ECF CHOICES Family Caregiver Stipend Tennessee: Group 4 Eligibility, Amount, and Setup

What the Family Caregiver Stipend Is

The Family Caregiver Stipend (FCS) is a flat monthly payment available to ECF CHOICES Group 4 members aged 18 and older. It compensates the family caregiver for providing daily supports in lieu of hourly Supportive Home Care services. For 2026, the stipend can be up to $1,000 per month.

The stipend is paid directly to the caregiver as a flat amount. Unlike hourly consumer-directed services, the caregiver receiving the FCS does not register as a worker through Consumer Direct Care Network Tennessee (CDTN), does not submit timesheets, and is not paid through CDTN worker payroll. The payment comes through the member's MCO (BlueCare, UnitedHealthcare, or Amerigroup/Wellpoint).

Who Qualifies for the FCS

The FCS is available only within Group 4 (Essential Family Supports), which covers children under 21 and adults 21 and older with intellectual or developmental disabilities living at home with their family. The member must be enrolled in ECF CHOICES and have an active Person-Centered Support Plan.

The caregiver must be the primary family caregiver providing unpaid care in the family home. The FCS replaces hourly Supportive Home Care — a member cannot receive both the stipend and hourly consumer-directed personal assistance for the same support needs. Families choose one model or the other.

One important constraint: the FCS cannot be the member's only ECF CHOICES service. Other authorized services — community integration, employment supports, respite, assistive technology — must be in place before the stipend can be added to the support plan. The FCS is designed as a supplemental benefit that acknowledges the caregiver's work, not as a standalone payment.

How the FCS Differs from Hourly Consumer-Directed Services

The distinction matters for tax planning and record-keeping:

Hourly Supportive Home Care through CDTN treats the worker as a W-2 employee. CDTN processes payroll, withholds federal income tax plus Social Security and Medicare, files quarterly reports, and manages workers' compensation coverage. Workers submit electronic timesheets every pay period. Hours are capped by the support plan authorization, and the total cost counts against the member's $18,000 annual Group 4 expenditure cap.

The Family Caregiver Stipend is a flat monthly payment with no timesheet requirement. The caregiver receives the full amount without CDTN worker-payroll deductions. However, tax treatment depends on the caregiving and living arrangement — families should consult a tax professional about reporting requirements because the stipend is not processed through CDTN worker payroll. The stipend also counts against the $18,000 annual expenditure cap: a $1,000 monthly stipend uses $12,000 of the cap, leaving $6,000 for other Group 4 services.

Setting Up the FCS

The stipend is authorized through the Person-Centered Support Plan developed with the member's MCO Support Coordinator. The steps:

1. The member must already be enrolled in ECF CHOICES Group 4 with at least one other active service
2. The Support Coordinator documents the caregiver's role and confirms the member's preference for the stipend model over hourly services
3. The MCO authorizes the stipend amount (up to $1,000 per month) within the remaining annual expenditure cap
4. The caregiver completes any MCO-required enrollment forms
5. The MCO confirms when payments begin after authorization

Because the stipend replaces hourly services rather than adding to them, the total expenditure cap impact should be roughly equivalent — but the stipend model shifts the administrative burden away from time tracking and toward the annual spending plan.

When the Stipend Makes Sense

The FCS works best for families where one parent or household member is already providing full-time care and the primary need is financial recognition of that work rather than bringing outside workers into the home. It eliminates the scheduling, hiring, and supervision demands of consumer direction.

It's a harder fit when the family needs more than the stipend amount can cover, or when splitting care between a family caregiver and outside workers would better serve the member. In those cases, hourly consumer-directed services through CDTN offer more flexibility, even at the cost of more paperwork.

Families navigating the choice between the FCS and hourly consumer direction within the broader ECF CHOICES framework can use the Tennessee SSI at 18 & Adult Disability Benefits Guide to map out Group 4 services alongside SSI coordination, TennCare continuity, and the other financial planning pieces of the transition.

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