Texas Medicaid caregiver payment guide
Last checked: May 18, 2026
Texas Medicaid has a self-directed care option called Consumer Directed Services, or CDS. It may let a person who gets approved Medicaid long-term care hire, train, and manage a caregiver instead of using only an agency worker.
This page is for family caregivers who need to know where to start, what to ask for, and what can go wrong before pay starts.
Quick answer
In Texas, the main self-directed Medicaid route is called Consumer Directed Services (CDS). CDS can let the person receiving services, or their legally authorized representative, hire and manage caregivers for approved services.
An adult child, relative, friend, or neighbor may be allowed if they meet the program rules and pass required checks. A spouse usually cannot be hired under standard Medicaid CDS services, except Texas lists a limited CMPAS exception that families must confirm before counting on it.
Start here
- If the person already has STAR+PLUS or another Medicaid long-term care program: call the health plan service coordinator or case manager and ask for the Consumer Directed Services option.
- If the person does not have Medicaid long-term care yet: apply through Your Texas Benefits or call 2-1-1 and ask about Medicaid long-term services and supports.
- If you are not sure where to start: call the Texas Aging and Disability Resource Center line at 855-937-2372. For age 60 or older, you can also call the Area Agency on Aging line at 800-252-9240.
Main Texas routes to ask about
Texas does not use one single program for all home care. The right door depends on the person’s age, disability, Medicaid status, county, and type of care needed.
Use this table to ask for the right office or worker. Do not guess based on a blog or a friend’s case. Ask Texas HHSC, the managed care plan, or the case manager to confirm the current rule for your person’s service.
| Route | Who it may help | Where to start |
|---|---|---|
| STAR+PLUS | Adults who have disabilities or are age 65 or older and get Medicaid managed care. It can include long-term services and supports. | Call the STAR+PLUS health plan and ask for the service coordinator. Say you want to ask about CDS for approved services. |
| STAR+PLUS HCBS | People who need a nursing facility level of care but can be served at home or in the community if approved. | Ask the STAR+PLUS service coordinator or HHSC about STAR+PLUS HCBS screening and CDS options. |
| Community First Choice (CFC) | Medicaid members who meet CFC rules and need help with daily tasks or habilitation services in the community. | Ask the Medicaid health plan, case manager, or HHSC about CFC personal assistance services and CDS. |
| Primary Home Care, Community Attendant Services, or Family Care | Some people who need personal attendant help through Texas community care services. | Call 2-1-1, HHSC, or the caseworker and ask which attendant service route fits the person. |
| CMPAS | A limited program for people with physical disabilities who can supervise attendants or have help supervising them. | Ask HHSC whether CMPAS is open in your area and whether it fits. Do this before assuming a spouse can be paid. |
Texas warning: Rules can change. Counties, managed care plans, waiver contractors, and agencies may use different names. Always confirm the exact program, service, and worker rule with Texas HHSC, the health plan, the case manager, or the Financial Management Services Agency before a family caregiver starts work.
What self-directed care means
Self-directed care means the person getting services has more control over who provides care and how the approved care is scheduled.
In Texas, this does not mean Medicaid gives the family a blank check. The person must first qualify for a Medicaid service. The service must be approved in the care plan. The hours, tasks, budget, and worker rules must fit the program.
Under CDS, the person getting care, or their legally authorized representative, becomes the employer for the worker. That can include hiring, training, setting schedules, signing timesheets, and ending employment if needed.
A payroll agency is still required. Texas calls this a Financial Management Services Agency, or FMSA. The FMSA helps with payroll, employer taxes, forms, and budget steps. The FMSA does not decide that the person needs care. That part comes through Medicaid, the managed care plan, and the service plan process.
Program name in Texas
The state name to ask for is Consumer Directed Services, or CDS.
Texas HHSC says CDS lets people who receive Texas Medicaid services hire and manage the people who provide those services. Texas lists CDS as a choice across many long-term services and supports programs, including STAR+PLUS, STAR+PLUS HCBS, Community First Choice, Primary Home Care, Community Attendant Services, Family Care, CLASS, HCS, TxHmL, DBMD, MDCP, STAR Kids, and STAR Health.
