Texas caregiver pay and benefits
Last checked: May 18, 2026
Yes, a family caregiver may be able to get paid in Texas, but only through certain routes. The most common route is Texas Medicaid long-term care with Consumer Directed Services, often called CDS. Some veterans may also have VA routes that help pay for care at home.
Texas does not have one simple state program that pays every family caregiver. The person who needs care must usually qualify for Medicaid, VA benefits, or another covered program first.
Quick answer
In Texas, a family member may be paid if the person who needs care qualifies for a program that covers in-home help and allows the person to choose the worker. The main Texas route is Medicaid Consumer Directed Services, or CDS, inside programs such as STAR+PLUS or other Medicaid long-term care services.
Texas has limits on who can be hired. A spouse is usually not allowed to be the paid worker under CDS, except in the Consumer Managed Personal Attendant Services program. Adult children, siblings, other relatives, friends, or neighbors may be possible in some cases, but the managed care plan, Financial Management Services Agency, and Texas rules must approve the worker.
Texas warning
Rules can change. Counties, managed care plans, waiver workers, and agencies may use different names. Always confirm the rule with Texas Health and Human Services, the STAR+PLUS health plan, the Financial Management Services Agency, or the VA before you quit work or count on being paid.
Main ways a family caregiver may be paid in Texas
The table below shows the main routes to check first. Some routes pay the caregiver directly. Some pay the person who needs care, who may then use the money for care. Some provide support but not a paycheck.
| Program or route | Who it may help | Where to start |
|---|---|---|
| STAR+PLUS Medicaid long-term services and supports | Adults age 65 or older and adults with disabilities who have Texas Medicaid and need help at home | Call the STAR+PLUS health plan and ask for service coordination and an in-home assessment |
| STAR+PLUS Home and Community Based Services | Adults 21 or older who need a nursing facility level of care but can be served in the community | Ask Texas HHS or the STAR+PLUS health plan about the STAR+PLUS HCBS interest list and assessment |
| Community First Choice | Medicaid members who meet the required level of care and need attendant or habilitation help in the community | Ask the Medicaid plan or Texas HHS about Community First Choice and covered personal help |
| Consumer Directed Services | People in certain Texas Medicaid programs who want to hire and manage their own workers | Ask the service coordinator for the CDS option and a Financial Management Services Agency list |
| Adult Foster Care under STAR+PLUS HCBS | Some people who need a 24-hour home-like living arrangement with a contracted provider | Ask the STAR+PLUS service coordinator whether Adult Foster Care is part of the service plan |
| VA Aid and Attendance or Housebound benefits | Some wartime veterans or survivors who qualify for VA pension and need help with daily care | Start with VA.gov, a VA-accredited representative, or the Texas Veterans Commission |
| VA PCAFC | Some caregivers of eligible veterans enrolled in VA health care | Contact the VA Caregiver Support Program or the local VA caregiver support team |
| Veteran Directed Care | Some veterans who need nursing-home-level care and want more choice over home care services | Ask the local VA medical center or VA social worker if Veteran Directed Care is available |
Texas Medicaid home care routes
STAR+PLUS
STAR+PLUS is Texas Medicaid managed care for adults who have disabilities or are age 65 or older. It can include health care and long-term services and supports. Long-term services and supports can include help in the home with basic daily tasks.
If the person already has STAR+PLUS, do not start by asking, “Can I get paid?” Start by asking for a service coordinator and an in-home assessment. The plan first decides what services the member needs. Then you can ask whether the approved services can be self-directed through CDS.
STAR+PLUS Home and Community Based Services
STAR+PLUS Home and Community Based Services, often called STAR+PLUS HCBS, is for some adults who need a nursing facility level of care but can live safely in the community with services. Texas HHS says a person may be assessed when their name reaches the top of the STAR+PLUS HCBS interest list.
This matters because there may be a wait. If you are caring for someone with major daily needs, ask to be placed on the correct interest list and ask what other services may help while waiting.
Community First Choice
Community First Choice, or CFC, is a Medicaid service route for people who meet CFC rules and need support in the community. It can cover certain personal assistance or habilitation services. Habilitation means help learning or keeping daily living skills.
