Sooner or later, many families in Tennessee sit down at the kitchen table with the same question. Mom or Dad needs more help at home than the family can give, and the cost of paying a caregiver every week feels out of reach. Someone mentions TennCare, and suddenly there is a new set of questions: does it cover home care, who qualifies, and where do you even start?
The good news is that TennCare, Tennessee’s Medicaid program, can pay for in-home care for older adults who qualify. The help comes through a specific program with its own rules, and knowing those rules ahead of time makes the process far less stressful. This guide walks through how it works in plain language, so you can have a clearer conversation with your family and the people who will help you apply.
The Quick Answer for Busy Families
Yes, TennCare can pay for care at home. The program that does this is called CHOICES, and it is TennCare’s long-term services and supports program for older adults and adults with physical disabilities. According to TennCare, CHOICES serves adults age 65 and older, and adults age 21 and older with a physical disability, who need help with daily living.
Having regular TennCare coverage on its own does not automatically mean home care is covered. A person needs to be enrolled in CHOICES, which means meeting a medical need test and a financial test. Once enrolled, services are arranged through the person’s TennCare health plan and delivered by approved providers or, in some cases, by caregivers the family hires directly.
If that sounds like a lot, it helps to take it one piece at a time. The sections below cover each step in the order most families meet them.
How TennCare Approaches Long-Term Care
Most people think of Medicaid as health insurance that pays for doctor visits and hospital stays. TennCare does that, but it also has a separate side for long-term care, the kind of everyday help a person needs when age, illness or disability makes ordinary tasks hard to manage alone.
Long-term care can happen in a nursing home, or it can happen at home and in the community. Tennessee calls the at-home side Home and Community Based Services, often shortened to HCBS. The idea behind CHOICES is simple: when it is safe and the person wants it, help them stay in their own home with support coming to them.
For many older adults, that matters a great deal. Staying near familiar rooms, neighbors, pets and routines can make the later years feel much more like their own life.
The Three CHOICES Groups in Plain Language
Everyone in CHOICES is placed in a group based on their needs. TennCare describes three of them, and knowing which one fits your loved one will help you understand what kind of support to expect.
- Group 1 is for people of any age who receive care in a nursing home.
- Group 2 is for seniors age 65 and older, and adults 21 and older with a physical disability, who qualify for nursing home care but choose to receive care at home instead.
- Group 3 is for seniors and adults with a disability who do not yet need nursing home level care but need help at home to delay or prevent that move.
Most families asking about home care are looking at Group 2 or Group 3. Group 2 tends to fit someone who needs a lot of hands-on help every day. Group 3 fits someone who is still fairly independent but is starting to slip, and who would benefit from support before things become harder. TennCare notes that Group 3 has a limited number of openings for people who do not receive SSI, so it is worth asking about availability early.
What Home Care Through CHOICES Can Include
CHOICES services are built around the tasks that make it possible to live safely at home. TennCare keeps a full benefit table on its website, and every service has to be approved as medically necessary before it starts. In general, the home and community services families ask about most include help with personal care such as bathing, dressing and grooming, help around the house, meals, adult day programs, short breaks for family caregivers and emergency response devices.
The amount and type of help depends on the person’s assessment and care plan. A care coordinator from the health plan works with the person and family to build that plan, and it can change as needs change. If your parent’s situation shifts after a fall or a hospital stay, for example, the plan can be revisited.
Keep in mind that CHOICES home care focuses on daily living support. It sits alongside regular TennCare medical coverage, which still handles things like doctor visits and prescriptions.
Meeting the Medical Need Requirement
The first test is about need. TennCare calls this level of care eligibility, and it means the person needs help with daily living activities. These are the basic tasks most of us do without thinking: getting out of bed, using the bathroom, bathing, dressing, eating, moving around the house and managing everyday routines.
For Groups 1 and 2, the person must need the level of care normally provided in a nursing home. For Group 3, the person must be at risk of needing that level of care unless they get help at home. An assessment looks at what the person can and cannot do safely on their own.
Families sometimes underplay how much help a parent actually needs, often out of respect or habit. During an assessment, it helps to be honest and specific. If your father has needed help getting out of the shower for months, say so. If your mother forgets meals unless someone reminds her, share that too. An accurate picture leads to a care plan that actually fits.
