TennCare CHOICES: Get Paid To Care For A Family Member In Tennessee

It depends on the pathway. Through CHOICES Consumer Direction (the self-directed option where the member is the employer), a spouse cannot be paid. TennCare rules exclude spouses, legal guardians, and powers of attorney from being consumer-directed workers. However, Tennessee's Freedom for Family Caregiving Act (Public Chapter 182 of 2025, in effect since July 1, 2025) created a separate pathway: a TennCare-contracted home care provider agency may now hire a spouse (or a parent) as a W-2 employee to deliver a member's authorized CHOICES service hours. In that model the agency employs, schedules, and supervises the caregiver rather than the member. So if you specifically need a spouse to be paid, ask your MCO Care Coordinator about the agency-employed route instead of Consumer Direction. Adult children and most other relatives can be paid under either pathway.

Tennessee does not set one statewide hourly wage for CHOICES caregivers. In Consumer Direction, the pay rate is negotiated between the member and the worker, but it has to fit inside the service budget the MCO Care Coordinator authorizes and stay within the wage ceiling that Consumer Direct Care Network Tennessee (CDTN) publishes. In 2026, consumer-directed personal care attendants in Tennessee generally earn in the range of about $11 to $16 per hour. Workers are W-2 employees, so federal income tax, Social Security, and Medicare are withheld from each paycheck by CDTN. If a family member is hired through a provider agency under the 2025 Freedom for Family Caregiving Act instead, the agency sets the wage. Because rates are tied to the member's budget rather than a fixed schedule, confirm the current wage limit with CDTN before agreeing on a rate.

TennCare has up to 90 days to process a CHOICES application, and it aims to finish sooner, often around 45 days, though you generally cannot file a complaint about a delay until 90 days have passed. The two parts that drive the timeline are the Pre-Admission Evaluation (PAE), which establishes nursing-facility level of care, and the financial eligibility review of income and assets. If the member is not already on TennCare, add time for that underlying Medicaid determination. Once clinical and financial eligibility are confirmed and a slot is available, the MCO Care Coordinator builds the support plan and you can elect Consumer Direction and enroll your worker with CDTN, which usually takes a few more weeks. You can speed things up by gathering documents early: identification, Social Security card, bank statements, deeds, vehicle titles, and insurance cards.

One of the main advantages of Consumer Direction is that no formal license or certification is required. A consumer-directed worker does not need to be a Certified Nursing Assistant (CNA) or Home Health Aide (HHA). Because the member (or their representative) is the employer, they train the worker on the specific tasks they need, such as bathing, dressing, meal preparation, and mobility. There are still basic onboarding requirements handled through Consumer Direct Care Network Tennessee (CDTN): completing employment paperwork such as the I-9 and W-4, passing a background check, and any orientation CDTN or the MCO requires. This makes Consumer Direction well suited to family members who have already been providing care informally. Note that the agency-employed pathway under the 2025 Freedom for Family Caregiving Act can carry additional agency training and credential requirements set by the provider agency.

In a traditional CHOICES setup, the managed care organization assigns a licensed provider agency, and the agency selects, schedules, and supervises the worker who comes to your home. Consumer Direction flips that: the member (or a designated representative) becomes the legal employer of their own caregiver. The member recruits, hires, trains, schedules, and can dismiss the worker, and can choose a family member or friend they already trust. Consumer Direct Care Network Tennessee (CDTN) acts as the Fiscal Employer Agent, handling payroll, tax withholding, and worker paperwork, but CDTN does not pick or supervise the caregiver. Consumer Direction is available for eligible in-home services such as personal care visits, attendant care, companion care, and in-home respite. If you do not have a family member or friend available to hire, a traditional provider agency may be the better fit.

TennCare CHOICES is delivered statewide through three managed care organizations (MCOs): BlueCare, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup). Your MCO assigns a Care Coordinator who assesses your needs, builds your individualized support plan, authorizes your service budget, and refers you to Consumer Direct Care Network Tennessee (CDTN) if you elect Consumer Direction. If you are already on TennCare, you can reach your plan directly to ask about CHOICES: BlueCare at 888-747-8955, UnitedHealthcare Community Plan at 800-690-1606, and Wellpoint at 833-731-2153. If you are not yet enrolled in TennCare, start with your local Area Agency on Aging and Disability, or call the statewide line at 1-866-836-6678. The Care Coordinator is your main point of contact for changing services, adjusting hours, or switching between the agency and consumer-directed models.

Consumer Direction applies to specific in-home services in CHOICES, most commonly personal care visits (help with bathing, dressing, meals, eating, and toileting), attendant care, companion care, and in-home respite. It does not cover clinical services like skilled nursing. The number of hours you are authorized is not a flat allowance; it is based on the member's assessed needs from the Pre-Admission Evaluation and the individualized support plan the MCO Care Coordinator develops. CHOICES home and community based services are also subject to cost-effectiveness limits, so the combined value of your in-home services generally has to stay within a cap tied to what nursing-facility care would cost. Within that budget, the member sets the worker's pay rate and can split hours across more than one caregiver, for example two adult children sharing the week.

No. Choosing CHOICES and electing Consumer Direction does not take away the member's other TennCare benefits. Doctor visits, hospital care, prescription drugs, and other covered Medicaid services continue as usual. CHOICES is the long-term services and supports piece that sits alongside the rest of the TennCare benefit package. If the member is also covered by Medicare (dually eligible), Medicare keeps paying for acute care such as hospital stays, physician visits, and short-term skilled home health, while TennCare CHOICES covers the ongoing personal care and other HCBS. The two programs coordinate. Keep in mind that CHOICES long-term care has its own income and asset limits, so if the member's finances change, they should report it to their MCO Care Coordinator or TennCare so eligibility can be reviewed and coverage is not interrupted.