Ask the Medicaid plan or Texas HHS if the person can be assessed for CFC. If services are approved, ask whether the service can be delivered through CDS and whether the family member you want to hire is allowed under the person’s program.
Consumer Directed Services
Consumer Directed Services is not a separate cash benefit. It is a way to manage approved Medicaid services. With CDS, the person receiving services, or a legally authorized representative, can hire, train, schedule, and manage workers. A Financial Management Services Agency helps with payroll and tax paperwork.
Texas says CDS may let a person hire family, friends, or neighbors. But the rules also say some people cannot be hired. This is why you must ask the plan and the Financial Management Services Agency before assuming a family member can be paid.
Adult Foster Care and family care models
Texas has Adult Foster Care in some long-term care settings. It is not the same as a simple “pay my daughter for caregiving” program. Adult Foster Care is a 24-hour living arrangement in a home-like setting, and the person must live with a contracted provider.
If your family is thinking about a live-in care setup, ask the STAR+PLUS service coordinator whether Adult Foster Care is available, what provider rules apply, and whether a current family home can qualify. Do not assume it can.
Can a spouse, adult child, sibling, or live-in caregiver be paid?
This is the part that causes the most confusion. Texas may let some relatives be hired through CDS, but the answer depends on the program, the person’s role, and whether the worker is legally responsible for the person.
| Family caregiver | What to know in Texas |
|---|---|
| Spouse | Usually no under Texas CDS. Texas HHS lists the spouse of the person receiving services as someone who cannot be hired, except in the Consumer Managed Personal Attendant Services program. |
| Adult child | May be possible in some CDS cases if the adult child is not barred by the program rules. If the adult child is the legally authorized representative, designated representative, guardian, or another barred role, they may not be allowed to be the paid worker. |
| Sibling or other relative | May be possible if the person meets worker rules, passes required checks, and is not in a barred role. The plan and Financial Management Services Agency must confirm. |
| Live-in caregiver | May be possible in some services, but live-in rules can affect respite, time records, and service plans. Ask the plan, service coordinator, and Financial Management Services Agency before setting this up. |
| Primary caregiver | Texas HHS materials say the person’s primary caregiver cannot be the employee in STAR+PLUS HCBS. Ask the plan what “primary caregiver” means in your case before you rely on payment. |
Plain English rule
The person who needs care must first be approved for covered help. Then Texas must allow that service to be self-directed. Then the family member must be allowed to work in that role. All three things must line up.
Can a spouse be paid?
In most Texas Medicaid CDS routes, a spouse cannot be paid as the hired worker. Texas HHS lists a spouse as someone who cannot be hired, except in the Consumer Managed Personal Attendant Services program.
A spouse may still have other routes to check. If the person is a veteran, the spouse may ask the VA about the PCAFC. If the person has VA Aid and Attendance, the payment goes to the veteran or survivor, not straight to the spouse, but it may help cover care costs.
Can an adult child be paid?
An adult child may be able to be paid in Texas if the parent qualifies for covered Medicaid services and the service can be self-directed through CDS. The adult child still must meet hiring rules.
Ask this exact question before you count on payment: “Can my adult child be hired as the CDS employee, or are they barred because they are the legally authorized representative, designated representative, guardian, or primary caregiver?”
What if the person is a veteran?
VA benefits are separate from Texas Medicaid. If the person served in the military, check VA routes even if Medicaid does not work.
VA Aid and Attendance or Housebound benefits
Aid and Attendance and Housebound benefits can add money to a VA pension for qualified veterans or survivors who need help with daily activities or are housebound. The money is paid as part of the VA pension. It is not a Texas Medicaid caregiver paycheck.
Families often use this route to help pay for in-home care. Ask a VA-accredited representative before paying a family member from these funds, because tax and care agreement issues can matter.
Related guide: VA Aid and Attendance for caregivers.
PCAFC
The VA PCAFC, or PCAFC, may provide support and a monthly stipend to approved family caregivers of eligible veterans. The caregiver must be at least 18, and the veteran and caregiver must meet VA rules.
Start with the VA Caregiver Support Program or the caregiver support team at the veteran’s VA medical center. Ask whether PCAFC is the right program and how to apply.
Veteran Directed Care
Veteran Directed Care may let eligible veterans have more choice over home and community care services. The program may allow the veteran to hire family, friends, or neighbors for care. It is not available in every place in the same way.
