Texas caregiver pay guide
Last checked: May 18, 2026
Yes, an adult child may be able to get paid to care for a parent in Texas, but only through the right program or a proper private pay setup. Texas does not usually send a check just because a son or daughter helps at home. Most public payment routes need Medicaid approval, a care assessment, approved service hours, and a payroll or provider process.
The main Texas routes to ask about are STAR+PLUS, STAR+PLUS Home and Community Based Services, Community First Choice, and Consumer Directed Services. Veterans may also have VA options. Rules can change, and counties, managed care plans, waiver contractors, and agencies may use different names. Always confirm with Texas Health and Human Services or the health plan before you rely on a rule.
Quick answer
An adult child can sometimes be paid as a caregiver in Texas if the parent is approved for a Medicaid long-term care service that allows self-direction, or if the parent pays the child under a clear private caregiver agreement. The most important Medicaid term to ask about is Consumer Directed Services, often called CDS. CDS can let the person getting services, or a legally authorized representative, hire and manage workers, including some family members, but program rules can limit who may be paid.
If your parent already has Medicaid or STAR+PLUS, start with the health plan service coordinator. If your parent does not have Medicaid, start with an Aging and Disability Resource Center, 2-1-1 Texas, or the local Area Agency on Aging.
Start here
- Call the Texas Aging and Disability Resource Center system. Ask for long-term care help, STAR+PLUS, STAR+PLUS HCBS, Community First Choice, and Consumer Directed Services.
- If your parent already has STAR+PLUS, call the health plan. Ask for the service coordinator. Ask for a care needs review and ask whether CDS can be used for the services your parent needs.
- Write down the care you provide. List help with bathing, dressing, toileting, meals, transfers, memory safety, medication reminders, rides, and overnight safety. Keep dates and examples.
Helpful next pages on this site: Can I get paid to be a caregiver?, the caregiver pay quiz, phone scripts, and caregiver checklists.
Main options for adult children in Texas
Texas has more than one path. The right one depends on your parent’s Medicaid status, age, disability, care needs, income, assets, and whether a health plan is already involved.
| Route | Who it may help | Where to start |
|---|---|---|
| STAR+PLUS | Adults with disabilities and many adults age 65 or older who qualify for Medicaid and need health care plus long-term services and supports. | Call 2-1-1 Texas, Your Texas Benefits, or the STAR+PLUS health plan if your parent is already enrolled. |
| STAR+PLUS Home and Community Based Services | Adults who need a nursing facility level of care but may be able to live at home or in the community with services. | Ask Texas HHS or the STAR+PLUS plan about the STAR+PLUS HCBS program, the interest list, and a care assessment. |
| Community First Choice | Medicaid members who need certain attendant or habilitation services and meet program rules. | Ask the Medicaid health plan, service coordinator, or HHS about CFC and whether CDS is allowed for the needed service. |
| Consumer Directed Services | People approved for certain Medicaid services who want to hire and manage workers instead of using only an agency. | Ask for CDS, an FMSA, and the rules for hiring a family member in your parent’s exact program. |
| Area Agency on Aging or ADRC help | People age 60 or older, adults with disabilities, and caregivers who need screening, local referrals, respite options, or help finding the right door. | Call the Texas AAA line or the ADRC line and ask for caregiver and long-term care options. |
| VA caregiver and pension options | Veterans or surviving spouses who meet VA rules. Some programs help with care costs or support a family caregiver. | Ask VA about PCAFC, Aid and Attendance, Housebound benefits, and local VA caregiver support. |
| Private caregiver agreement | Families where the parent has funds and wants to pay an adult child directly. | Talk with an elder law attorney or tax professional before payment starts, especially if Medicaid may be needed later. |
Medicaid and self-directed care
Medicaid is usually the main public route for paying a family caregiver in Texas. For older adults and adults with disabilities, the programs to ask about are STAR+PLUS, STAR+PLUS HCBS, Community First Choice, Primary Home Care, Community Attendant Services, and Consumer Directed Services.
