Get Paid to Care for Your Elderly Parent in Tennessee
Tennessee families who are already spending hours each week caring for an aging parent have a legitimate path to getting paid for that work. Through the CHOICES program: Tennessee's Medicaid-funded home care alternative, eligible seniors can hire a family member as their paid personal care attendant rather than relying on a home care agency.
This guide explains how CHOICES works for Tennessee families, the pay rates you can expect, how to apply, and what additional programs may support you as a caregiver.
Tennessee's CHOICES program pays family caregivers $10–$14 per hour through the Agency with Choice (AWC) self-direction option. Your parent must qualify for TennCare Medicaid and meet the clinical criteria for CHOICES Group 1 (nursing facility level of care). Adult children are eligible; spouses are generally excluded.
Tennessee's Main Program: CHOICES
CHOICES is Tennessee's home and community-based services program for seniors (65+) and adults with physical disabilities who need long-term care. Rather than requiring enrollment in a nursing home, CHOICES provides services at home, including personal care, homemaker services, and respite care, through TennCare managed care organizations.
Tennessee's three TennCare managed care contractors, BlueCross BlueShield of Tennessee, UnitedHealthcare Community Plan, and Amerigroup Tennessee: each administer CHOICES for their enrolled members.
Agency with Choice (AWC), The Family Caregiver Option
Within CHOICES, the Agency with Choice (AWC) model allows participants to select their own caregiver, including an adult child, while the home care agency handles payroll, taxes, and compliance paperwork. This is the most practical option for most families because it avoids the administrative burden of being a direct employer while still giving your parent control over who provides their care.
Under AWC, you are technically employed by the home care agency contracted with the TennCare MCO, but your parent (or their representative) directs your schedule and tasks. Your parent can request that the AWC agency hire you specifically.
What CHOICES Pays You to Do
- Personal care: bathing, grooming, dressing, oral care
- Incontinence care and toileting assistance
- Transfer and mobility assistance
- Meal preparation and dietary support
- Light housekeeping related to health and safety
- Laundry (participant's personal items)
- Medication reminders
- Transportation to medical appointments
- Supervision for participants with cognitive impairment
- Respite care
CHOICES Group 1 vs. Group 2
Group 1 serves individuals who need a nursing facility level of care but choose to remain at home. This group offers the most comprehensive services, including personal care, home-delivered meals, respite, and more. Group 1 operates as an entitlement with no waiting list for qualifying individuals, if your parent meets the clinical criteria, they are entitled to services.
Group 2 serves individuals at risk of nursing home placement but with lower current care needs. Group 2 provides preventive services and may have enrollment limitations in some years. The AWC family caregiver payment option is most readily available in Group 1.
Eligibility Requirements
Your Parent Must:
- Be age 65 or older (or an adult with a physical disability for the disability track)
- Be enrolled in TennCare (Tennessee Medicaid)
- Meet the clinical criteria for CHOICES Group 1 (nursing facility level of care)
- Reside in a community setting in Tennessee
- Choose the Agency with Choice self-direction option through their TennCare MCO
You (the Caregiver) Must:
- Be 18 years of age or older
- Not be the participant's spouse in most cases
- Pass a Tennessee Bureau of Investigation (TBI) background check
- Pass a Tennessee Adult Protective Services (APS) registry check
- Complete required caregiver orientation provided by the AWC home care agency
- Be legally eligible to work in the United States
Under the Agency with Choice model, you are a W-2 employee of the contracted home care agency, not directly employed by your parent. Your parent directs your tasks and schedule, but the agency handles your paycheck, taxes, and workers' compensation. This simplifies the arrangement for families unfamiliar with managing payroll.
How to Apply: Step-by-Step
- Apply for TennCare Medicaid. Apply online at tn.gov/tenncare or call 1-800-342-3145. Your parent must meet income and asset limits for TennCare (Long Term Care category has separate eligibility rules from standard TennCare).
- Request a CHOICES assessment. Contact your parent's TennCare managed care organization or the Tennessee Department of Health's Long-Term Care division. A care coordinator will schedule a home visit to conduct a functional assessment.
- Receive CHOICES Group 1 enrollment determination. If your parent meets the nursing facility level of care criteria, they will be enrolled in CHOICES Group 1. Your parent's care coordinator will develop an Individual Support Plan (ISP) specifying authorized services and hours.
- Request Agency with Choice self-direction. When reviewing service delivery options with the care coordinator, ask specifically for the Agency with Choice option. Explain that your parent wants to choose their own caregiver (you, an adult child).
- Get approved as the caregiver. The AWC home care agency contracted with your parent's TennCare MCO will process your background check and orientation. Once cleared, the agency will add you to their roster as your parent's designated caregiver.
- Complete caregiver orientation. Attend the orientation provided by the AWC agency. This typically covers personal care skills, infection control, reporting requirements, and emergency procedures.
- Begin care and submit timesheets. Provide care per your parent's Individual Support Plan and submit timesheets through the AWC agency's system. Paychecks are issued bi-weekly with taxes withheld.
The Tennessee Commission on Aging and Disability (TCAD) funds CHOICES navigators through local Area Agencies on Aging who can guide your family through the application process at no cost. Call 1-866-836-6678 or visit tn.gov/aging to find your local navigator.
