Paid Family Caregiver Programs in Texas

Last updated: 6 April 2026

Bottom line: In Texas, a senior can sometimes have an adult child or other relative paid to help at home, but usually not through a simple state cash benefit. The real path is usually Medicaid long-term care with Consumer Directed Services inside programs such as STAR+PLUS, Community First Choice, Primary Home Care, or Community Attendant Services. Spouses usually cannot be paid, although Texas has one narrow spouse exception in the regional Consumer Managed Personal Attendant Services program in South Texas.

Emergency help now

1. If the senior already has Medicaid and is unsafe at home, call the STAR+PLUS plan now and ask for urgent service coordination and a long-term services review.
2. If the senior is not already on Medicaid, call the Texas ADRC at 855-937-2372 today and ask which long-term care path fits your county and situation.
3. If services were denied, reduced, or stopped, request an appeal right away; if you want services to continue, the Texas fair hearing guide says you usually must act within 10 business days or by the end date, whichever is later.

What this help actually looks like in Texas

Texas does not have a simple statewide program that sends a paycheck to any daughter, son, or spouse who is caring for an older parent. As of March 2026, the official Texas options we verified are program-based. In practice, that means the older adult usually must first qualify for Medicaid long-term services or another specific program, then choose a self-direction model if the service allows it.

In Texas, Consumer Directed Services is the key idea. Texas HHS explains that CDS is a service delivery option where the person getting services, or the legal representative, hires and manages the worker. Texas training materials also say CDS is not a separate program. It is a way to run certain services.

That matters because a family caregiver in Texas is usually paid through an approved service, not by getting labeled “the caregiver.” The senior must be assessed. A service plan must be approved. If CDS is chosen, a Financial Management Services Agency handles payroll, tax forms, and other employer paperwork. If CDS is not chosen, the worker is usually employed by a home care agency instead.

For most older Texans, the main paid-family-caregiver path is Medicaid through STAR+PLUS or other attendant services. Texas HHS Form 1583 shows the biggest relationship rule: the paid worker generally cannot be the spouse, the person’s legally authorized representative or guardian, that person’s spouse, the designated representative, or the designated representative’s spouse. Texas also says “spouse” includes marriage without formalities, so the spouse rule can apply to common-law marriage too.

Quick facts

Question	Texas answer
Can a family member be paid?	Yes, sometimes, usually through Medicaid long-term services using CDS.
Can an adult child be paid?	Often yes, if the service allows CDS and the adult child is not also the senior’s guardian, LAR, or designated representative under HHSC Form 1583.
Can a spouse be paid?	Usually no. Texas lists one narrow spouse exception in the regional CMPAS program.
Is Medicaid required?	Usually yes. The main exceptions are CMPAS and certain VA caregiver options.
Main Texas senior routes	STAR+PLUS HCBS, Community First Choice, and attendant services such as PHC/CAS.
Waitlist issues	Some waiver limits matter. Texas says there is a statewide interest list for people not enrolled in STAR+PLUS who want STAR+PLUS HCBS, but no interest list for people already enrolled in STAR+PLUS who are eligible.
Best first phone call	ADRC at 855-937-2372, unless the senior already has STAR+PLUS.

Who qualifies

The senior. For most paid family caregiver paths in Texas, the older adult must be a Texas resident who needs help at home because of age, disability, or illness. For STAR+PLUS HCBS, Texas uses nursing-facility level-of-care and medical-necessity rules. For Community First Choice, Community Attendant Services, and similar attendant services, Texas looks at medical need, functional limits, and help needed with daily tasks.

The caregiver. Under HHSC Form 1583, the worker usually must be 18 or older, have the needed Social Security and I-9 documents, pass required background and registry checks, and meet any service-specific qualifications. Texas also uses Form 1725 for criminal history and registry checks and Form 1729 to verify that a worker can be hired.

The relationship. Adult children, siblings, grandchildren, friends, and neighbors may be possible. Spouses usually are not. The court-appointed guardian or other legally authorized representative also cannot usually be the paid worker under Form 1583. That is why many Texas families use one person as the employer or decision-maker and another relative as the paid attendant.

