How to Pay for In-Home Care
How to Pay for Home Care in Tennessee
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
Tennessee families typically start with TennCare CHOICES, the state's principal Medicaid LTSS program for adults 65+ and adults 21+ with physical disabilities: Group 2 is for people who meet a nursing-facility level of care and choose community services, while Group 3 serves people at risk of nursing-facility care. CHOICES Consumer Direction lets eligible members act as employer and hire workers, including family members, friends, and neighbors, subject to program limits, with Consumer Direct Care Network Tennessee serving as the fiscal employer agent, and current TennCare guidance under Public Chapter 182 separately permits qualified family or household members to be hired by provider agencies for HCBS in CHOICES, ECF CHOICES, Katie Beckett, and existing 1915(c) waivers, plus certain Medicaid nursing and home-health services, when worker qualifications and authorized service-plan limits are met. Intellectual/developmental disability needs route through ECF CHOICES for new LTSS enrollment, and children under 18 who aren't Medicaid-eligible due to parent income or assets should be screened for Katie Beckett Parts A and B. Every plan can be layered with OPTIONS, Title III-B, caregiver respite, TN SHIP, Medicare Savings Programs, Extra Help, SNAP, LIHEAP, weatherization, property-tax relief, and Veteran benefits, and dual-eligible members should also review Tennessee's 2027 D-SNP plan-alignment requirements.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
Medicaid LTSS
TennCare Medicaid LTSS / HCBS
Yes, when authorizedHelps pay for: Medicaid long-term services and supports delivered through CHOICES, ECF CHOICES, Katie Beckett or existing 1915(c) programs.
Who qualifies: Must meet applicable Medicaid, clinical/level-of-care and program criteria.
How to start: Apply for TennCare and request LTSS screening for the applicable population.
Good to know: Family caregiver payment: Depends on program/service
CHOICES
CHOICES Group 2
YesHelps pay for: Home and community-based services for adults who meet nursing-facility level of care but choose to remain at home/in the community.
Who qualifies: Adults 21+ with physical disability or adults 65+; nursing-facility level of care plus Medicaid LTSS financial eligibility.
How to start: If not on TennCare call AAAD; current members contact their MCO.
Good to know: Family caregiver payment: Potentially
CHOICES Group 3
YesHelps pay for: Home/community services intended to delay or prevent nursing-facility placement.
Who qualifies: Adults 21+ with disability or adults 65+ who are at risk of nursing-facility care; SSI/Medicaid LTSS rules and enrollment targets apply.
How to start: Request CHOICES screening through AAAD or MCO.
Good to know: Family caregiver payment: Potentially
Self-Direction
CHOICES Consumer Direction
YesHelps pay for: Lets an authorized member employ, train, schedule and manage workers for eligible consumer-directed services.
Who qualifies: Member or representative becomes employer; service must be authorized for consumer direction. Family, friends, neighbors or acquaintances may be hired subject to limitations.
How to start: Ask MCO care coordinator to discuss Consumer Direction.
Good to know: Family caregiver payment: Yes, subject to limits
CHOICES Service
CHOICES Attendant Care
YesHelps pay for: Hands-on or supportive assistance with daily activities when authorized under the CHOICES benefit package.
Who qualifies: Must be medically necessary and included in authorized CHOICES plan.
How to start: Ask CHOICES care coordinator to assess need and delivery model.
Good to know: Family caregiver payment: Potentially through consumer direction or qualified agency employment
CHOICES Personal Care
YesHelps pay for: Scheduled personal assistance with ADLs and related home-care needs.
Who qualifies: Authorization, service definition and plan limits apply.
How to start: Request assessment through CHOICES care coordinator.
Good to know: Family caregiver payment: Potentially
CHOICES In-Home Respite
YesHelps pay for: Temporary in-home care to relieve an unpaid caregiver.
Who qualifies: Must meet CHOICES service definition and be authorized in plan of care.
How to start: Ask care coordinator for respite assessment.
Good to know: Family caregiver payment: Potentially
CHOICES Companion Care
YesHelps pay for: Extended companion/support service under the CHOICES benefit structure; current benefit materials identify it as consumer-directed.
Who qualifies: Only available when service definition, need and authorization are met.
How to start: Ask care coordinator whether Companion Care fits the assessed need.
Good to know: Family caregiver payment: Potentially
CHOICES Adult Day Care
Indirect / partialHelps pay for: Daytime supervision, activities and supportive services that can reduce paid in-home hours.
Who qualifies: Availability and authorization depend on member need and benefit group.
How to start: Ask care coordinator about adult-day options.
