Getting paid to care for a parent in Tennessee

Who can be the paid caregiver

Under Consumer Direction: adult children, siblings, in-laws, grandchildren, friends, and neighbors can be the paid worker. Cannot be paid: the spouse, the member's legal guardian/conservator, anyone holding Power of Attorney, or the person serving as the member's Consumer Direction Representative — TennCare's rule is blunt about that last one: the Representative "shall not receive payment for serving in this capacity and shall not serve as the Member's Worker for any Consumer-Directed Service." Here is the trap most families fall into: if you live in the same house as your parent, Consumer Direction cannot pay you for Personal Care Visits, Attendant Care, or In-Home Respite Care. This is not a leftover from an old handbook. It is in TennCare's current rule, 1200-13-01-.05, as revised October 2025 — three months after the Freedom for Family Caregiving Act took effect — in these words: "A Member shall not be permitted to employ any person who resides with the Member to deliver Personal Care Visits, Attendant Care, or In-Home Respite Care." Companion Care is stricter still: no immediate family at all (spouse, parent, grandparent, child, grandchild, sibling, or in-law, step and adopted included) and nobody the member lives with now or has lived with in the last five years. You also can't be paid for help you were already giving for free — the rule says a family member "shall not be reimbursed for a service that he would have otherwise provided without pay," so hours are authorized only for needs the family wasn't already meeting. If you live with your parent, don't fight this — use the other door. Under Public Chapter 182 of 2025, a TennCare-contracted home-care agency can hire you as its W-2 employee, and the agency may not turn you down because you are family, because you live in the home, or because of your parent's age. Ask the MCO care coordinator for the agencies in your area that hire family caregivers.

The spouse question

Spouses cannot be paid under Consumer Direction — the CHOICES handbook bars hiring "your spouse, your Representative for Consumer Direction, a legal guardian, or Power of Attorney." But since Tennessee's Public Chapter 182 of 2025 (Freedom for Family Caregiving Act, effective July 1, 2025), a TennCare-contracted home-care agency MAY hire a spouse as its W-2 employee to care for the member, and agencies may not refuse based on the spousal relationship or shared residence. No agency is required to hire any particular person, and pay can't exceed what's authorized in the member's person-centered care plan. TennCare's implementing rules were listed as pending as of mid-2026.

Waitlist reality

Honest picture: CHOICES Group 1 (nursing home care) is a mandatory Medicaid benefit — if your parent qualifies medically and financially, there is no waitlist. Group 2 (home-based care for people who meet nursing-home level of care) is not unlimited. TennCare's rule sets the Group 2 enrollment target at 12,500 and says that number "functions as a cap on the total number of persons who can be enrolled into CHOICES Group 2 at any given time"; when it is full, qualified applicants go on a formal Group 2 waiting list unless they fit an exception (moving out of a nursing home, a Critical Early Access finding, or a reserved slot). In practice, people who clearly meet nursing-facility level of care usually get in without a long wait, but plan for the possibility. Group 3 ("at risk" — not yet nursing-home level) is squeezed from two directions. There is an enrollment target of 1,750 for the at-risk group, which CMS reopened effective October 1, 2022 after it had been closed to new enrollment since June 2015; TennCare posts the current target numbers at tn.gov/tenncare. And there is a hard ceiling of $18,000 per calendar year on all CHOICES home-based services except minor home modifications. At roughly $20 an hour charged against the care budget, that ceiling works out to about 17 hours of care a week at the very most — and only for the hours the assessment finds medically necessary. Nobody is entitled to spend the whole cap. ECF CHOICES (for intellectual and developmental disabilities) uses a referral/reservation list — waits can be long, often years, unless the situation is emergent. The state-funded OPTIONS program has had waitlists prioritized by need and income.

Other doors in Tennessee

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

1. 1. If your parent is NOT on TennCare: call the statewide Area Agency on Aging and Disability line at 1-866-836-6678 and ask for a CHOICES screening — an AAAD representative can come to the home to help complete the application.
2. 2. If your parent already HAS TennCare: call their health plan (MCO) at the number on their TennCare card and ask for a CHOICES referral. The three plans are BlueCare (888-747-8955), UnitedHealthcare Community Plan (800-690-1606), and Wellpoint, formerly Amerigroup (833-731-2153).
3. 3. Get through both gates: medical (nursing-home level of care, or "at risk" for Group 3, decided by a level-of-care assessment) and financial (2026 limits: income under $2,982/month, countable assets under $2,000, 5-year lookback on asset transfers).
4. 4. Once enrolled, tell the MCO care coordinator you want Consumer Direction and name your family member as the worker; the worker enrolls through Consumer Direct Care Network Tennessee (background check with fingerprinting, I-9/W-4, Electronic Visit Verification app) before any paid shifts can start.
5. 5. If the caregiver is the spouse, or lives in the same home as your parent, or an agency job with benefits simply fits better — skip Consumer Direction and ask the care coordinator for TennCare-contracted home-care agencies that hire family caregivers under Public Chapter 182.
6. 6. Questions along the way: TennCare LTSS Help Desk 1-877-224-0219.

Where to start: Area Agency on Aging and Disability (AAAD), statewide single point of entry: 1-866-836-6678 — or, for current TennCare members, the MCO number on the TennCare card. Program info: https://www.tn.gov/tenncare/long-term-services-supports/choices.html

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.