Self-Direction and FMS in Tennessee

All states: self-direction map

Tennessee self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Tennessee offer self-direction?

Tennessee offers self-direction in six TennCare programs: CHOICES, Employment and Community First (ECF) CHOICES, Katie Beckett, and three 1915(c) waivers for adults with intellectual disabilities. The state calls the option Consumer Direction in every program except the Self-Determination Waiver, where it is called Self-Direction. In all of them the member, or a representative acting for the member, hires and manages the workers. Only the 1915(c) waivers also give the member a dollar budget to manage.

• CHOICES Consumer Direction (Groups 2 and 3): serves older adults (65 and over) and adults with physical disabilities who receive home care. It is run by the Division of TennCare through the member's managed care organization (BlueCare, UnitedHealthcare or Wellpoint). The member has employer authority but not budget authority. Services that can be consumer directed are personal care visits, in-home respite (up to 216 hours a year), community transportation and, in Group 2 only, live-in companion care.
• Employment and Community First (ECF) CHOICES Consumer Direction: serves people with intellectual and developmental disabilities. It is run by the Division of TennCare through the member's managed care organization. The member has employer authority but not budget authority. Services that can be consumer directed are personal assistance, supportive home care, hourly respite and community transportation. Members who live in Community Living Supports housing cannot use consumer direction.
• Katie Beckett Consumer Direction (Part A and Part B): serves children under 18 with disabilities or complex medical needs. It is run by the Division of TennCare with the Department of Disability and Aging (DDA). Part A works through the child's health plan with a Nurse Care Manager, and Part B works through a DDA Case Manager. The parent or a representative has employer authority. Services that can be consumer directed are supportive home care and hourly respite. We did not find a clear statement on whether families have budget authority.
• Consumer Direction in the Statewide and Comprehensive Aggregate Cap (CAC) waivers: two 1915(c) waivers that serve adults with intellectual disabilities. DDA operates them under TennCare oversight, and Independent Support Coordinators coordinate services. The member has both employer authority and budget authority. Services are Personal Assistance, Respite and Individual Transportation. Consumer direction is not available to people in residential services.
• Self-Direction in the Self-Determination Waiver: a 1915(c) waiver that serves adults with intellectual disabilities who live in their own home, with family or with a non-related caregiver. DDA runs it, and DDA Case Managers coordinate services. The member has both employer authority and budget authority, under the same protocol and the same three services as the other two waivers.

Employer authority means the member recruits, hires, schedules and supervises the workers. Budget authority means the member also manages a set amount of money for the service. In the 1915(c) waivers each service has its own dollar budget (monthly for personal assistance and transportation, yearly for hourly respite), under a Consumer Direction Protocol that took effect January 1, 2025. TennCare's 1915(c) waiver page says these waivers closed to new enrollment on July 1, 2016, with limited exceptions.

Who handles financial management services (FMS) in Tennessee?

One company handles financial management services for all TennCare consumer direction: Consumer Direct Care Network Tennessee (CDTN). Tennessee uses a fiscal employer agent (FEA) model, which means CDTN runs payroll and taxes while the member or a representative stays the legal employer of the workers. Because there is a single statewide FEA under a TennCare contract, members do not pick among FMS vendors.

A fiscal employer agent is the organization that handles the paperwork side of being an employer. It enrolls the workers, processes their time, pays them and files the employer taxes on the member's behalf. In Tennessee the FEA also provides supports brokerage. A supports broker is a person who helps the member learn the employer role, find and enroll workers, and keep up with program rules.

• Legal employer: the member, or a representative the member names, is the employer of record. TennCare's CHOICES page says the member becomes the employer of the people who provide the home care. In Katie Beckett the employer is the parent or a representative.
• Representatives: a representative who acts as employer of record is not paid for that role and cannot also be a paid worker for the member.
• Vendor by program: CDTN is the FEA for CHOICES, ECF CHOICES, Katie Beckett (Part A and Part B) and the Statewide, CAC and Self-Determination waivers.
• How long: TennCare's member resources page says the FEA transition took place on July 1, 2023, and CDTN says it has served Tennessee since 2023.

Pay rates work differently by program. In CHOICES, ECF CHOICES and Katie Beckett the employer picks each worker's pay from a range of rates set by the State, one rate per worker, and CHOICES companion care rates are fixed by the State. In the 1915(c) waivers the member sets the worker's rate with the support coordinator, up to a TennCare maximum and within the service budget.

