8pm 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 for the side-by-side breakdown of Consumer Direction, agency-employed (PC 182), the ECF CHOICES stipend, and VA programs, plus the spouse rules and what to ask the MCO Care Coordinator.

Tennessee Caregiver Programs and the Caring for Caregivers Act

The Tennessee Caring for Caregivers Act, sponsored by Rep. Renea Jones and Sen. Rusty Crowe, became law on May 18, 2026 as Public Chapter 940 of 2026 after passing the House 92-3 and the Senate 30-0.

The act establishes 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 or assistive technology, 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 lower-income households.

The first-year appropriation is $600,000, divided across the state's three regions (East, Middle, and West Tennessee). The grant is a reimbursement, not a tax credit and not an hourly caregiver wage; caregivers front qualifying expenses and submit documentation. Because the program is newly enacted, watch for DDA's implementation guidance and application opening dates.

A Quick Note on Taxes

Tennessee does not levy a state personal income tax on wages, so CHOICES, agency-employed, ECF stipend, and VA caregiver wages are not subject to any Tennessee state income tax. The state's only individual income tax, the Hall income tax on interest and dividend income, was repealed for tax years beginning on or after January 1, 2021. 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

Can I be paid as a caregiver for my spouse in Tennessee?

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.

Can I be paid as a caregiver for my parent in Tennessee?

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.

What's the difference between the AAADs and DDA?

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.

Can I get paid for caring for a child or adult with intellectual disabilities through Katie Beckett or ECF CHOICES?

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.

My loved one isn't on TennCare. What programs are available?

Several. NFCSP services 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 new Caring for Caregivers Act (now law) does not require Medicaid. The Family-Directed Respite Voucher works for both Medicaid and non-Medicaid families.

How do I find a TennCare-contracted home care agency that will hire me?

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?"

My loved one has dementia. Where do I start?

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 Program Manager Jackie Moment at 615-854-9610 for ADPI Dementia Navigator referrals. If your loved one is on TennCare CHOICES, also ask the MCO Care Coordinator about authorized respite hours.

Are there tax credits for family caregivers in Tennessee?

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 Caring for Caregivers Act signed in 2026 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.

What if I'm burning out?

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.

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging.

Find personalized help mapping Tennessee caregiver programs to your family's situation 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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Brevy Care Team

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