Meeting the Financial Requirement
The second test is about money. TennCare explains that a person is financially eligible if they receive SSI (Supplemental Security Income) or qualify for Medicaid long-term services and supports. For the second path, TennCare’s CHOICES page lists three main conditions.
- Income: For 2026, monthly income cannot be more than $2,982. This figure is tied to the SSI benefit and changes every year. If income is higher, a Qualifying Income Trust may be an option.
- Assets: The total value of what the person owns cannot be more than $2,000. The home they live in does not count toward that limit.
- The five-year look-back: The person cannot have given away or sold anything for less than its value in the last five years.
That look-back rule catches many families by surprise. A parent who signed over a car, gave money to grandchildren or sold property cheaply to a relative within that window may face questions during the application. If anything like that has happened, it is wise to speak with an elder law attorney before applying so you understand how it may be viewed.
A Qualifying Income Trust, sometimes called a Miller Trust, is a legal arrangement that can help someone whose income sits above the limit. It has specific rules, so it is another area where an elder law attorney is helpful.
Where to Start an Application in Tennessee
The starting point depends on whether your loved one already has TennCare.
If they do not have TennCare yet, the place to begin is the local Area Agency on Aging and Disability, often called the AAAD. TennCare lists a statewide number, 1-866-836-6678, that connects callers to their nearest Area Agency. The AAAD can help with the application and explain CHOICES and other long-term care options.
If they already have TennCare, call the member services line for their health plan and ask about CHOICES. Tennessee’s TennCare health plans are BlueCare, UnitedHealthcare Community Plan and Wellpoint (formerly Amerigroup). The health plan will guide the next steps, including the assessment.
TennCare also runs a Long-Term Services and Supports help desk at 1-877-224-0219 for general questions. Before you call any of these numbers, it helps to gather a few things:
- Your loved one’s Social Security and TennCare or Medicare card information
- Recent bank statements and proof of income
- A list of medications, doctors and recent hospital stays
- Notes on the daily tasks they need help with and how often
- Any power of attorney paperwork, if someone is helping manage their affairs
Consumer Direction: When Family Wants to Provide the Care
Many families want to know whether a son, daughter or friend can be paid to provide care. CHOICES has an option for this called Consumer Direction.
In Consumer Direction, the person receiving care becomes the employer of their own caregivers. They can hire, train and schedule the people who help them instead of going through a provider agency. TennCare says family members, friends and neighbors can be hired, though some limits may apply. Payroll and paperwork are handled by a fiscal employer agent, which in Tennessee is Consumer Direct Care Network Tennessee.
This route gives families a lot of control, and it also brings real responsibility. Someone has to manage schedules, find a backup when the regular caregiver is sick and keep track of hours. Some families love that control. Others find that an agency, which handles staffing and backup care, is a better fit for their lives. Many families try one approach and adjust later.
Where Medicare Fits In
A common mix-up is assuming Medicare will cover ongoing home care. Medicare can cover short-term home health care after an illness or injury when a doctor orders skilled services, such as nursing or therapy, for a limited time. It generally does not pay for long-term help with daily tasks like bathing, dressing, meals and companionship when that is the main need.
That gap is exactly why so many families look at TennCare. Some older adults have both Medicare and TennCare, sometimes called being dual eligible. In that case, Medicare usually stays the main medical coverage, and TennCare’s CHOICES program can fill in the long-term help at home.
If your loved one has a Medicare Advantage plan, it is worth checking what extra benefits the plan offers. Some plans include limited in-home support, though the details vary widely from plan to plan.
Other Ways Tennessee Families Pay for Care at Home
Not every family will qualify for CHOICES, and some will find the wait or the paperwork does not match how quickly they need help. There are other paths worth exploring, often in combination.
- Private pay: Many families pay for a few hours of care each week out of savings or with help from several siblings. Starting small can be a practical bridge while an application is in progress.
- Long-term care insurance: If your parent bought a policy years ago, dig it out and read the home care section. Many policies cover in-home help once certain conditions are met.
- Veterans benefits: Veterans and surviving spouses may qualify for VA programs that help with care at home, such as Aid and Attendance. A county veterans service officer can explain the options at no cost.
