For families and caregivers

TennCare CHOICES: how to get paid to care for a family member in Tennessee

By the CaregiverConnect team · Updated 2026-10-26 · Sources checked on the same date and listed at the end.

In Tennessee, the usual way to be paid for caring for a parent or other relative at home is Consumer Direction in TennCare CHOICES, the state Medicaid program for long-term care. Your relative becomes the employer, and a family member can be hired as their worker, but not a spouse, and not someone who lives in the home for most services. This guide covers who qualifies for CHOICES, the relative rules, who runs payroll and what pay looks like, drawing on a 2026 TennCare plan handbook, an AAAD website and federal pages consulted October 26, 2026.

A smiling caregiver with her arm around an older woman in a bright room at home

What TennCare CHOICES is and who qualifies

CHOICES pays for nursing home care and home and community-based services for Tennesseans aged 65+ and for adults (21 or over) living with a physical disability. Services range from personal care and home-delivered meals to respite and adult day care, depending on each person's needs. Your relative's TennCare health plan manages their physical health, behavioral health and long-term care together.

The BlueCare 2026 member handbook describes three groups:

Group	Who it is for	Consumer Direction?
Group 1	People of any age receiving nursing home care that TennCare pays for	No
Group 2	Seniors 65+, or adults 21+ with a physical disability, who need nursing home level of care but choose home care instead	Yes, including companion care
Group 3	Seniors 65+, or adults 21+ with a physical disability, who fall short of nursing home level of care yet risk going into one without home care	Yes

Members in Groups 2 and 3 must also qualify for Medicaid long-term services and supports, either because they receive SSI or because they will receive home care instead of nursing home care. For Group 2, the assessment also checks whether home care would cost more than nursing home care.

How to apply for TennCare CHOICES, and the waiting list

Already on TennCare. Call the health plan; the number is on the TennCare card. BlueCare members call 800-468-9698.
Not on TennCare yet. Contact the local Area Agency on Aging and Disability (AAAD) free at 866-836-6678; the call is routed to the nearest AAAD, which helps check whether your relative qualifies for TennCare and CHOICES.
TennCare Connect handles applications, renewals and changes at 855-259-0701.
Disability Rights Tennessee is TennCare's beneficiary support system and can help people apply for CHOICES and explain their rights.

Not everyone who qualifies can start home care right away. The handbook says Groups 2 and 3 have an enrollment target, a limit on how many people can be enrolled at once that the state sets in TennCare rules. If no slots are open, or the remaining slots are reserved and your relative does not meet the guidelines for them, their name goes on a waiting list. People leaving a nursing home get the first open slots in Group 2, and Group 1 nursing home care has no enrollment limit.

Ask about estate recovery too. The First Tennessee AAAD notes that the state must seek repayment from the estate of a person who received Medicaid long-term services and supports after they die.

TennCare CHOICES consumer direction: how the family caregiver is hired

In Consumer Direction your relative employs the workers directly instead of using an agency. In CHOICES, three services can be consumer directed: personal care visits, in-home respite, and companion care for Group 2 members only. The member, or a Representative for Consumer Direction, must:

Find, interview, hire, train and, if needed, fire workers, and write a job description.
Set the schedule, make sure workers clock in and out with electronic visit verification (EVV) every shift, and keep care within the approved amount.
Make sure no hourly worker gives more than 40 hours of care in a week.
Decide each worker's pay within limits set by the state, check reported time and keep a back-up plan for missed shifts.

A Representative must be at least 18, know the member well, live with them or be in the home often enough to supervise, and sign a Representative Agreement. No pay comes with the Representative job.

A Care Coordinator from the health plan raises Consumer Direction when the support plan includes services that qualify and starts enrollment. Until it is set up, care comes from a network provider. Choosing Consumer Direction does not add hours; it changes who provides the services already in the plan.

Which relatives can be paid under TennCare CHOICES

The BlueCare 2026 handbook answers the question directly: yes, a family member can be paid, but a member cannot:

Pay a spouse to provide care.
Pay anyone who lives with them for personal care, community transportation or in-home respite.
Pay an immediate family member for companion care. That means a spouse, parent, grandparent, child, grandchild, sibling, or a mother-, father-, sister-, brother-, daughter- or son-in-law, including adopted and step relatives.
Pay anyone they live with now, or lived with in the last five years, for companion care.

CHOICES also will not pay relatives for care they would have given for free; it covers only needs that family and other helpers cannot meet. In practice, an adult child or sibling who lives in their own home is the clearest case for paid personal care visits.

Wellpoint's Consumer Direction handbook, which carries no date, adds that a worker cannot be the member's Representative for Consumer Direction, legal guardian or power of attorney, and lists worker requirements: age 18 or above, a criminal record check including abuse and sexual offender registries, CPR and first aid among the required training, and a signed Medicaid agreement. The 2026 BlueCare handbook does not repeat the guardian and power-of-attorney points, so confirm them with your Care Coordinator.

Who runs payroll: the fiscal employer agent

Under Consumer Direction, a Fiscal Employer Agent (FEA) helps the member and workers complete the employment paperwork, pays the workers for the care they give, and files the payroll tax forms an employer has to file. The FEA also hires or contracts with a Supports Broker, who helps with job descriptions, paperwork, training, scheduling and the first back-up plan, calls at least once a month and visits at least once every six months. The Supports Broker cannot supervise workers; that stays with the member or Representative.