For many adult caregivers, the most common words to ask about are:
- STAR+PLUS Consumer Directed Services
- STAR+PLUS HCBS Consumer Directed Services
- Community First Choice CDS
- Primary Home Care, Community Attendant Services, or Family Care through CDS
If the person is not sure what program they have, ask for the Medicaid plan name, the case manager name, and a copy of the current service plan.
Who controls the care plan or budget?
The person getting services does not set the whole Medicaid care plan alone. Medicaid and the managed care plan still decide what services are approved.
But under CDS, the employer has control over many day-to-day parts of care. The employer may:
- choose workers who meet the rules;
- set work schedules within the approved hours;
- train workers on the approved tasks;
- approve and sign timesheets;
- set pay within state and program limits;
- keep worker records; and
- make a backup plan if a worker misses a shift.
The service coordinator, case manager, or service planning team still matters. Ask them to explain what is approved, what is not approved, and how to request a change if care needs have grown.
Who can be hired
Texas CDS may allow the employer to hire a family member, adult child, relative, friend, or neighbor if that person meets the program rules. The worker must be able to do the approved tasks. They must complete the required hiring packet. They must also pass required criminal history, registry, and exclusion checks.
Do not let a caregiver start paid work until the FMSA or program tells you the hire is cleared. If someone works before approval, the family may not be paid for that time.
People who are usually worth asking about
- an adult child who is not the legal guardian, legally authorized representative, or designated representative;
- a sibling, grandchild, niece, nephew, cousin, or other relative who meets the rules;
- a trusted friend or neighbor; and
- a backup worker who can fill in when the main worker cannot come.
People who may not be allowed
Texas rules are strict about some relationships. Based on Texas HHSC sources, the following people may be barred for many CDS services:
- the spouse of the person receiving services, except for the CMPAS exception Texas lists;
- the legally authorized representative, often called the LAR;
- the spouse of the LAR;
- a designated representative who is helping the employer with CDS duties;
- a person barred by criminal history, registry, or Medicaid exclusion checks; and
- in some programs or services, a person who lives with the individual.
This is one of the most important places to confirm. Ask the FMSA or service coordinator to check the exact relationship rule before you count on any worker.
Spouse and adult child rules
Can a spouse be paid?
For standard Medicaid CDS services in Texas, the safe answer is: usually no. Texas HHSC’s CDS materials list the spouse of the person receiving services as an excluded employee, except in the Consumer Managed Personal Attendant Services program, called CMPAS.
CMPAS is limited. It is not the same as saying every spouse can be paid under STAR+PLUS or CFC. If the caregiver is a husband or wife, ask this exact question:
Phone script: “I am the spouse. Does this person’s exact program allow a spouse to be paid, or is the only possible exception CMPAS? Please tell me the rule and where I can get it in writing.”
Can an adult child be paid?
An adult child may be allowed if the adult child meets the worker rules and is not also serving in a barred role. For example, an adult child who is also the court-appointed guardian, LAR, or designated representative may not be allowed to be the paid worker.
If the adult child only provides care and is not the legal decision-maker, ask the FMSA to review the relationship form and hiring packet.
Can a live-in relative be paid?
Sometimes a live-in worker may be possible. Sometimes the service or program does not allow it. Texas HHSC notes that the CDS option can be available to STAR+PLUS members living in their own home or a family member’s home, but some services have extra limits. Texas also lists some program-specific exclusions for people who live with the individual.
Ask for a written answer before you rely on a live-in relative. Use the exact service name, such as CFC personal assistance services, STAR+PLUS personal assistance services, respite, or nursing.
Payroll and timesheets
CDS is not an informal family payment. It is an employer setup.
The person getting services, the LAR, or the designated representative must work with an FMSA. The FMSA helps with payroll, taxes, forms, and training. The FMSA may also help the employer build the budget for approved services.
