Key takeaway
Tennessee pays family caregivers primarily through TennCare CHOICES and ECF CHOICES with Consumer Direction. Veterans’ programs and TCAD resources can complement these options.
- CHOICES: Medicaid LTSS with Consumer Direction to hire certain family members.
- ECF CHOICES: For I/DD; some family members can be paid depending on rules.
- Consumer Direction: Lets members hire and schedule caregivers directly.
- Veterans: Aid & Attendance and PCAFC provide monetary support to families.
- Private pay/LTC insurance can fill gaps where public programs don’t apply.
Overview
Family caregivers in Tennessee can receive compensation through Medicaid programs (CHOICES and ECF CHOICES) that support care at home. Consumer Direction offers flexibility to hire and manage caregivers, often including relatives.
Programs that pay family caregivers in Tennessee
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| TennCare CHOICES (Medicaid LTSS) | Medicaid eligibility and nursing‑home level of care; assessment via AAAD/MCO. | Consumer Direction allows hiring certain family members for ADLs/IADLs; pay varies by MCO and region. |
| ECF CHOICES (I/DD) (Medicaid) | Medicaid‑eligible with qualifying intellectual/developmental disability. | Home‑based services; some family members may be hired depending on program rules and needs. |
| Consumer Direction (Self‑direction) | Available within CHOICES and ECF CHOICES when member opts in and requirements are met. | Member (or representative) recruits, trains, and schedules caregivers and can choose relatives within program rules. |
| Veterans Programs (Aid & Attendance, PCAFC) (Federal) | Eligible veterans; program‑specific criteria apply. | A&A increases pension; PCAFC provides a stipend, training, and supports for a designated family caregiver. |
| TCAD / AAAD supports (State/Local) | Varies by county and program funding. | Respite, training, and caregiver support; typically no direct salary. |
| Private Pay / Long‑Term Care Insurance (Private) | Policy coverage or private agreement. | Some LTC policies reimburse family caregiving; otherwise use a written caregiver agreement. |
TennCare programs: CHOICES, ECF CHOICES, and Consumer Direction
TennCare supports in‑home care through CHOICES (LTSS) and ECF CHOICES (I/DD). Opting into Consumer Direction lets members hire certain family caregivers and manage schedules.
CHOICES (LTSS)
Helps seniors and adults with disabilities remain at home with assistance for ADLs/IADLs; pay rates vary by managed care organization and region.
- Eligibility: Medicaid plus nursing‑home level of care.
- Apply via TennCare and AAAD for assessment.
ECF CHOICES (I/DD)
Provides home‑based services and supports for individuals with intellectual or developmental disabilities; can allow family caregivers depending on rules.
Consumer Direction
Self‑direction option within CHOICES and ECF CHOICES for hiring and managing caregivers (including some relatives) with fiscal support.
Caregiver supports (TCAD and AAAD)
The Tennessee Commission on Aging and Disability and local AAADs offer respite, training, and caregiver resources and help with navigation.
Short‑term relief and skills/resources for caregivers.
Get connected to CHOICES/ECF and community resources.
Who qualifies
- Family caregivers supporting older adults or people with disabilities; criteria vary locally.
Veterans’ programs
Veterans can use Aid & Attendance and PCAFC to support family caregiving; contact the VA Caregiver Support Program to apply.
Aid & Attendance Pension
Adds to a veteran’s pension to offset in‑home care costs.
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Provides a stipend, training, and supports to a primary family caregiver.
Private pay and long‑term care insurance
If public programs do not apply, families can use private caregiver agreements or long‑term care insurance.
What to check in the policy
- Policy covers in‑home personal care and pays the policyholder (cash/indemnity).
- Use a written caregiver agreement for clarity on duties, hours, and pay.
How to apply in Tennessee (step-by-step)
- Decide the path: CHOICES, ECF CHOICES, Consumer Direction, VA programs, TCAD resources, or private insurance.
- Gather documents: ID, Medicaid status, medical records, and contact info for providers; income/assets if requested.
- Start with the right agency:
- CHOICES: apply via TennCare; request assessment through your AAAD.
- ECF CHOICES: apply through TennCare for I/DD services.
- Consumer Direction: opt in during your CHOICES/ECF planning if available.
- Veterans: apply via the VA Caregiver Support Program.
- TCAD/AAAD: contact your local agency for caregiver supports and respite.
- Complete functional and financial assessments as required.
- If eligible, designate your family caregiver and complete enrollment/orientation and timesheets.
- Begin services; track hours/claims; keep documentation for renewals and audits.
Tennessee paid caregiver FAQs
Can a spouse be paid as a caregiver in Tennessee?
Consumer Direction allows hiring certain relatives. Spousal eligibility depends on program rules; confirm with TennCare/your MCO.
How do I start with CHOICES?
Apply via TennCare and request an assessment through your Area Agency on Aging and Disability (AAAD).
What is Consumer Direction?
A self‑direction option that lets members hire and schedule caregivers (including some relatives) with payroll support.
Can I combine programs?
You may use VA benefits alongside TennCare services when rules allow; AAADs can help coordinate.