Other Tennessee Programs That Pay Family Caregivers
Tennessee Caregiver Support Program
Funded through the Older Americans Act, the Tennessee Caregiver Support Program provides supplemental assistance to family caregivers including caregiver training, respite services, and modest stipends or reimbursements in some counties. Contact your local Area Agency on Aging to learn what is available in your county.
VA Programs for Tennessee Veterans
If your parent is a Tennessee veteran, the VA Veteran-Directed Care program (available through the Tennessee Valley Healthcare System in Nashville/Murfreesboro or the Memphis VA) provides a monthly budget to pay family caregivers. The PCAFC program offers monthly stipends for caregivers of eligible post-9/11 veterans.
Personal Care Agreement (Private Pay)
Tennessee families who do not qualify for TennCare can establish a formal written Personal Care Agreement for private-pay caregiving. This contract must be prospective, specify fair market value, and be drafted with an elder law attorney. It is especially important for families considering future TennCare enrollment, as it protects payments from being classified as gifts under the 5-year Medicaid lookback period.
TennCare CHOICES Respite Services
Within CHOICES Group 1, respite care is an authorized service that can be provided by a family member other than the primary caregiver. If you are the primary caregiver, a sibling or other family member may be paid to provide respite so you can take a break, this is a useful option for multi-family caregiving situations.
Check Your Parent's TennCare Eligibility
Use our free Benefits Checker to see if your parent meets Tennessee's CHOICES clinical and financial eligibility requirements before starting the application.
Check Eligibility NowTax Implications for Tennessee Caregivers
Federal Taxes
- W-2 from the AWC agency: Your wages are reported on a W-2 from the home care agency. Federal income tax, Social Security, and Medicare taxes are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent, CHOICES wages may qualify for the federal Difficulty of Care income exclusion. Consult a tax professional before claiming this exclusion.
Tennessee State Taxes
- Tennessee eliminated its state income tax on wages entirely. As of 2022, Tennessee has no individual income tax, which means there is no state-level tax on your CHOICES caregiver wages.
- This effectively gives Tennessee caregivers a slightly higher net wage compared to states with income taxes at similar gross pay rates.
Tennessee is one of a small number of states with no personal income tax on wages. Your CHOICES earnings are subject only to federal income tax (potentially excluded under IRS Notice 2014-7 for live-in caregivers) and FICA taxes, maximizing your take-home pay.
What Tennessee Caregivers Are Earning
At 30 hours per week and $12 per hour, you earn approximately $1,440/month or $17,280 per year. At 40 hours per week and $14 per hour, annual income reaches $29,120. With no Tennessee state income tax and the potential federal Difficulty of Care exclusion for live-in caregivers, net take-home exceeds what these gross figures suggest.
Tennessee nursing home costs average $75,000–$100,000 annually. In-home agency care runs $20–$30 per hour. CHOICES self-direction allows your parent to receive comparable care from a trusted family member at a wage that is meaningful, even if it is lower than higher-wage states.
Contact Information
- TennCare: 1-800-342-3145 | tn.gov/tenncare
- Tennessee Commission on Aging and Disability: 1-866-836-6678 | tn.gov/aging
- Tennessee CHOICES info line: 1-855-259-0701
- Eldercare Locator: 1-800-677-1116 | eldercare.acl.gov
Frequently Asked Questions
Tennessee pays personal care attendants hired through the CHOICES program, including family members, between $10 and $14 per hour. Rates are set by the TennCare managed care contractor and reflect the lower cost of living in most Tennessee communities compared to northeastern states.
CHOICES is Tennessee's Medicaid-funded home and community-based services program for seniors (age 65+) and adults with physical disabilities. It is administered through TennCare, Tennessee's Medicaid program, via managed care organizations. CHOICES covers personal care, homemaker services, and other supports to help people live at home rather than in a nursing facility.
Yes. CHOICES Group 1 (the community-based alternative to nursing home care) includes a self-direction option, Agency with Choice, that allows participants to hire family members as paid personal care attendants. The participant or their representative can choose an adult child or other relative as their caregiver.
CHOICES has two groups. Group 1 serves individuals who need a nursing facility level of care and want to remain at home, this group has the most comprehensive services and includes the self-direction option. Group 2 serves individuals at risk of nursing home placement but who have lower care needs. Group 1 is where the family caregiver payment option is most available.
Apply for TennCare Medicaid first through the Tennessee Department of Human Services. Once enrolled in TennCare, contact your TennCare managed care organization, BlueCross BlueShield of Tennessee, UnitedHealthcare, or Amerigroup Tennessee, and request a CHOICES assessment and enrollment. A care coordinator will conduct a functional needs assessment to determine eligibility and authorized hours.
CHOICES Group 1 (nursing facility level of care) operates as an entitlement with no waiting list for qualifying individuals. CHOICES Group 2 (prevention-focused) may have limited enrollment slots in some years. If your parent requires nursing-level care, they should qualify for Group 1 without waiting.
The self-direction option within CHOICES is called Agency with Choice (AWC). Under AWC, your parent's TennCare managed care plan contracts with a home care agency that serves as the legal employer, but your parent has the right to select and direct their own caregiver, including a family member. The agency handles payroll and compliance.
Yes. Tennessee CHOICES covers personal care and supervision services for individuals with Alzheimer's disease and other dementias who qualify under the CHOICES Group 1 clinical criteria. If your parent cannot direct their own care, an authorized representative can manage the Agency with Choice arrangement on their behalf.