Ask the veteran’s VA social worker, VA medical center, or local caregiver support team if Veteran Directed Care is offered in your area.
How to apply step by step
Step 1: Write down the care needs
List what the person needs help with each day. Include bathing, dressing, eating, toileting, moving around, taking medicine, cooking, cleaning, shopping, transportation, memory problems, and fall risk.
Step 2: Check Medicaid status
If the person already has STAR+PLUS, call the health plan. Ask for the service coordinator. If the person does not have Medicaid, apply through Your Texas Benefits or ask for Form H1200 for Medicaid for the Elderly and People with Disabilities.
If income or assets may be a problem, read Medicaid spend down and Medicaid look-back period before moving money or giving anything away.
Step 3: Ask for an in-home long-term care assessment
Ask for an assessment for long-term services and supports. Use those exact words. If the person may need nursing home level care but wants to stay home, ask about STAR+PLUS HCBS and the interest list.
Step 4: Ask about CDS
If services are approved, ask whether they can be managed through Consumer Directed Services. Ask for the forms, the Financial Management Services Agency options, and the worker rules.
Step 5: Check whether the family caregiver can be hired
Do this before the caregiver stops other work. Ask if the family member is barred because they are a spouse, legally authorized representative, designated representative, guardian, primary caregiver, or another excluded person.
Step 6: Keep every notice
Save letters from Texas HHS, the health plan, the Financial Management Services Agency, and the VA. If you are denied or services are cut, these letters tell you how to appeal.
What to ask on the phone
Try not to ask only, “Can I get paid?” That question is too broad. Ask for the program route and assessment.
Phone script for Texas Medicaid or STAR+PLUS
“I care for my family member in Texas. They need help with daily tasks at home. I want to ask about Medicaid long-term services and supports, STAR+PLUS, Community First Choice, STAR+PLUS HCBS, and Consumer Directed Services. Can we request an in-home assessment and check whether a family member can be hired?”
Phone script if the person already has a STAR+PLUS plan
“My family member is enrolled in STAR+PLUS. I need to speak with the service coordinator. We need an assessment for personal assistance services or other long-term services. If services are approved, I want to ask about the CDS option and the rules for hiring a family member.”
Phone script for the VA
“I care for a veteran at home. I want to ask about Aid and Attendance, the PCAFC, and Veteran Directed Care. Can you connect me with the caregiver support team or a social worker?”
Documents to gather
You may not need every document on this list. But having them ready can reduce delays.
- Photo ID for the person who needs care
- Social Security card or Social Security number
- Medicare and Medicaid cards, if any
- Proof of Texas address
- Proof of income, such as Social Security, pension, or pay records
- Bank statements and other asset records
- Health insurance cards
- Doctor names, diagnosis list, and medication list
- Hospital, rehab, home health, or nursing facility records
- Notes about help needed with bathing, dressing, toileting, meals, walking, memory, and safety
- Power of attorney, guardianship papers, or legal representative papers, if any
- VA discharge papers and VA decision letters, if the person is a veteran
For planning help, use the caregiver checklists and the care cost calculator.
If you are told no
A first “no” does not always mean there is no help. It may mean the person called the wrong office, asked for the wrong program name, or has not had the right assessment yet.
Ask for the reason in writing
If Medicaid, STAR+PLUS, or a health plan denies services, reduces hours, or ends services, ask for the written notice. The notice should explain appeal rights.
Ask for a fair hearing or appeal
Texas HHS has fair hearing rules for state benefits and services. STAR+PLUS plans also have complaint and appeal steps. Act fast because deadlines can be short.
Ask for a different route
If the person does not qualify for STAR+PLUS HCBS now, ask about Community First Choice, regular STAR+PLUS long-term services, Area Agency on Aging support, respite, or VA programs.
Call an ADRC or AAA
ADRCs and Area Agencies on Aging can help families find long-term care programs, benefits counseling, caregiver support, respite options, and local referrals.
Common delay reasons
- The person has not applied for the right Medicaid category.
- The person needs an in-home assessment, but it has not been scheduled.
- The person is waiting on the STAR+PLUS HCBS interest list.