Good to know: Family caregiver payment: No regular family wage
CHOICES Home-Delivered Meals
Indirect cost reductionHelps pay for: Prepared meals delivered to eligible members at home.
Who qualifies: Must meet service criteria and be authorized.
How to start: Ask care coordinator to screen for meal support.
Good to know: Family caregiver payment: No
CHOICES Personal Emergency Response System (PERS)
Indirect cost reductionHelps pay for: Emergency call system that may support safer independent living.
Who qualifies: Authorization based on assessed need.
How to start: Ask care coordinator about PERS.
Good to know: Family caregiver payment: No
CHOICES Assistive Technology / Specialized Equipment
Indirect / can reduce care needHelps pay for: Devices/equipment that support function, safety or independence and may reduce hands-on care burden.
Who qualifies: Must meet benefit definition, medical necessity and authorization rules.
How to start: Request assessment and prior authorization through MCO.
Good to know: Family caregiver payment: No
CHOICES Minor Home Modifications
Indirect cost reductionHelps pay for: Authorized accessibility/safety changes to help a member remain in the home.
Who qualifies: Benefit limits, medical necessity, ownership/landlord and contractor requirements may apply.
How to start: Ask care coordinator for home-modification assessment.
Good to know: Family caregiver payment: No
CHOICES Pest Control
Indirect cost reductionHelps pay for: Targeted pest treatment when covered criteria are met and pests threaten health/safety or community living.
Who qualifies: Only when included in the member benefit package and authorized.
How to start: Ask CHOICES care coordinator.
Good to know: Family caregiver payment: No
CHOICES Community Transportation
Indirect cost reductionHelps pay for: Transportation support for qualifying community activities/services under current CHOICES benefit rules.
Who qualifies: Benefit limits and authorized purposes apply.
How to start: Ask care coordinator about available transportation benefit.
Good to know: Family caregiver payment: No regular caregiver wage
CHOICES Enabling Technology
Indirect / can reduce care needHelps pay for: Technology solutions designed to increase independence and reduce reliance on paid supports when clinically appropriate.
Who qualifies: Assessment, technology plan and program authorization apply.
How to start: Ask care coordinator for enabling-technology screening.
Good to know: Family caregiver payment: No
Care Coordination
CHOICES Care Coordination
Indirect - unlocks benefitsHelps pay for: MCO care coordinator assesses needs, builds person-centered plan, authorizes covered LTSS and coordinates providers.
Who qualifies: Available to enrolled CHOICES members.
How to start: Contact assigned health plan and request care coordinator review.
Good to know: Family caregiver payment: No
Paid Family Caregiver
Consumer-Directed Family Worker
YesHelps pay for: Authorized CHOICES consumer-directed services may be delivered by a hired family member, friend, neighbor or acquaintance, subject to program limitations.
Who qualifies: Worker must meet program requirements; member/representative is employer; authorized hours/services control payment.
How to start: Ask MCO to enroll in Consumer Direction, then complete CDTN worker/employer setup.
Good to know: Family caregiver payment: Yes
Provider-Agency Family Caregiver
YesHelps pay for: Qualified family or household members may be employed by a Medicaid-participating provider agency for eligible HCBS and certain Medicaid home nursing/aide services.
Who qualifies: Current TennCare guidance covers CHOICES, ECF CHOICES, Katie Beckett and existing 1915(c) HCBS, plus PDN, Home Health Nursing and Home Health Aide. Court-appointed guardians/conservators need explicit permission in the order. Payment cannot exceed authorized plan benefits.
How to start: Ask the member's MCO and participating provider agencies about qualified family-worker hiring.
Good to know: Family caregiver payment: Yes, when employed and qualified
Self-Direction Administration
Consumer Direct Care Network Tennessee (CDTN)
Enables paid careHelps pay for: Fiscal employer agent/payroll and employer-support administration for TennCare consumer-directed HCBS.
Who qualifies: Participant remains employer and must follow program/employment requirements.
How to start: Enroll after MCO authorizes consumer direction.
Good to know: Family caregiver payment: Processes authorized worker payroll
Medicaid State Plan
TennCare Home Health
Yes, skilled/covered careHelps pay for: Medically necessary home health nursing, therapy and home health aide services when covered and authorized.
Who qualifies: Medicaid coverage and medical necessity/provider requirements apply. TennCare family-caregiver guidance includes Home Health Nursing and Home Health Aide for qualified agency employees.
How to start: Ask treating clinician and TennCare plan about home-health authorization.