What the FMSA usually helps with
- new employer paperwork;
- new employee paperwork;
- criminal history and registry check steps;
- wage and benefit forms;
- service agreements;
- payroll and employer tax filings;
- timesheet or service log rules;
- Electronic Visit Verification, often called EVV, if required; and
- training on employer duties.
Common forms you may hear about
Texas HHSC keeps a CDS forms list. The exact packet can vary by program and FMSA. Common form names include:
- Form 1581, Consumer Directed Services Option Overview;
- Form 1582, Consumer Directed Services Responsibilities;
- Form 1724, New Employee Packet Cover Sheet;
- Form 1725, Criminal Conviction History and Registry Checks;
- Form 1726, Relationship Definitions for Consumer-Directed Services;
- Form 1730, Wage and Benefits Plan Employee Compensation;
- Form 1731, Employee Work Schedule and Assigned Tasks;
- Form 1732, Management and Training of Service Provider;
- Form 1734, Service Provider and Employer Certification of Relationship Status for CDS;
- Form 1735, Employer and Financial Management Services Agency Service Agreement; and
- Form 1740, Service Backup Plan.
Payment warning: A worker may miss pay or lose pay if the hiring packet is not complete, hours are not approved, timesheets are late, EVV does not match, the worker fails a required check, or the service was not authorized for that date.
How to switch from agency care
If the person already gets agency care, ask before you stop anything. You do not want a gap in care.
Start with the service coordinator, case manager, or health plan member services. Ask for the CDS option for the services already approved. Texas HHSC says the case manager or service coordinator should give information about CDS and provide a list of available FMSAs.
Step 1: Ask for CDS in plain words
Say: “We want to switch approved services from the agency option to Consumer Directed Services. Please explain the steps and send the FMSA choice list.”
Step 2: Keep agency care until the start date is clear
Ask for the last day of agency service and the first day of CDS service. Get the answer in writing if you can.
Step 3: Pick an FMSA
The FMSA must be approved for the person’s program and county or service area. Ask how long the employer setup and worker clearance may take.
Step 4: Complete training and employee paperwork
The employer must understand the duties. The worker must clear the employee packet before paid work starts.
Step 5: Confirm backup care
CDS employers must plan for missed shifts. The state will not send an agency backup worker just because your chosen worker cannot come.
What to say on the phone
If the person already has STAR+PLUS:
“I am calling about Consumer Directed Services. My family member already has STAR+PLUS. We want to know if their current personal assistance, CFC, respite, or other approved services can be self-directed. Please connect me with the service coordinator or the person who handles CDS.”
If the person is applying for help:
“I need to ask about Medicaid long-term services and supports for a person who needs help at home with bathing, dressing, meals, transfers, toileting, or safety. Please tell me how to apply and how to ask about STAR+PLUS, Community First Choice, and Consumer Directed Services.”
If the first person says no:
“Can you tell me which rule says no? Is the service not covered, is the person not eligible, or is this caregiver not allowed to be hired? Can I get a written notice or speak with the service coordinator?”
Documents to gather before you apply or switch
Keep these in one folder. You may not need every item, but having them ready can save calls.
- Medicaid card, Medicare card, or health plan card;
- Social Security number and date of birth;
- proof of Texas address;
- income and resource records, if applying for Medicaid;
- doctor names, diagnoses, medicine list, and recent hospital or rehab papers;
- a daily care list showing help needed with bathing, dressing, eating, transfers, toileting, walking, memory, or safety;
- current service plan, if the person already gets Medicaid home care;
- names and phone numbers for the case manager, service coordinator, and health plan;
- any denial, reduction, or appeal notice;
- the proposed caregiver’s name, address, date of birth, relationship, and work eligibility documents; and
- notes showing missed shifts, unsafe gaps, or why agency care is not working.
Common problems
“The family member started working, but payroll says no.”
This can happen if the employee packet was not approved first. Ask the FMSA what is missing. Do not assume back pay is allowed.
“The spouse wants to be paid.”
Ask about the exact program rule. For standard Medicaid CDS, a spouse is usually not allowed. Ask whether CMPAS is a real option for this person and area.