What STAR+PLUS means
STAR+PLUS is a Texas Medicaid managed care program. Managed care means a health plan helps run covered services. STAR+PLUS can include long-term services and supports, often called LTSS. LTSS can include help at home with basic daily tasks.
If your parent is in STAR+PLUS, the health plan should have a service coordinator. That person is often the best first contact for a caregiver pay question.
What STAR+PLUS HCBS means
HCBS means home and community based services. These services are meant to help a person stay at home or in a community setting instead of moving to a nursing facility. STAR+PLUS HCBS has medical and financial rules. It may also have an interest list.
Do not wait until a crisis to ask about the interest list. If your parent may need this level of help, ask HHS or the service coordinator how to be screened and how to get on the list if needed. You can also read Medicaid HCBS waivers explained.
What Community First Choice means
Community First Choice, or CFC, is a Medicaid service route for certain people who need help with daily activities and meet the required level of care. Texas HHS says some CFC services may be used with the CDS option. That matters because CDS is the part that may allow a family member to be hired.
What Consumer Directed Services means
Consumer Directed Services, or CDS, lets the person getting Medicaid services hire and manage workers for certain approved services. The person may also appoint a designated representative if they need help with employer tasks.
Under CDS, the worker is not simply paid by the state as a favor. The worker is hired for approved tasks and approved hours. A Financial Management Services Agency, often called an FMSA, helps with payroll and tax reporting. The employer must follow program rules, keep records, and have backup care if a worker does not show up.
Texas HHS says CDS may allow hiring family, friends, or neighbors. But it also lists program exclusions. For example, HHS states that under STAR+PLUS HCBS, the person’s primary caregiver or caregivers cannot be the employee. Because this rule can affect adult children who already provide most of the care, ask the service coordinator and FMSA for the rule in writing for your parent’s exact service.
Important Texas warning
Do not assume that every adult child, live-in child, or main caregiver can be paid through Medicaid. The answer can depend on the exact service, who is the employer, whether the child is the primary caregiver, whether the child lives in the home, and whether another person is serving as the legally authorized representative.
Live-in caregiver options
Many adult children live with a parent or move in after a fall, stroke, dementia diagnosis, or hospital stay. Living in the home does not automatically make you eligible for pay. It can also create extra rules.
In Texas, ask about three separate issues:
- Can a live-in family member be paid for this exact service? Some services have limits for people who live in the same home.
- Is the adult child the primary caregiver? Texas HHS lists a STAR+PLUS HCBS exclusion that says the person’s primary caregiver or caregivers cannot be the employee.
- Is Adult Foster Care an option? STAR+PLUS HCBS has Adult Foster Care rules for home providers. This is not the same as simply paying a child who already lives with a parent. Ask the health plan if it applies and what provider rules must be met.
Some websites use the name Structured Family Caregiving. As of the last check date above, this guide did not find an official Texas HHS older-adult Medicaid page using that name as a main route for adult children caring for parents. Ask Texas HHS or the STAR+PLUS plan if any local plan, waiver contractor, or provider is using a similar name, and ask for the official program authority.
If respite is the goal, see respite care for caregivers. Respite rules are different from paid daily caregiving rules.
If your parent pays you privately
A parent can choose to pay an adult child from private funds. This is not the same as Medicaid caregiver pay. It is a private family payment, and it should be handled carefully.
Use a written caregiver agreement before payment starts. The agreement should say what care tasks you will do, how many hours you will work, how much you will be paid, when you will be paid, how time will be tracked, what happens if your parent’s needs change, whether room and board is part of the arrangement, and who pays taxes, insurance, and work-related costs.
Keep time sheets. Pay by check, bank transfer, or another method that leaves a record. Avoid cash when possible. Keep care notes and copies of bills.