Good to know: Family caregiver payment: Potentially through qualified provider-agency employment
Private Duty Nursing
Yes, skilled nursingHelps pay for: Extended skilled nursing for eligible members with substantial medical needs when medically necessary and authorized.
Who qualifies: Nurse must meet licensure/qualification requirements; authorization and medical necessity apply.
How to start: Ask treating clinician/MCO for PDN assessment and provider options.
Good to know: Family caregiver payment: Potentially for qualified family nurse employed by provider agency
Children / Medicaid
EPSDT Medically Necessary Services
PotentiallyHelps pay for: For Medicaid members under 21, EPSDT can require coverage of medically necessary Medicaid-coverable services to correct or ameliorate conditions.
Who qualifies: Under age 21 and TennCare enrolled; medical necessity and service rules apply.
How to start: Ask child's provider and MCO; appeal if a medically necessary covered service is denied.
Good to know: Family caregiver payment: Depends on service/provider model
Hospice
TennCare / Medicare Hospice Coordination
Yes, clinical hospice careHelps pay for: Hospice can cover end-of-life clinical care while other authorized supports may continue when not duplicative or inconsistent with hospice coverage.
Who qualifies: Hospice eligibility and payer coordination rules apply.
How to start: Ask hospice, Medicare/TennCare plan and LTSS coordinator to coordinate benefits.
Good to know: Family caregiver payment: No regular family wage
Integrated Care
PACE - Alexian PACE
YesHelps pay for: Comprehensive medical/social services including adult day, transportation and in-home personal care for qualifying frail adults.
Who qualifies: Current TennCare page: age 55+, nursing-facility level of care, live in Hamilton County, and able to live safely in community.
How to start: Call Alexian PACE intake.
Good to know: Family caregiver payment: Generally no direct family wage
Dual Eligible
Tennessee D-SNP / FIDE SNP Coordination
Indirect / sometimes supplementalHelps pay for: Coordinates Medicare and Medicaid benefits; plan supplemental benefits may reduce food, utility, equipment or care-related costs.
Who qualifies: Must meet D-SNP eligibility. Beginning Jan. 1, 2027, full-benefit duals who want a D-SNP must align Medicare D-SNP and TennCare plan with the same company.
How to start: Review plan alignment now; TN SHIP can provide unbiased Medicare counseling.
Good to know: Family caregiver payment: No regular family wage
I/DD Medicaid
Employment and Community First CHOICES (ECF CHOICES)
YesHelps pay for: Medicaid HCBS for people of all ages with I/DD, supporting family/community living, employment and independence.
Who qualifies: I/DD onset criteria, Medicaid financial/clinical criteria and benefit-group rules apply. Funding is limited; referral list/priority may apply.
How to start: Complete ECF self-referral; MCO or DDA regional intake can assist.
Good to know: Family caregiver payment: Yes in eligible services/pathways
ECF CHOICES
ECF Supportive Home Care
YesHelps pay for: In-home supports for eligible ECF members living with family, based on assessed needs and benefit-group rules.
Who qualifies: Available only in applicable ECF benefit group(s), medically necessary and authorized.
How to start: Ask ECF support coordinator.
Good to know: Family caregiver payment: Potentially via qualified family employment
ECF Family Caregiver Stipend
Yes - stipendHelps pay for: Monthly stipend in lieu of Supportive Home Care for qualifying Group 4 members living with family.
Who qualifies: Only ECF Group 4; other appropriate ECF supports/goals addressed first. Current guidance caps authorized stipend at $500/month for members under 18 and $1,000/month for adults 18+.
How to start: Ask ECF health plan/support coordinator whether stipend criteria are met.
Good to know: Family caregiver payment: Yes - direct stipend
ECF Personal Assistance
YesHelps pay for: Hands-on or cueing assistance to support independent/community living for eligible ECF members.
Who qualifies: Applicable ECF group, service definition, medical necessity and authorization apply.
How to start: Request through ECF support plan.
Good to know: Family caregiver payment: Potentially through qualified family employment
ECF Respite
YesHelps pay for: Temporary relief for unpaid family caregivers when authorized.
Who qualifies: Available to applicable ECF groups and subject to current benefit limits.
How to start: Ask ECF support coordinator.
Good to know: Family caregiver payment: Potentially
ECF Community Living Supports - Family Model
Yes - residential/community supportsHelps pay for: Residential/community support model in a family setting for qualifying members needing ongoing support.
Who qualifies: Benefit-group, setting, provider and person-centered plan requirements apply.
How to start: Ask ECF support coordinator about fit and available providers.