Best Texas programs, protections, portals, and options

1) STAR+PLUS HCBS with Consumer Directed Services

What it is: Texas uses STAR+PLUS HCBS to provide home and community-based services instead of nursing facility care. Texas CDS training says STAR+PLUS services that can be self-directed include personal assistance, Community First Choice attendant services, respite, nursing, and some therapies.

Who can use it: This is the main older-adult route when the senior has Medicaid, needs a high level of care, and wants to stay at home instead of going into a nursing facility.

How it helps: With CDS, the senior or legal employer chooses who works, when services happen, and how much the worker is paid within the approved budget and spending limits. A Financial Management Services Agency runs payroll and tax paperwork.

How to apply or use it: If the senior is already in STAR+PLUS, call the plan and ask for the service coordinator to assess long-term services and supports and explain CDS. Texas rules say there is no interest list for current STAR+PLUS members who are eligible for STAR+PLUS HCBS. If the senior is not already in STAR+PLUS, start with ADRC or YourTexasBenefits.

What to gather first: Medicaid number, doctor names, medication list, recent hospital or rehab records, and a short list of the tasks the senior cannot safely do alone.

2) Community First Choice, Primary Home Care, and Community Attendant Services

What they are: Texas describes Community First Choice as help with activities of daily living and instrumental activities of daily living, plus support management. Texas also describes Community Attendant Services as in-home attendant help for people with an approved medical need and functional limitation. Public HHSC rate sheets also show Primary Home Care and CAS CDS rates, which is a strong sign these are real paid-attendant paths in Texas.

Who can use them: These services can be a better fit when the senior needs hands-on daily help but may not need the full STAR+PLUS HCBS waiver package.

How they help: If CDS is available for the service, an eligible adult child or other relative can often be hired. Texas HHS says the employer sets the pay within the approved funds. There is no single statewide wage. For example, the 2024 PHC/CAS rate sheet showed PHC CDS rates of $13.04 to $13.20 per hour, while the 2024 STAR+PLUS rate sheet showed PAS at $3.56 per 15 minutes and PAS with CFC at $3.63 per 15 minutes. HHSC later approved higher personal attendant rates effective 1 September 2025, so always ask your plan or FMSA for the current local rate. These are reimbursement examples, not guaranteed take-home wages.

How to apply or use them: Ask your service coordinator or intake worker: “Does this senior qualify for CFC, PHC, CAS, or other attendant services, and can we use CDS so a family member can be the attendant?” That is much better than asking only, “How do I get paid?”

What to gather first: A clear list of help needed with bathing, dressing, toileting, transfers, meals, medication reminders, walking, and supervision.

3) CMPAS: the narrow spouse exception in South Texas

What it is: Consumer Managed Personal Attendant Services is a Title XX, non-Medicaid program. Texas says it serves adults age 18 or older living in their own homes, who can supervise an attendant or have someone supervise for them.

Who can use it: Texas says CMPAS is for people who do not meet the income and resource rules for Medicaid-funded personal assistance programs. Texas also says in its LTSS appendix that CMPAS operates in the lower 19 counties of South Texas.

How it helps: This is the rare place where Form 1583 lists a spouse exception. Texas also says CMPAS has an interest list and an income-based copay, and HHS materials describe a limit of up to 52 hours per week.

How to apply or use it: If you live in South Texas and the spouse is the only realistic caregiver, ask ADRC or HHS whether your county is in the CMPAS area and whether the interest list is open. For most Texans, this is not the main path.

What to gather first: County of residence, monthly income details, and a short description of the senior’s daily care needs.

4) VA options for Texas veterans and their families

What they are: The VA Veteran-Directed Care fact sheet says veterans can get a flexible budget and hire their own personal care aides, which might include a family member or neighbor. The VA Caregiver Support Program also includes the Program of Comprehensive Assistance for Family Caregivers, which can provide a stipend to enrolled and eligible caregivers.

Who can use them: Texas veterans who are enrolled in VA health care and need help with daily living tasks, or family caregivers of qualifying veterans.

How they help: VA programs can be the best non-Medicaid pay route for some Texas families, especially when the veteran is not a good fit for Medicaid or needs a second option.

How to apply or use them: Ask the veteran’s VA primary care team or social worker about Veteran-Directed Care and PCAFC. If you are unsure where to start, ask for the local VA caregiver support coordinator.