A private pay agreement can help show that payments were for real work and not gifts. This matters if your parent later applies for Medicaid long-term care. Large payments, back payments, or transfers without records can cause problems. Read more about the Medicaid look-back period, Medicaid spend-down, and care costs.
Before you start private pay, it is wise to talk with an elder law attorney in Texas and a tax professional. This is even more important if your parent may need nursing home care, STAR+PLUS HCBS, or other Medicaid long-term care in the next few years.
Tax and Medicaid cautions
Tax caution
The IRS says special tax rules can apply to family caregivers. A caregiver who works in the home may be treated as an employee when the person receiving care has the right to control what work is done and how it is done. This can mean household employment tax duties.
Do not guess on taxes. Ask a tax professional how to report wages and whether Schedule H, W-2 reporting, or other forms apply. See caregiver tax deductions for a plain-English starting point.
Medicaid look-back caution
When someone applies for Medicaid long-term care, transfers of money or property can be reviewed. Gifts or payments for less than fair market value can cause a penalty period. A fair market payment means the amount matches real work, real hours, and a reasonable rate.
Do not make large back payments to an adult child without legal advice. Do not transfer a house, car, or savings to a child without advice from a Texas elder law attorney.
Estate recovery caution
Texas has a Medicaid Estate Recovery Program. It may apply after the death of a Medicaid recipient who was age 55 or older and received certain long-term care services. Estate recovery is separate from whether an adult child can be paid today, but it is part of long-term care planning.
How to start
Start with the office that fits your parent’s current situation.
1. If your parent already has STAR+PLUS
Call the STAR+PLUS health plan member services number on the Medicaid card. Ask for the service coordinator.
Phone script
Hello. I help care for my parent. My parent needs help at home with daily care. I want to request a review for long-term services and supports. Please connect me with the STAR+PLUS service coordinator. I also want to ask about Consumer Directed Services and whether a family member can be hired for the approved services.
2. If your parent has Medicaid but not STAR+PLUS
Call 2-1-1 Texas or Texas HHS benefits help. Ask which Medicaid program your parent has and whether they can be screened for long-term services at home.
3. If your parent does not have Medicaid
Call an Aging and Disability Resource Center. You can also call 2-1-1 Texas or apply through Your Texas Benefits. Ask about Medicaid for the Elderly and People with Disabilities, STAR+PLUS, STAR+PLUS HCBS, and Community First Choice.
Phone script
Hello. I am caring for my parent in Texas. My parent needs help with bathing, dressing, meals, getting around the home, and safety. We need to know if Medicaid long-term care, STAR+PLUS, STAR+PLUS HCBS, Community First Choice, or Consumer Directed Services could help. What application or screening should we start?
4. If your parent is age 60 or older
Call the local Area Agency on Aging. Ask for caregiver support, benefits counseling, respite options, and help finding long-term care services. This office may not pay you directly, but it can help you find the correct Texas door.
5. If your parent is a veteran or surviving spouse
Ask VA about PCAFC if the veteran needs a family caregiver because of serious service-connected needs. Also ask about Aid and Attendance or Housebound benefits if the veteran or survivor needs help with daily activities or is mostly homebound. Start with VA Aid and Attendance for a plain-English overview.
Documents to gather before you call
- Your parent’s full legal name, date of birth, address, and phone number.
- Social Security number, Medicare card, Medicaid card, and health plan card, if any.
- Proof of income, such as Social Security, pension, VA benefits, or pay stubs.
- Bank statements, life insurance papers, property records, and other asset records.
- Doctor names, diagnoses, medication list, hospital discharge papers, and therapy notes.
- A list of daily tasks your parent cannot do safely without help.
- Fall records, wandering events, emergency room visits, or safety concerns.
- Power of attorney, guardianship papers, or other legal authority, if you have it.
- Any denial, reduction, or termination letters from Medicaid, STAR+PLUS, or a health plan.
What to do if the first answer is no
A no is not always the end. Ask what was denied and why. Ask if the answer applies to all programs or only one service.
- Ask for the denial or decision in writing.