Good to know: Family caregiver payment: Potentially under qualified-worker/provider rules
ECF Assistive Technology / Adaptive Equipment / Supplies
Indirect / can reduce care needHelps pay for: Equipment and technology that support independence and reduce support burden.
Who qualifies: Applicable benefit-group limits and authorization apply.
How to start: Request through ECF support plan.
Good to know: Family caregiver payment: No
ECF Minor Home Modifications
Indirect cost reductionHelps pay for: Home accessibility or safety changes to support community living.
Who qualifies: Benefit limits, project approval and person-centered need apply.
How to start: Request through ECF support plan before purchase/work begins.
Good to know: Family caregiver payment: No
ECF Community Transportation
Indirect cost reductionHelps pay for: Transportation supporting community participation and person-centered goals.
Who qualifies: Applicable benefit-group and authorization rules apply.
How to start: Ask ECF support coordinator.
Good to know: Family caregiver payment: No regular family wage
ECF Consumer Direction / Self-Directed Services
YesHelps pay for: Eligible ECF services can use self-direction with fiscal administration and member control where offered.
Who qualifies: Only designated services; participant/representative and worker requirements apply.
How to start: Ask ECF coordinator which authorized services may be self-directed.
Good to know: Family caregiver payment: Potentially
Children with Disabilities
Katie Beckett Part A
YesHelps pay for: Full Medicaid for qualifying children with significant disabilities/complex medical needs who meet institutional level of care but are not otherwise Medicaid eligible because of parent income/assets.
Who qualifies: Child under 18; Part A clinical and program criteria; limited enrollment/funding.
How to start: Start self-referral through TennCare Connect; DDA can assist.
Good to know: Family caregiver payment: Potentially
Katie Beckett Part B
Yes / cost offsetHelps pay for: Up to $10,000/year in flexible services for qualifying children at risk of institutional care who are not enrolled in Medicaid.
Who qualifies: Child under 18 with disability/complex medical need; Part B criteria and limited enrollment/funding apply.
How to start: Apply through TennCare Connect self-referral.
Good to know: Family caregiver payment: Potentially through self-directed services
Katie Beckett
Katie Beckett Part A HCBS Budget
YesHelps pay for: Up to $15,000/year in HCBS such as respite, supportive home care and home/vehicle modifications, in addition to full Medicaid, for enrolled Part A children.
Who qualifies: Part A enrollment and authorized service plan required.
How to start: Work with Katie Beckett case manager on approved HCBS plan.
Good to know: Family caregiver payment: Potentially
Part B Self-Directed Respite / Supportive Home Care
YesHelps pay for: Part B budget may include self-directed respite and supportive home care, alongside other flexible supports.
Who qualifies: Must fit approved Part B budget and program self-direction rules.
How to start: Discuss service mix with Katie Beckett case manager.
Good to know: Family caregiver payment: Potentially
Katie Beckett Part C / Continued Medicaid Pathway
Yes - Medicaid continuationHelps pay for: Continuation pathway for certain children losing Medicaid due to parent income/resources who meet Part A-level criteria when Part A capacity is unavailable.
Who qualifies: Specific Part C transition/eligibility rules apply; verify current availability and process.
How to start: Ask TennCare/DDA during Medicaid loss or Katie Beckett assessment.
Good to know: Family caregiver payment: Depends on covered service
Legacy I/DD Waiver
Statewide 1915(c) Waiver - Existing Members
YesHelps pay for: HCBS for people with I/DD already enrolled in the legacy waiver.
Who qualifies: Closed to new enrollment; new I/DD enrollment is through ECF CHOICES. Existing member service rules still apply.
How to start: Existing members work with DDA/MCO/case manager.
Good to know: Family caregiver payment: Yes via eligible agency employment; some self-directed services may exist
Comprehensive Aggregate Cap (CAC) Waiver - Existing Members
YesHelps pay for: HCBS for existing members with I/DD under the legacy CAC waiver.
Who qualifies: Closed to new enrollment; current participants remain subject to waiver/service rules.
How to start: Existing members contact case manager/DDA.
Good to know: Family caregiver payment: Yes via eligible agency employment
Self-Determination Waiver - Existing Members
YesHelps pay for: Legacy I/DD waiver emphasizing participant direction for existing enrollees.
Who qualifies: Closed to new enrollment; current members use existing waiver/self-direction rules.
How to start: Existing members contact case manager/CDTN DDA.
Good to know: Family caregiver payment: Potentially
I/DD Transition
Money Follows the Person (MFP)
Yes - transition to HCBSHelps pay for: Helps eligible people transition from qualified institutions into community-based HCBS and qualified residences.
