Updated September 4, 2026. Quick answer: yes, through TennCare CHOICES, ECF CHOICES and Katie Beckett Consumer Direction. Most adult family members can be hired and paid to provide the care. A spouse cannot be the paid caregiver; the federal rule against paying a “legally responsible relative” still applies here.
How Tennessee pays a family caregiver
| Program | TennCare CHOICES, ECF CHOICES and Katie Beckett Consumer Direction |
|---|---|
| Can a family member be paid? | Yes. “You may already know who you want to hire to give your care. It could be a friend or family member.” |
| Can a spouse be paid? | No. “BUT, you can’t hire your spouse, your Representative for Consumer Direction, a legal guardian, or Power of Attorney to provide care.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
Not published by the state in the materials reviewed this session.
How it works
A member enrolled in CHOICES, ECF CHOICES, or Katie Beckett who elects Consumer Direction becomes the employer of record; Consumer Direct Care Network Tennessee (CDTN), the statewide Fiscal Employer Agent, trains the member on employer duties and runs payroll, tax withholding, and background checks. The member can hire friends and most family members as workers, but not a spouse, legal guardian, Power of Attorney, or the person’s own Representative for Consumer Direction, and cannot pay someone who already lives with them for Personal Care Visits, Attendant Care, or In-Home Respite.
What this doesn’t answer
No official published hourly wage rate was found; the CDTN handbook’s only dollar figure is a sample want-ad illustration and is not a real rate, so it was excluded. A 2025 state law (Public Chapter 182) reportedly opened a separate, agency-employed pathway letting TennCare-contracted home care agencies hire spouses as W-2 workers outside Consumer Direction, but that claim came only from secondary sources this session and could not be independently confirmed on a tn.gov page, so it is not reflected in the Yes/No verdict above, which covers Consumer Direction only.
Sources
- Consumer Direct Care Network Tennessee (TennCare’s contracted Fiscal Employer Agent): CHOICES Member Binder, Section 6: Consumer Direction Handbook, March 2025
- TennCare: CHOICES program page
Read September 4, 2026.
Same question, other states: Texas · Utah.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.