Consumer Direct Care Network Tennessee: How to Get Paid as a Family Caregiver

Your mother needs help with bathing, dressing, and getting around the house. You've been doing it unpaid for months — burning through your own savings and PTO to be there. What most Tennessee families don't know is that TennCare can pay you for exactly that care, and the program is specifically designed to keep seniors out of nursing homes.

That program runs through Consumer Direct Care Network Tennessee (CDTN). Here's how it works and what it actually pays.

What Is Consumer Direct Care Network Tennessee?

Consumer Direct Care Network Tennessee is the fiscal employer agent (FEA) for TennCare's consumer direction option. "Fiscal employer agent" means CDTN handles the administrative side of employment — payroll, taxes, background checks, timesheets — while the TennCare member (your parent) remains the managing employer who directs the care.

This model exists under TennCare CHOICES, the Medicaid Home and Community Based Services waiver that pays for home care instead of nursing facility placement. When a member opts into consumer direction, they choose their own care workers rather than using a home care agency. CDTN makes that legally and financially possible.

Who Can Be a Paid Caregiver?

TennCare allows certain family members to be paid as personal care attendants:

Eligible family members:

• Adult children (18+)
• Siblings
• Other adult relatives

Not eligible under standard consumer direction:

• Spouses
• Conservators and legal guardians
• Holders of power of attorney

The spouse exclusion has historically been the sticking point for many families. However, the 2025 Freedom for Family Caregiving Act (Public Chapter 182) created a pathway for spouses to be compensated through TennCare-contracted agencies rather than the consumer direction model. If the parent's spouse is the primary caregiver, ask the CHOICES care coordinator specifically about agency-based compensation under that law.

What Does CDTN Pay?

The current pay range for consumer-directed personal care workers in Tennessee is $11 to $15 per hour, depending on the member's approved hours and acuity level. That rate covers hands-on personal care tasks: bathing, dressing, grooming, toileting, transferring, meal preparation, and medication reminders.

Hours are set by the care plan, which is developed during the TennCare CHOICES enrollment process. The number of approved weekly hours depends on the member's functional assessment score.

How the Consumer Direction Model Works

1. Member enrolls in TennCare CHOICES with consumer direction as the service delivery model
2. Member selects their care worker — this is where you, as a family member, come in
3. CDTN processes the hiring — background check, I-9 verification, W-4, direct deposit setup
4. Care worker submits timesheets through CDTN's electronic verification system
5. CDTN issues paychecks directly to the care worker, withholding applicable taxes

The member's care manager (from one of the three TennCare MCOs — BlueCare Tennessee, UnitedHealthcare Community Plan, or Wellpoint Tennessee) oversees the plan and approves hour changes.

CHOICES vs. the OPTIONS Program

Two Tennessee programs pay for home care, and they work differently:

TennCare CHOICES is Medicaid-funded. Eligibility requires meeting nursing facility level of care (a clinical assessment), passing a financial means test (income under $2,982/month, assets under $2,000), and being enrolled in TennCare. Consumer direction is available within CHOICES.

OPTIONS for Community Living is state-funded, not Medicaid. It's open to Tennessee residents 60+ or adults 18–59 with disabilities who need help with at least three daily activities, with no hard income or asset limit. OPTIONS does offer a self-directed care option at approximately $14.95/hour, but spouses are excluded from being compensated under OPTIONS as well.

If your parent doesn't qualify for TennCare CHOICES financially, OPTIONS may be the right path. Contact your regional Area Agency on Aging and Disability (AAAD) at 1-866-836-6678 to find out which program fits.

What the Consumer Direction Option Does Not Cover

CDTN handles personal care (ADL support). It does not cover:

• Skilled nursing visits (RN/LPN wound care, IV therapy, medication management by a nurse)
• Physical, occupational, or speech therapy
• Durable medical equipment
• Transportation

Skilled services go through a home health agency that bills TennCare separately. If your parent needs both personal care and skilled nursing, the care plan can include both — but you as a family member can only be paid for the personal care component.

Getting Started

To start the process, your parent needs to:

1. Apply for TennCare CHOICES through TennCare Connect (online) or by calling their TennCare MCO
2. Complete the Pre-Admission Evaluation (PAE) — a functional assessment submitted through the PERLSS portal by a registered assessor
3. Score high enough on the acuity scale to qualify (minimum 9 points on the 26-point scale for CHOICES Group 2 home services)
4. Request consumer direction as the service model when the care plan is developed

Once enrolled and approved, CDTN will reach out to onboard both the member and the chosen care worker.

The process takes time — TennCare has a 90-day application processing window for long-term services. Starting the application before a crisis point makes the difference between having support in place when you need it and scrambling after a hospitalization.

Navigating TennCare CHOICES, consumer direction, and the caregiver eligibility rules is exactly the kind of process that's hard to figure out from official websites alone. The Tennessee Home Care & Aging in Place Guide walks through the full CHOICES application process, financial eligibility rules, and how to coordinate consumer direction with other benefits — including what happens when circumstances change.

See more Tennessee guides →