Who qualifies: Current Tennessee MFP demonstration primarily supports institutional transitions into CHOICES, ECF CHOICES and Statewide waiver settings; eligibility/transition criteria apply.
How to start: Ask institutional transition team, DDA or TennCare MCO about MFP screening.
Good to know: Family caregiver payment: Depends on destination program/service
I/DD Alternative
Medicaid Alternative Pathways (MAPs)
Indirect / support servicesHelps pay for: State-funded, time-limited supports focused on independent living, employment, community skills and technology for eligible people with I/DD.
Who qualifies: I/DD diagnosis and program criteria; generally cannot be enrolled in another LTSS program such as ECF CHOICES, CHOICES, Katie Beckett or 1915(c).
How to start: Apply through DDA MAPs process.
Good to know: Family caregiver payment: No regular family wage
State Disability Support
Family Support Program
Yes / cost offsetHelps pay for: State-funded flexible assistance that can include respite, personal assistance, homemaker, equipment, supplies, transportation, home modifications and other family needs.
Who qualifies: For people with severe disabilities/families; selection depends on local resources. People receiving specified HCBS waiver programs are not eligible for Family Support funds.
How to start: Contact DDA or county Family Support agency.
Good to know: Family caregiver payment: Can support family care needs but not a standard wage program
Aging / Non-Medicaid
OPTIONS for Community Living
YesHelps pay for: State-funded home/community services for Tennessee adults with physical/cognitive disabilities, including older adults.
Who qualifies: TN resident, age 18+, ADL/IADL limitations; no income eligibility requirement, but sliding fee scale based on income. Services depend on availability/need.
How to start: Call local AAAD.
Good to know: Family caregiver payment: Generally no direct family wage
OPTIONS Service
OPTIONS Personal Care
YesHelps pay for: Personal-care assistance for eligible OPTIONS clients when available.
Who qualifies: OPTIONS eligibility plus regional availability and assessed need.
How to start: Request OPTIONS assessment through AAAD.
Good to know: Family caregiver payment: No standard family wage
OPTIONS Homemaker
Yes / partialHelps pay for: Household assistance that can reduce the amount of privately purchased home care.
Who qualifies: OPTIONS eligibility, assessed need and regional availability.
How to start: Ask AAAD about homemaker services.
Good to know: Family caregiver payment: No standard family wage
OPTIONS Home-Delivered Meals
Indirect cost reductionHelps pay for: Meal delivery for eligible clients, reducing household and caregiving burden.
Who qualifies: OPTIONS eligibility and service availability apply.
How to start: Ask AAAD about meals.
Good to know: Family caregiver payment: No
Older Americans Act
Title III-B In-Home Services
Yes / partialHelps pay for: Federally funded in-home services such as homemaker, personal care and meals for older adults, subject to local availability.
Who qualifies: Age 60+ plus ADL/IADL limitation requirements; services based on availability/need.
How to start: Contact AAAD.
Good to know: Family caregiver payment: Generally no direct family wage
Caregiver Support
National Family Caregiver Support Program (NFCSP)
Indirect / respiteHelps pay for: Information, counseling, training, respite and supplemental supports for qualifying caregivers.
Who qualifies: Caregiver/care-recipient eligibility under Older Americans Act categories; services vary by AAAD region and funding.
How to start: Call AAAD and request caregiver-support screening.
Good to know: Family caregiver payment: No regular wage
Caregiver Respite
Tennessee Lifespan Respite / Caregiver Respite Vouchers
Yes - respite offsetHelps pay for: Respite help or voucher-based relief through state/community caregiver partnerships when funding and local criteria allow.
Who qualifies: Eligibility, voucher amount and availability vary; funding may be limited.
How to start: Ask AAAD / Tennessee caregiver resources about current respite voucher availability.
Good to know: Family caregiver payment: No regular wage
Dementia Caregiver Support
Alzheimer's and Dementia Respite Pilot
Yes - respite offsetHelps pay for: State pilot supporting respite for qualifying dementia caregivers; current law extends the pilot through Dec. 31, 2026.
Who qualifies: Program criteria, funding and local implementation apply; verify status after Dec. 31, 2026.
How to start: Ask AAAD/caregiver-support program about current pilot availability.
Good to know: Family caregiver payment: No regular wage
Medicare Counseling
Tennessee SHIP
Indirect cost reductionHelps pay for: Free, unbiased Medicare counseling that can identify MSP, Extra Help, D-SNP and coverage opportunities that free household funds for care.
Who qualifies: Medicare beneficiary/caregiver seeking counseling.
How to start: Call TN SHIP.
