Home Health Care Tennessee: What It Covers, What It Costs, and How to Find Agencies

Your mother was discharged from the hospital after hip replacement surgery. The discharge planner mentioned "home health" and handed you a list of agencies. Three days later you're confused about what's actually covered, what you'll be billed for, and why different agencies seem to be talking about completely different services.

That confusion is common because "home health care" in Tennessee (and everywhere) actually describes two different things: skilled medical care at home and non-medical personal care support. They have different funding sources, different eligibility requirements, and different agencies provide them.

Skilled Home Health Care vs. Personal Care

Skilled home health care is Medicare- or Medicaid-covered medical care delivered in the home. It includes:

• Registered nurse visits (wound care, IV therapy, catheter care, medication management)
• Physical therapy, occupational therapy, speech-language pathology
• Medical social worker services
• Home health aide services (when accompanying skilled care)

Skilled home health requires a physician's order, a homebound status determination, and care from a Medicare-certified agency.

Non-medical home care (personal care or home care) is custodial support: help with bathing, dressing, grooming, mobility, meal preparation, and companionship. It is not covered by Medicare. It's covered by TennCare CHOICES (for qualifying members) or paid out of pocket.

Median costs in Tennessee (2026):

• Non-medical home care: $32/hour ($4,576/month at 44 hrs/week)
• Skilled home health care: $35/hour
• Adult day care (as an alternative): $78/day ($1,733/month at 5 days/week)

Medicare Coverage for Home Health

Medicare Part A covers skilled home health care when all of these apply:

• Your parent is homebound (leaving home requires considerable effort and a doctor's order or assistance)
• A physician certifies that skilled care is medically necessary
• Care is provided by a Medicare-certified home health agency
• The care need is intermittent, not ongoing (daily skilled nursing for an acute condition, not indefinite maintenance)

Medicare covers 100% of approved costs for skilled home health — there is no copay as long as the visit is covered. Coverage typically lasts for the duration of a medically necessary episode (often 60-day certification periods, renewable as long as the patient qualifies).

What Medicare does not cover: 24-hour home care, personal care only (without skilled need), or indefinite custodial support.

Tennessee Home Health Agencies: Medicare-Certified vs. Licensed-Only

Tennessee requires all home health agencies operating in the state to be licensed through the Tennessee Department of Health. But there are two tiers:

Medicare-certified agencies can bill Medicare and Medicaid directly. They must meet federal Conditions of Participation including clinical supervision standards, quality improvement programs, and OASIS assessment requirements. If your parent needs Medicare-covered post-hospital care, only Medicare-certified agencies qualify.

Licensed-only (non-certified) agencies can provide non-medical personal care but cannot bill Medicare. They may still contract with TennCare through CHOICES, or they may serve private-pay clients only.

When you receive a hospital discharge list, verify that the agencies listed are Medicare-certified if your parent needs skilled care post-discharge. CMS's Care Compare website lets you look up any home health agency's Medicare certification status, star ratings, and quality metrics.

TennCare CHOICES for Long-Term Personal Care

Once post-hospital skilled needs resolve, most seniors still need ongoing help with daily activities. That's where TennCare CHOICES becomes relevant for lower-income Tennesseans.

CHOICES is Tennessee's Medicaid waiver for long-term home and community-based services. Eligible members can receive:

• Personal care aide services (non-medical)
• Adult day health services
• Personal emergency response systems (PERS, approximately $30–$60/month value)
• Respite care
• Home-delivered meals
• Some home modification supports

The cost-neutrality cap for CHOICES Group 2 (the main home and community-based waiver group) is $107,627.55 per year — meaning TennCare will fund home care up to the cost of a nursing facility placement.

Financial eligibility: income under $2,982/month, countable assets under $2,000.

Choosing a Tennessee Home Health Agency

Key factors to evaluate:

For Medicare-certified skilled care:

• Check the agency's Care Compare star rating (CMS)
• Verify they serve your parent's county — rural areas have fewer options
• Ask about response time for urgent needs (falls, wound changes)
• Confirm which specific therapies they offer (not all agencies employ all therapy disciplines)

For personal care / private duty:

• Ask whether they're licensed in Tennessee and whether they perform background checks on aides
• Understand the minimum hour requirement per visit (many agencies require 3–4 hour minimums)
• Ask about continuity — will the same aide be assigned regularly?
• Confirm how scheduling works for last-minute cancellations

For CHOICES-contracted agencies:

• Confirm the agency accepts TennCare CHOICES and which MCO plans they're contracted with (BlueCare Tennessee, UnitedHealthcare Community Plan, or Wellpoint Tennessee)
• Ask whether they also offer consumer direction if your family wants to self-manage care

When Home Care Isn't Enough

Home health care and personal care can maintain most seniors in the community for years with proper support. But certain situations make it difficult:

• 24/7 supervision needs (advanced dementia, fall risk that can't be mitigated)
• Complex medical needs requiring nursing oversight more than once daily
• Home environment that cannot safely accommodate care delivery
• Caregiver burnout with no relief option

If you're concerned that home care may not be sustainable long-term, working with a Tennessee AAAD care manager (reachable at 1-866-836-6678) or a hospital social worker can help you map out realistic options before a crisis forces the decision.

Understanding how home health care, TennCare CHOICES, and long-term planning fit together is the challenge every Tennessee family navigating this faces. The Tennessee Home Care & Aging in Place Guide covers the full picture — from the initial CHOICES application through coordinating skilled and non-medical care, financial eligibility rules, and what to do when needs change.

See more Tennessee guides →