Who can be a paid caregiver under self-direction in Tennessee?

Members can hire friends, neighbors and relatives, but Tennessee sets firm limits. In CHOICES, ECF CHOICES and Katie Beckett a paid worker cannot be the member's spouse, legal guardian, power of attorney or representative for consumer direction. For most services, a person who lives with the member cannot be paid either.

• CHOICES: no one who lives with the member can be paid for personal care visits, in-home respite or community transportation. Live-in companion care cannot be given by an immediate family member or by anyone the member lives with or has lived with in the last 5 years.
• ECF CHOICES: no one who currently lives with the member, immediate family included, can be paid for personal assistance, supportive home care, hourly respite or community transportation.
• Katie Beckett: no one who lives with the child, parents and other immediate family included, can be paid for hourly respite or supportive home care.
• 1915(c) waivers (Statewide, CAC and Self-Determination): we did not find a published list of who may or may not be a paid worker. The Consumer Direction Protocol does not address it. Ask the member's support coordinator or DDA Case Manager, or call CDTN's DDA line at 888-450-3242.

Hours are capped as well. Consumer-directed workers are generally limited to 40 hours a week. CHOICES does not allow overtime except for companion care. The 1915(c) protocol says overtime is not allowed. Katie Beckett allows more than 40 hours only when the child's plan and consumer directed budget call for it.

Does EVV apply to self-directed workers in Tennessee?

Yes. Electronic visit verification (EVV) applies to consumer-directed workers in Tennessee. Workers check in and out of each shift in the CareAttend mobile app, which comes through the fiscal employer agent. A worker who does not use EVV will not be paid on time, and continued non-use can end the worker's role or the member's place in consumer direction.

• CHOICES, ECF CHOICES and Katie Beckett: the CDTN handbooks require workers to record every shift through an EVV-compliant method, normally CareAttend. In ECF CHOICES the member approves the time by portal, app or phone. The Katie Beckett handbook allows other time entry methods only when CareAttend is not available, and lists workers not using EVV as a reason for ending consumer direction.
• 1915(c) waivers: the supports broker trains members and workers on the EVV application. The FEA reports EVV compliance to TennCare and DDA every month. Workers who do not stay compliant may be removed, and members may be disenrolled from consumer direction. DDA's EVV page says self-directed services use the CareAttend app through Consumer Direct Tennessee.

Two points could not be confirmed. We did not find a published EVV exemption for live-in caregivers, including for CHOICES companion care, which is a live-in service. We also did not find a statement that a shift recorded outside EVV is never paid. The sources describe late pay and loss of the worker role, not a flat denial. For either question, ask CDTN or the TennCare LTSS Help Desk at 1-877-224-0219.

What is changing next for self-direction in Tennessee?

TennCare lists a procurement for its single statewide fiscal employer agent contract, with release projected for the second quarter of 2027. The state describes its procurement dates as estimates, so the timing can move. This is a planned solicitation, not an announced change of vendor, and CDTN remains the FEA today.

The entry on TennCare's upcoming procurements page (procurement 31865-00673) covers financial administration and supports brokerage across the state's home and community based programs under one contract. We did not find a published end date for the current contract or any statement about which organizations will bid.

A second item to watch concerns paid family caregivers. TennCare says rulemaking under Public Chapter 621 of 2024, which would remove limits on paying immediate family members for home and community based services, is pending and not yet final. No date has been set, and we did not find a statement on how a final rule would affect the consumer direction limits described above. Until TennCare publishes a final rule, the handbook limits stand.

Tennessee self-direction sources

• TennCare: CHOICES (Consumer Direction section)
• TennCare: 1915(c) Consumer Direction Protocol (effective January 1, 2025)
• TennCare: Persons with intellectual disabilities receiving services in the 1915(c) HCBS waivers
• TennCare: Upcoming procurements
• TennCare: Provider agency information for hiring family caregivers
• Tennessee Department of Disability and Aging: Electronic Visit Verification
• Consumer Direct Care Network Tennessee: CHOICES member handbook
• Consumer Direct Care Network Tennessee: ECF CHOICES member handbook
• Consumer Direct Care Network Tennessee: Katie Beckett member handbook

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Tennessee EVV requirements

Other states with one statewide FMS vendor

Arkansas, Connecticut, District of Columbia, Indiana, Iowa, New Mexico, North Dakota, Oklahoma, South Carolina, Vermont, Washington, West Virginia, Wyoming. See every state on the self-direction map.

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.