Good to know: Family caregiver payment: No
Medicare Cost Offset
Medicare Savings Programs (QMB / SLMB / QI)
Indirect cost reductionHelps pay for: Can pay Medicare premiums and, for QMB, certain Medicare cost-sharing, freeing income for home-care expenses.
Who qualifies: Income/resource and Medicare status rules apply; categories have different limits.
How to start: Apply through TennCare Connect; TN SHIP can help screen.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - limited skilled/home-health careHelps pay for: Intermittent skilled nursing, therapy and home health aide services for eligible homebound beneficiaries under Medicare rules.
Who qualifies: Requires Medicare eligibility, homebound status and qualifying skilled-care need; not a substitute for continuous custodial care.
How to start: Ask clinician for Medicare-certified home-health referral.
Good to know: Family caregiver payment: No regular family wage
Medicare Hospice
Yes - hospice careHelps pay for: Interdisciplinary end-of-life care, medications/equipment related to terminal illness, and limited respite when eligibility is met.
Who qualifies: Medicare hospice eligibility/election rules apply.
How to start: Ask clinician or Medicare-certified hospice for evaluation.
Good to know: Family caregiver payment: No regular family wage
Prescription Cost Offset
Medicare Part D Extra Help
Indirect cost reductionHelps pay for: Reduces Part D premiums, deductibles and prescription copays, preserving income for caregiving/home expenses.
Who qualifies: Medicare and Extra Help eligibility rules apply; some people qualify automatically.
How to start: Apply through SSA or ask TN SHIP.
Good to know: Family caregiver payment: No
Food Cost Offset
SNAP
Indirect cost reductionHelps pay for: Monthly food assistance can reduce household grocery expenses and preserve funds for care.
Who qualifies: Household income/resource and program rules apply.
How to start: Apply through One DHS or local DHS office.
Good to know: Family caregiver payment: No
Utility Cost Offset
Low Income Home Energy Assistance Program (LIHEAP)
Indirect cost reductionHelps pay for: Helps eligible low-income households with home energy costs, preserving funds for care.
Who qualifies: Income, household and local agency funding rules apply; assistance is limited.
How to start: Apply through local LIHEAP agency/community action agency.
Good to know: Family caregiver payment: No
Home Cost Offset
Weatherization Assistance Program
Indirect cost reductionHelps pay for: Energy-efficiency improvements can lower utility burden and improve home comfort/safety.
Who qualifies: Income and property/program rules apply; priority/wait lists may apply.
How to start: Apply through local weatherization provider.
Good to know: Family caregiver payment: No
Property Tax
Tennessee Property Tax Relief
Indirect cost reductionHelps pay for: State-funded property-tax relief for qualifying low-income elderly/disabled homeowners and certain disabled veterans/surviving spouses.
Who qualifies: Age/disability/veteran, ownership/residency and income rules vary by relief category.
How to start: Apply through county trustee or city collecting official.
Good to know: Family caregiver payment: No
Private Funding
Long-Term Care Insurance / Personal Savings / Private Home Care
YesHelps pay for: Private insurance benefits, savings, retirement income or family funds can purchase care without Medicaid service limits.
Who qualifies: Policy definitions, elimination periods, benefit limits and private contracts control.
How to start: Review LTC policy and compare providers or lawful private-employment arrangements.
Good to know: Family caregiver payment: Yes, if policy/private arrangement allows and employment/tax rules are followed
VA Benefits
VA Homemaker / Home Health Aide (H/HHA)
Direct in-home helpHelps pay for: VA-authorized personal care and homemaker assistance through community agencies.
Who qualifies: VA enrollment, clinical need, eligibility and local authorization apply. Ask VA primary care/social work for H/HHA assessment.
How to start: Ask the VA social worker or care team about VA Homemaker / Home Health Aide (H/HHA).
Good to know: Family caregiver payment: No direct family wage
Veteran-Directed Care (VDC)
Direct/self-directed home careHelps pay for: Participant-directed budget for personal care/supports where locally available.
Who qualifies: VA eligibility, clinical need and local VDC availability required. Ask VA Geriatrics/Extended Care or social work whether VDC is available locally.
How to start: Ask the VA social worker or care team about Veteran-Directed Care (VDC).
Good to know: Family caregiver payment: Potentially, under VDC worker rules
VA Skilled Home Health
Direct skilled home careHelps pay for: Intermittent skilled nursing, therapy and related home health authorized by VA.
Who qualifies: Clinical need and VA authorization/provider participation apply. Ask VA clinician for skilled-home-health referral.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No direct family wage
VA Respite Care
Temporary relief for caregiverHelps pay for: In-home, adult-day or facility respite depending on eligibility and local availability.