The health plan pages reviewed for this guide do not name the current FEA, so ask the Care Coordinator which company will handle enrollment and pay.

Consumer Direction pay in Tennessee: rates and wage benchmarks

The state sets a range of rates for consumer-directed services, and the member picks one rate per worker from that range, but the pages reviewed for this guide do not publish the figures. Ask the Care Coordinator or FEA for the current rate sheet. Hours are limited to the support plan and to 40 a week per hourly worker.

Two public numbers help with comparison, though neither is a CHOICES rate:

Comparison	Value	Agency
Tennessee workers in BLS occupation 31-1120 (home health and personal care), hourly median, May 2025	$15.45 (35,950 jobs)	BLS OEWS
Minimum wage	No state law; the federal $7.25 applies to employers covered by the FLSA	US Department of Labor, updated July 1, 2026

Taxes on CHOICES pay and private caregiver wages

IRS Notice 2014-7 deals with payments from Medicaid home and community-based waiver programs under section 1915(c): when a provider cares for someone in the provider's own home, those payments can be excluded as difficulty of care payments. For any other kind of state program, the IRS will look at how that program is designed and what it is for before deciding. Most CHOICES services cannot go to a live-in relative in the first place, so ask the FEA or a tax professional before you count on an exclusion.

IRS Topic 756 covers private hiring. The $3,000 cash-wage threshold for 2026 triggers Social Security and Medicare (FICA) withholding for a household employee, while federal unemployment (FUTA) ignores wages the employer pays their own spouse, parent, or child younger than 21.

VA programs that pay family caregivers of Tennessee veterans

PCAFC, the VA family caregiver stipend. A veteran rated 70% disabled or more (individually or combined), discharged or holding a medical discharge date, enrolled in VA health care, and expected to need hands-on personal care for at least six continuous months may name a Primary Family Caregiver, who can get a monthly payment from VA. That person must be 18 or over and either a relative or a full-time housemate of the veteran. It is one route by which a spouse can be paid in Tennessee, since CHOICES will not pay one.
Veteran Directed Care. Instead of agency services, the veteran controls a VA-funded budget and may employ family or neighbors. It is not offered everywhere; a VA social worker can confirm eligibility and local availability.

AAAD offices and Adult Protective Services in Tennessee

The statewide AAAD line, 866-836-6678, connects you to the agency for your area. In northeast Tennessee, the First Tennessee AAAD serves Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi and Washington counties; its general number is 423-928-0224.

Suspected mistreatment of an adult, whether abuse, neglect or financial exploitation, goes to Adult Protective Services at the Tennessee Department of Human Services, toll-free 1-888-277-8366. In an emergency, call 911.

Where CaregiverConnect fits

CaregiverConnect has no role in CHOICES enrollment: it isn't a TennCare provider, fiscal employer agent or home care agency. It is useful for care a family arranges and funds on its own, such as while waiting for a CHOICES slot or for hours the support plan leaves uncovered. A family can list the job at no charge and choose a caregiver itself, becoming that worker's household employer. Step-by-step detail sits on how it works, optional paid plans are on pricing, and this hiring walkthrough deals with interviews and written agreements.

Caregivers looking for work can make a no-cost profile and answer job posts in Greene County, including Greeneville, Mohawk and Bulls Gap, as well as Morristown, Rogersville and Newport. Our profile guide covers what to include, and Medicaid programs for family caregivers compares other states.

Frequently asked questions

What is TennCare CHOICES?

TennCare's program for long-term services and supports: nursing home care plus home and community-based services, open to seniors (65+) and to adults from 21 with a physical disability. It has three groups; Groups 2 and 3 receive care at home and can use Consumer Direction.

What is TennCare CHOICES consumer direction?

A way for a CHOICES member in Group 2 or 3 to hire their own workers for personal care visits, in-home respite and (Group 2 only) companion care. The member or a Representative acts as employer, and a Fiscal Employer Agent pays workers and files payroll taxes.

Can I get paid to take care of my mom in Tennessee?

Often, yes. If she is enrolled in CHOICES Group 2 or 3, she can hire you through Consumer Direction. The 2026 BlueCare handbook bars paying a spouse and bars paying someone who lives with her for personal care, community transportation or in-home respite, so an adult child living in a separate home is the clearest case.

Can a spouse be paid under TennCare CHOICES?

No. The handbook says a member cannot pay a spouse to provide care in Consumer Direction. A veteran's spouse could still receive the PCAFC stipend from VA if the veteran meets that program's rules.

Is there a weekly hour limit for CHOICES family caregivers?

No hourly worker may give more than 40 hours of care in a week, and total hours cannot exceed what the support plan approves. Choosing Consumer Direction does not add hours.

How do I apply for CHOICES if my parent is not on TennCare?

Call the Area Agency on Aging and Disability line free at 866-836-6678. The AAAD helps check whether your parent qualifies for TennCare and CHOICES. If your parent already has TennCare, call the health plan on their card instead.

Sources

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