“The adult child is also the legal decision-maker.”
This can block payment. Ask whether another person can serve as the LAR or designated representative, or whether a different worker must be hired. Do not change legal roles without legal advice.
“The plan approved care, but not enough hours.”
Ask for a reassessment. Give clear notes about what help is needed each day. If services are denied or reduced, read the notice and ask about the appeal deadline.
“The agency worker keeps missing shifts.”
Report the problem to the agency and health plan. Ask whether CDS is an option and whether a backup worker can be hired under CDS.
“The timesheet or EVV is wrong.”
Contact the FMSA fast. Late or mismatched entries can slow pay. Keep copies of schedules, signed logs, and messages.
FAQ
What is self-directed care called in Texas Medicaid?
Texas calls its main self-directed option Consumer Directed Services, or CDS. Ask for CDS when you call the STAR+PLUS plan, HHSC caseworker, or service coordinator.
Can I hire my adult child as my Medicaid caregiver in Texas?
It may be possible if the adult child meets the program rules, passes the required checks, and is not serving in a barred role such as LAR, guardian, or designated representative. Confirm this with the FMSA or service coordinator before the adult child starts work.
Can a spouse be paid as a caregiver under Texas Medicaid CDS?
Usually no for standard Medicaid CDS services. Texas HHSC materials list a spouse exclusion, with a CMPAS exception. Ask HHSC or the case manager whether CMPAS is available and fits your situation before relying on spouse pay.
Who pays the caregiver in Texas CDS?
A Financial Management Services Agency, or FMSA, handles payroll and employer tax steps for approved CDS services. The person receiving services or their representative acts as the employer and approves work within the approved plan.
Can I switch from an agency worker to a family caregiver?
You can ask to switch approved services to CDS if the service is allowed under CDS. Do not stop agency care until the service coordinator and FMSA confirm the CDS start date and the worker is cleared.
What if Texas Medicaid says no to home care or cuts hours?
Ask for the notice in writing. Read the deadline. STAR+PLUS members may have plan appeal steps and state fair hearing rights. Ask the health plan or HHSC how to file before the deadline passes.
Resumen en español
En Texas, la opción principal de cuidado autodirigido de Medicaid se llama Consumer Directed Services, o CDS. Puede permitir que la persona que recibe servicios contrate y supervise a su propio cuidador para servicios aprobados.
Un hijo adulto u otro familiar puede ser permitido si cumple las reglas. Un esposo o esposa normalmente no puede ser pagado bajo las reglas comunes de Medicaid CDS, excepto una posible excepción limitada llamada CMPAS. Llame al plan STAR+PLUS, a HHSC, a 2-1-1, o al ADRC al 855-937-2372 para confirmar.
Official sources used
- Texas Health and Human Services: Consumer Directed Services (CDS)
- Texas Health and Human Services: How CDS Works
- Texas HHSC Form 1581: Consumer Directed Services Option Overview
- Texas HHSC Consumer Directed Services Handbook: CDS Forms
- Texas HHSC: Consumer Directed Services
- Texas HHSC: STAR+PLUS
- Texas HHSC STAR+PLUS Handbook: 8200, Consumer Directed Services
- Texas HHSC: Community First Choice (CFC)
- Texas HHSC Community Care Services Eligibility Handbook: 6300, Consumer Directed Services
- Texas HHSC: Consumer Managed Personal Attendant Services (CMPAS)
- Texas HHSC: Questions About Your Benefits
- Texas HHSC: Aging and Disability Resource Centers
- Texas HHSC: Area Agencies on Aging
- Texas HHSC: Fair and Fraud Hearings
- Medicaid.gov: Self-Directed Services
About this guide
CaregiverBenefits.org writes for family caregivers who need real benefit routes, not general care tips. This guide focuses on Texas Medicaid self-directed care, family caregiver hiring rules, payroll steps, and what to ask before applying or switching services.
Program names and worker rules can change. Health plans and local offices may use different words. Confirm the rule with the official Texas source before you make a work or money decision.
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.