Who qualifies: VA-enrolled Veteran with clinical need; benefit limits and availability apply. Ask VA social work/caregiver support for respite assessment.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No regular caregiver wage
VA Adult Day Health Care
Can reduce paid home-care hoursHelps pay for: Daytime health, rehabilitation and social services that can reduce home-care burden.
Who qualifies: Clinical eligibility, local availability and VA authorization apply. Ask VA Geriatrics/social work for Adult Day Health referral.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No direct family wage
VA Home Based Primary Care (HBPC)
Reduces outside medical visitsHelps pay for: Interdisciplinary primary care at home for Veterans with complex chronic conditions who have difficulty traveling.
Who qualifies: VA-enrolled Veteran with qualifying clinical need and local program availability. Ask VA primary care or social work for HBPC screening.
How to start: Ask the VA social worker or care team about VA Home Based Primary Care (HBPC).
Good to know: Family caregiver payment: No direct family wage
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Direct caregiver supportHelps pay for: Education, support and, when eligibility criteria are met, a monthly stipend and other benefits for an approved primary family caregiver.
Who qualifies: Veteran and caregiver must meet current PCAFC clinical/service requirements; stipend is not hourly home-care wages. Apply through VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes - stipend for approved caregiver
Program of General Caregiver Support Services (PGCSS)
Indirect caregiver supportHelps pay for: Training, coaching, peer support, referrals and caregiver resources.
Who qualifies: Generally for caregivers of Veterans enrolled in VA health care; program-specific rules apply. Contact VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of General Caregiver Support Services (PGCSS).
Good to know: Family caregiver payment: No stipend under PGCSS
VA Pension Aid & Attendance / Housebound
Cash may offset private home careHelps pay for: Additional pension amount for qualifying Veterans/survivors who need ADL help, are housebound or meet specified criteria.
Who qualifies: Must qualify for VA pension/survivors pension and meet A&A or Housebound criteria. File with VA or an accredited VSO/claims representative.
How to start: Ask the VA social worker or care team about VA Pension Aid & Attendance / Housebound.
Good to know: Family caregiver payment: Can be used for care expenses; not an hourly VA wage
VA Community Care Network - Tennessee Region 3
May include authorized home health/community servicesHelps pay for: VA-authorized community providers can deliver approved care when Community Care eligibility/referral applies.
Who qualifies: Tennessee is in CCN Region 3, administered by Optum. Non-emergency community care generally requires VA referral/authorization. Work through VA care team/community care office before scheduling non-emergency care.
How to start: Ask the VA social worker or care team about VA Community Care Network - Tennessee Region 3.
Good to know: Family caregiver payment: Depends on underlying benefit
VA Caregiver Support Program - Tennessee
Direct navigationHelps pay for: Navigation to respite, caregiver programs, in-home services and community resources.
Who qualifies: Each VA benefit has its own eligibility; caregiver support staff can triage options. Call the national Caregiver Support Line and request local coordinator.
How to start: Ask the VA social worker or care team about VA Caregiver Support Program - Tennessee.
Good to know: Family caregiver payment: Connects to PCAFC and other programs
Tennessee Department of Veterans Services (TDVS)
Indirect - helps unlock benefitsHelps pay for: Accredited benefits/claims assistance and navigation to federal and state Veteran resources.
Who qualifies: Benefit-specific Veteran/dependent eligibility applies. Contact TDVS or a county Veterans Service Office.
How to start: Ask the VA social worker or care team about Tennessee Department of Veterans Services (TDVS).
Good to know: Family caregiver payment: No direct caregiver wage
Where Tennessee Families Can Start
Not sure where to begin? Match your situation to a contact below.
Apply for TennCare, Medicare Savings Programs, renew coverage and start Katie Beckett self-referral.
TennCare Connect
Best first call for CHOICES applicants not already on TennCare, OPTIONS, Title III-B and caregiver supports.
Area Agencies on Aging and Disability (AAAD)
CHOICES, ECF CHOICES and broader long-term-services questions.
TennCare LTSS Help Desk
Current members: CHOICES/ECF applications, care coordination, authorization and consumer direction.
TennCare CHOICES / ECF Health Plans
Consumer-directed payroll/employer support after MCO authorization.
Consumer Direct Care Network Tennessee
Help with ECF CHOICES and Katie Beckett self-referral for people not already on Medicaid.
DDA Regional Intake - West
Help with ECF CHOICES and Katie Beckett self-referral for people not already on Medicaid.
DDA Regional Intake - Middle
Help with ECF CHOICES and Katie Beckett self-referral for people not already on Medicaid.