- The family asked about caregiver pay before asking about covered services.
- The chosen caregiver is barred by Texas CDS hiring rules.
- Medical records do not show the daily help the person needs.
- Bank or income documents are missing.
Taxes, Medicaid rules, and family payments
If a family caregiver is paid through CDS, the Financial Management Services Agency helps with payroll tasks. Ask how taxes, time records, overtime, background checks, and worker forms are handled.
If the family pays a caregiver privately, use a written care agreement and get legal or tax advice before money changes hands. This can matter for Medicaid eligibility, the Medicaid look-back period, taxes, and family disputes.
Related guide: Caregiver tax deductions and tax issues.
If you need a break now
Payment programs can take time. If you are burned out or the person is unsafe alone, ask about respite care, adult day services, home-delivered meals, transportation, and home safety supports. Some help may come through STAR+PLUS, Area Agencies on Aging, ADRCs, VA programs, or local caregiver support groups.
Related guide: Respite care for caregivers.
Resumen en español
En Texas, un familiar a veces puede recibir pago por cuidar a una persona en casa. La ruta principal suele ser Medicaid de Texas con Consumer Directed Services, conocido como CDS. Primero la persona debe calificar para servicios cubiertos. Después debe confirmarse si el familiar puede ser contratado.
Un esposo o esposa por lo general no puede ser contratado bajo CDS, excepto en un programa específico llamado Consumer Managed Personal Attendant Services. Llame a 2-1-1, al ADRC al 855-937-2372, o al Area Agency on Aging al 800-252-9240 si la persona tiene 60 años o más.
FAQ
Does Texas pay family caregivers just because they help a parent or spouse?
No. Texas does not have a simple cash program for every family caregiver. Payment usually depends on Medicaid or VA eligibility and approved services.
What is the best first call in Texas?
If the person already has STAR+PLUS, call the health plan and ask for the service coordinator. If not, call 2-1-1 or the ADRC line at 855-YES-ADRC (855-937-2372) and ask about Medicaid long-term services and supports.
Can I be paid through Medicare?
Usually no. Medicare may cover short-term home health care when the person meets Medicare rules, but it does not usually pay a family member for ongoing daily care.
Does Texas have paid family leave for private workers?
Texas does not have a broad state paid family leave program for private workers. Some workers may have unpaid job-protected leave under the federal FMLA, and some employers offer paid leave on their own.
Can I be paid if I live with the person?
Maybe, but it depends on the program and service. Ask the STAR+PLUS plan, the Financial Management Services Agency, or the VA before assuming live-in care can be paid.
About this guide
This guide was written for family caregivers in Texas who need practical steps, not general caregiving advice. It focuses on payment routes, Medicaid home care, VA options, first calls, documents, and what to do when the first answer is no.
Official sources used
- Texas Health and Human Services: STAR+PLUS
- Texas HHS: STAR+PLUS HCBS Program Eligibility
- Texas HHS: STAR+PLUS Long-Term Services and Supports
- Texas HHS: Community First Choice
- Texas HHS: Consumer Directed Services
- Texas HHS: How Consumer Directed Services Works
- Texas HHS: CDS Employer Option
- Texas HHS: Form 1583, Employee Qualification Requirements
- Texas HHS: Adult Foster Care
- Texas HHS: Programs for Seniors and Aging
- Texas HHS: Aging and Disability Resource Centers
- Texas HHS: Area Agencies on Aging
- Your Texas Benefits: Apply for benefits
- Texas HHS: Form H1200, Application for Assistance
- Texas HHS: Fair and Fraud Hearings
- Texas HHS: Fair and Fraud Hearings FAQ
- Texas HHS: Medicaid Estate Recovery Program
- U.S. Department of Veterans Affairs: Aid and Attendance and Housebound benefits
- U.S. Department of Veterans Affairs: PCAFC
- U.S. Department of Veterans Affairs: Veteran Directed Care
- U.S. Department of Veterans Affairs: Caregiver Support Teams
- VA Caregiver Support Line
- U.S. Department of Labor: Family and Medical Leave Act
- Texas Workforce Commission: Texas Work and Family Policies
Disclaimer
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state. Program rules can change, and Texas HHS, your managed care plan, the VA, or another official source should confirm details for your case.
