Provider Agency Information for Hiring Family Caregivers

Pursuant to Public Chapter 182 of 2025, the following guidance is being provided to provider agencies regarding the employment of qualified family members as family caregivers for eligible members.

IN GENERAL

Provider agencies are permitted to hire family members or other household members in caregiver roles to perform home and community-based (HCBS) services, as well as certain limited Medicaid services, provided that the individual meets the qualifications and criteria for employment (i.e. licensure/certification, background check qualifications, training requirements, etc.) that would apply to any individual in a paid caregiving role.

Which Programs and Services Are Eligible?

Family members or other household members may be hired to perform the following TennCare services:

All HCBS services provided by a provider agency in all LTSS waiver programs:

  • CHOICES
  • ECF CHOICES
  • Katie Beckett
  • 1915(c) waivers: Self-determination, Statewide, and Comprehensive Aggregate Cap waivers

The following Medicaid services provided the individual is qualified to perform the service:

  • Private Duty Nursing
  • Home Health Nursing
  • Home Health Aide

Are TennCare Rules Changing?

Historically, TennCare rules have allowed provider agencies to employ family members to perform HCBS services in our waiver programs with certain limited exceptions. Last year, pursuant to Public Chapter 621 of 2024, TennCare initiated rulemaking to remove restrictions on reimbursement to immediate family members for Community Living Supports and Community Living Supports Family Model services. With this change, all HCBS services in our waiver programs will now be eligible for family member employment by provider agencies. These rules are pending.

In addition, as part of that rulemaking, TennCare is also proposing to remove restrictions on the employment of family members for the following Medicaid services: Private Duty Nursing, Home Health Nursing, and Home Health Aide services. This change will provide further opportunity for provider agencies to hire family members who are qualified to perform those services. Note these services are specific to the Medicaid program and not considered HCBS waiver services.

What About Conservators and Legal Guardians?

Conservators and other court appointed legal guardians cannot be employed by a provider agency as a family caregiver unless such employment is explicitly permitted in the order of guardianship or conservatorship. Parents of minor children through birth or adoption are eligible to be a family caregiver without court approval.

Are there Specific Positions Eligible for Hiring Family Caregivers?

Family members may be employed to perform any HCBS service as long as the individual meets the qualifications and criteria applicable to that service. The same standard applies to Private Duty Nursing, Home Health Nursing, and Home Health Aide services in the Medicaid program.

What Rules and Expectations Should Provider Agencies Know?

The same rules and requirements apply to the hiring and ongoing employment of family members as all other qualified individuals employed by provider agencies. This includes standard requirements of timekeeping and record keeping.

In addition, Public Chapter 182 places additional requirements on provider agencies when hiring family members of individuals with a disability who are receiving services. Specifically, agencies may not impose additional restrictions on the hiring of family members or household members of the individual supported solely due to:

  • A family relation between a family care giver and individual with a disability receiving services;
  • Place of residence of the family care giver or individual with a disability receiving services;
  • The age of the individual with a disability receiving services;
  • The parental or spousal relationship between the family care giver and the individual with a disability receiving services;
  • The waiver program in which the individual with a disability is enrolled; or
  • The separate and additional employment of an unrelated care giver also providing services to an individual with a disability through a provider agency.

Finally, Public Chapter 182 also prohibits compensation for care provided in excess of the amount of benefits available on the enrolled individual’s person-centered plan.

Does this Guidance Apply to Consumer-Directed HCBS Services?

No. Provider agencies do not employ consumer-directed workers. Members interested in pursuing consumer direction should contact their MCO Coordinator. They can provide information about how a member can consumer direct services. It is important to note that by choosing to consumer direct services, the member or a designed representative acts as the employer for workers.

Who Can Provider Agencies Contact at TennCare or DDA with Additional Questions?

Providers may contact their MCO Provider Relations contact. MCO Provider Relations general contact information is listed below.

For additional questions, providers can email Katie Evans, Chief of LTSS (katie.evans@tn.gov) and

Providers can also email Timothy Hickman, Deputy Director of Intake and Case management (timothy.hickman@tn.gov)