- Local aging programs: Your Area Agency on Aging and Disability can also point you toward state and community programs outside of Medicaid, such as meal services or caregiver support.
Combining sources is common. A family might use veterans benefits for part of the week and private pay for the rest, or rely on a few paid hours while a CHOICES application moves forward.
Choosing a Home Care Provider Once You Know How You Will Pay
Once you understand the payment side, the next decision is who will come into the home. If your loved one will receive CHOICES services through an agency, the agency needs to work with their TennCare health plan, so ask about that directly on the first call. If you are paying privately or using other benefits, you have more freedom to choose.
Whichever route you take, a few questions help separate a good fit from a poor one. Ask how caregivers are screened and trained, whether caregivers are employees of the agency, how backup coverage works when someone is sick, and how the care plan will be reviewed over time. Families in Davidson County comparing options for home care in Nashville will find that local agencies vary in the services they offer, from companion care and personal care to transportation and help for veterans, so it pays to match the agency’s strengths to your parent’s needs.
It also helps to involve your loved one in the choice wherever possible. An older adult who meets a caregiver, asks their own questions and feels heard is far more likely to welcome help into the house.
A Closer Look at Williamson County Families
Families in the communities south of Nashville often face a particular mix of circumstances. Adult children may live nearby but work long hours, while parents want to stay in homes they have owned for decades. That makes home care a natural fit, and it means the TennCare question comes up often.
The same CHOICES rules apply across the state, so the steps are the same whether your parent lives in the city or the suburbs. When you start calling providers, look for one that clearly explains how families pay for care. Some agencies offering in-home care for seniors in Brentwood describe support for families who plan to pay through TennCare CHOICES, which can make that first conversation easier.
Smaller towns nearby have their own rhythm too. A parent who loves the local farmers market, a church group or a walk around the park will want care that keeps those routines going. Families looking at home care in Nolensville can ask whether caregivers can help with transportation to community events and errands, since staying connected matters as much as help with bathing or meals.
Keeping Things Moving While You Wait
Applications, assessments and enrollment take time, and life does not pause while the paperwork moves. A few habits can keep your loved one safe and your family steady during that stretch.
First, keep a simple notebook or shared document with every call you make: the date, who you spoke with, what they said and what happens next. When you are juggling a health plan, an Area Agency and possibly an attorney, this record saves a lot of repeat conversations.
Second, think about short-term support. A few hours of private care each week, help from a neighbor, an adult day program or a meal delivery service can ease the pressure on family caregivers. Rotating tasks among siblings also helps no one person carry the whole load.
Third, look after the caregiver in your family, which might be you. Caring for a parent while working, raising children or managing your own health is a lot. Taking a break is part of caring well, and it helps you show up with more patience for the person you love.
Questions Families Often Ask About TennCare and Home Care
Does every TennCare member get home care?
Home care is available to members who are enrolled in the CHOICES program. That requires meeting both the medical need test and the financial test, and services must be approved as medically necessary.
Can my parent keep their house and still qualify?
According to TennCare, the home where the person lives does not count toward the $2,000 asset limit. There are other rules around home equity, so it is worth asking the Area Agency on Aging and Disability or an elder law attorney about your parent’s specific situation.
Can I get paid to care for my mother or father?
Possibly. Through Consumer Direction, a CHOICES member can hire family members, friends or neighbors as caregivers, though some limits may apply. The health plan’s care coordinator can explain what is allowed in your case.
Who do I call first?
If your loved one does not have TennCare, call the Area Agency on Aging and Disability at 1-866-836-6678. If they already have TennCare, call the member services line for their health plan and ask about CHOICES.
What if my parent’s income is a little over the limit?
TennCare notes that a Qualifying Income Trust may be an option for people whose income is above the monthly limit. An elder law attorney can help set one up correctly.
One Steady First Step
Figuring out how to pay for care can feel like the hardest part of helping an aging parent, but it becomes much more manageable once you know the path. TennCare’s CHOICES program exists to help older Tennesseans stay at home with support, and the Area Agencies, health plans and local providers are there to help you through it.
If you are at the beginning, start with one phone call and one notebook. Write down what your loved one needs, gather their paperwork and ask your questions. Each step brings your family closer to a plan that lets the person you love stay safe, comfortable and at home.