DDA Regional Intake - East
PACE intake for current Tennessee service area (Hamilton County per TennCare page).
Alexian PACE
Free Medicare, Medicare Savings Program, Extra Help and D-SNP counseling.
Tennessee SHIP
VA caregiver programs, respite, PCAFC/PGCSS and home-care navigation.
VA Caregiver Support
Veteran benefits and accredited claims/navigation help.
Tennessee Department of Veterans Services
Before You Rely on Any Payment Source
Planning Note
Why It Matters
Start with the correct LTSS track
Older adults 65+ and adults 21+ with physical disabilities usually start with CHOICES. People with I/DD should screen ECF CHOICES; children under 18 not Medicaid-eligible because of parent income/assets should also screen Katie Beckett.
CHOICES Group 2 vs. Group 3 matters
Group 2 requires nursing-facility level of care; Group 3 is for people at risk of needing nursing-facility care. Service packages and enrollment rules differ, so do not assume the same benefits.
2026 CHOICES financial rules are time-sensitive
TennCare currently lists a 2026 Medicaid LTSS income ceiling of $2,982/month and $2,000 countable-resource limit for CHOICES Groups 1/2, with possible Qualifying Income Trust use. Recheck annually and before applying.
Consumer Direction and agency family employment are separate pathways
In Consumer Direction, the member or representative is the employer and CDTN handles fiscal functions. Under current agency-family-caregiver guidance, a qualified family/household member may instead be hired by a participating provider agency for eligible services.
Family relationship alone cannot drive an agency denial
Public Chapter 182 and TennCare guidance prohibit extra exclusion solely because of family/household relationship, parent/spouse status, age, residence or waiver program when the worker is otherwise qualified. Court-appointed guardians/conservators require explicit permission in the order, and payment cannot exceed authorized plan benefits.
ECF CHOICES capacity can delay enrollment
All new I/DD waiver enrollment is through ECF CHOICES, but funding is limited. Qualified applicants may be placed on a referral list and prioritized for openings.
The ECF Family Caregiver Stipend is narrow
The stipend is only for ECF CHOICES Group 4 and is in lieu of Supportive Home Care. Current guidance caps it at $500/month for members under 18 and $1,000/month for adults 18+, when authorized.
Katie Beckett has distinct Parts A, B and C
Part A provides full Medicaid plus up to $15,000/year in HCBS; Part B is not Medicaid and provides up to $10,000/year in flexible services; Part C can preserve Medicaid for certain children when Part A capacity is unavailable. Verify current enrollment capacity.
Legacy DDA 1915(c) waivers are not new-entry options
Statewide, CAC and Self-Determination remain relevant for existing members, but new I/DD enrollment is through ECF CHOICES. Do not send a new applicant to a legacy waiver as the primary entry point.
PACE is currently shown as Hamilton County
TennCare currently lists Hamilton County residence as a PACE eligibility requirement. Tennessee has authorized expansion activity, so verify the live service area before ruling PACE in or out.
Dual-eligible plan alignment changes January 1, 2027
Full-benefit duals who want a D-SNP must have Medicare D-SNP and TennCare Medicaid with the same company by Jan. 1, 2027. Tennessee's special TennCare plan-change window runs June 1-Oct. 31, 2026; TN SHIP can help compare options.
Some state-funded supports are limited or time-sensitive
OPTIONS, Family Support and respite programs depend on appropriations and local availability. The current Alzheimer/dementia respite pilot is extended only through Dec. 31, 2026 unless changed again; verify before planning around it.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in Tennessee to help you navigate the application process.
← Back to How to Pay for In-Home CareHome Care Providers in Tennessee
These providers serve families in Tennessee and can help you apply what you've learned above to your specific situation.
A Better Solution In Home Care – Chattanooga, TN
Serving Tennessee
A Better Solution In Home Care – Chattanooga, TN provides home care services in the Chattanooga area.
Communities Served
Chattanooga
View Provider Profile →
A Better Solution In Home Care – Knoxville, TN
Serving Tennessee
A Better Solution In Home Care – Knoxville, TN provides home care services in the Knoxville area.
Communities Served
Knoxville
View Provider Profile →
Senior Solutions – Brentwood, TN
Serving Tennessee
Senior Solutions provides home care services in Brentwood, TN and the surrounding communities it serves.
Services Available
24-Hour Home Care • Companion Care • Personal Care • Dementia & Alzheimer's Care • Respite Care
Communities Served
Brentwood, Gallatin, Goodlettsville and surrounding areas
View Provider Profile →