- Ask for the program name, service name, and rule used.
- Ask whether your parent can be screened for a different service.
- Ask whether an appeal or fair hearing is available.
- If your parent has a STAR+PLUS plan, ask the plan for its complaint or appeal process.
- If the issue is not fixed, contact the Texas HHS Office of the Ombudsman or the Ombudsman for Managed Care.
Texas HHS says appeals can apply to Medicaid and other state benefits when an action or failure to act affects benefits or services. Deadlines can be short. Save envelopes, notices, call dates, names, and reference numbers.
FAQ
Can Texas Medicaid pay an adult child to care for a parent?
Sometimes. The parent must qualify for a Medicaid service that covers in-home help, and the service must allow the worker to be hired under the rules. Consumer Directed Services is the main term to ask about.
Can I be paid if I live with my parent?
Maybe, but live-in status can create limits. STAR+PLUS HCBS rules also say the primary caregiver or caregivers cannot be the employee. Ask the service coordinator and FMSA to confirm the rule for the exact service.
Does Texas have a Structured Family Caregiving program?
This guide did not find an official Texas HHS older-adult Medicaid route by that name on the last check date. Texas does have CDS, STAR+PLUS HCBS, CFC, and Adult Foster Care rules. Ask Texas HHS or the health plan if any program or provider is using a similar name.
Can my parent just write me checks?
Your parent may be able to pay you privately, but use a written caregiver agreement before payments start. Keep time sheets and payment records. Talk with a tax professional and a Texas elder law attorney if Medicaid may be needed later.
Who should I call first in Texas?
If your parent already has STAR+PLUS, call the health plan and ask for the service coordinator. If not, call an ADRC, 2-1-1 Texas, or the Area Agency on Aging if your parent is 60 or older.
Resumen en espanol
Un hijo adulto puede recibir pago por cuidar a su padre o madre en Texas en algunas situaciones, pero no es automatico. La ruta mas comun es Medicaid con servicios en el hogar y la opcion Consumer Directed Services. Si su familiar ya tiene STAR+PLUS, llame al plan y pida hablar con el coordinador de servicios. Si no tiene Medicaid, llame a 2-1-1 Texas o a un Aging and Disability Resource Center y pregunte por servicios de cuidado a largo plazo en el hogar.
About this guide
This guide was written for adult children and family caregivers trying to find real payment or coverage paths in Texas. It focuses on official program routes, first calls, documents, and appeal steps. It does not promise approval or a pay rate.
Disclaimer
This is general information, not legal, tax, medical, or financial advice. Rules can change. For legal or tax questions, talk with a qualified professional in your state.
Official sources used
- Texas Health and Human Services: STAR+PLUS
- Texas HHS: STAR+PLUS HCBS Program Eligibility
- Texas HHS: STAR+PLUS Services and Service Delivery Options
- Texas HHS: Community First Choice
- Texas HHS: Consumer Directed Services
- Texas HHS: Consumer Directed Services Employer Option
- Texas HHS: How CDS Works
- Texas HHS: Aging and Disability Resource Centers
- Texas HHS: Area Agencies on Aging
- Texas HHS: Contact and Your Texas Benefits help
- Texas HHS: Form H1200 Application for Assistance
- Texas HHS: Benefits Application Next Steps
- Texas HHS: Fair and Fraud Hearings
- Texas HHS: Office of the Ombudsman
- Texas HHS: Medicaid Estate Recovery Program
- Medicaid.gov: Self-Directed Services
- Medicaid.gov: Home and Community Based Services
- Medicaid.gov: Estate Recovery
- CMS: Transfer of Assets in the Medicaid Program
- VA: Family Caregiver Assistance Program
- VA: Aid and Attendance and Housebound benefits
- U.S. Department of Labor: FMLA for Family Caregivers
- Texas Workforce Commission: FMLA
- IRS: Family Caregivers and Self-Employment Tax
- IRS: Hiring Household Employees