What to gather first: VA enrollment information, current diagnoses, help needed each day, and the name of the person who may serve as caregiver.

5) Texas caregiver support, respite, and navigation help

What it is: Texas has a statewide ADRC system, Area Agencies on Aging, and the Take Time Texas respite resource. Texas HHS materials also note that its 28 local AAAs connect people with services and can provide limited caregiver respite assistance.

Who can use it: Seniors, adult children, spouses, and other caregivers across Texas.

How it helps: These programs do not usually create a paid family caregiver paycheck, but they can help you find respite, adult day care, meals, transportation, benefits counseling, and the right application path. That can save weeks of confusion.

How to apply or use it: Call ADRC at 855-937-2372, search the Texas HHS county service finder, or use the Take Time Texas respite search.

What to gather first: County, age, diagnoses, insurance status, and the biggest caregiving problem you need solved first.

How to apply or use it without wasting time

1. Figure out whether the senior already has Medicaid. If yes, ask what plan they are in. If no, start with YourTexasBenefits or call ADRC.
2. Use the right words. Say: “My mother is 78, lives in Texas, needs help with bathing, dressing, transfers, and meals. Can she be assessed for long-term services and supports, and can we use Consumer Directed Services so a family member can be the attendant?”
3. Ask specifically about STAR+PLUS HCBS, CFC, PHC, and CAS. Do not settle for a vague answer about “home health.”
4. If CDS is approved, choose an FMSA and finish hiring paperwork before any work starts. Texas says on Form 1729 that the employer cannot offer employment until the FMSA confirms the worker can be hired.
5. Learn the timekeeping rules. Many Texas attendant services use Electronic Visit Verification, so missed clock-ins or bad logs can delay payment.

Checklist of documents or proof

• Texas ID, Medicaid number, Medicare card if any, and current health plan card.
• Doctor names, diagnoses, medication list, and recent hospital, rehab, or nursing facility records.
• A short written list of daily tasks the senior cannot safely do alone.
• Any guardianship or other legal decision-making papers.
• If using CDS, the proposed worker’s ID, Social Security/I-9 documents, and the official background check form.
• If someone will help with employer duties, review the designated representative rules before naming that person.

Reality checks

• Texas usually authorizes a set amount of service, not every hour the family already gives.
• The state reimbursement rate is not always the same as the caregiver’s take-home pay because payroll taxes, FMSA costs, and budget rules apply.
• If the adult child is also the guardian, LAR, or designated representative, that role can block payment under Form 1583.
• For most Texas seniors, assume a spouse cannot be paid unless you have confirmed the rare CMPAS exception applies.

Common mistakes to avoid

• Asking only “How do I get paid?” instead of asking about specific Texas programs and CDS.
• Using old blog posts that quote a single “Texas caregiver wage” instead of checking the latest official rate notices.
• Letting the paid worker also become the legal decision-maker without checking the rule first.
• Missing appeal deadlines. Texas says managed care members usually must complete the MCO internal appeal before the state fair hearing stage.
• Starting shifts before the worker is cleared by the FMSA.

Best options by need

If this sounds like you	Best first move	Why
Senior already has STAR+PLUS and an adult child wants to be paid	Call the plan and ask for LTSS review and CDS	That is the fastest direct path for many older Texans.
Senior is low-income but not yet on Medicaid	Call 855-937-2372 and start YourTexasBenefits	You usually need Medicaid before Texas can pay a family caregiver.
Spouse is the only possible caregiver	Ask whether CMPAS exists in your South Texas county	That is the narrow Texas spouse exception.
The senior is a veteran	Ask the VA social worker about Veteran-Directed Care and PCAFC	VA programs can pay or support caregivers without relying only on Medicaid.
You need relief now, even if no one gets paid	Use AAA, Take Time Texas, and 2-1-1 Texas	Respite and day services can keep the family going while the application is pending.
Hours were cut or care was denied	File the appeal, ask about EMR and fair hearing, call 866-566-8989	Texas has strict deadlines, but there are formal review rights.

What to do if denied, delayed, blocked, or waitlisted

First, ask for the decision in writing. If a Medicaid managed care organization denied, reduced, suspended, or ended a service, Texas says you usually must use the MCO internal appeal first. After that, you can ask for an External Medical Review and/or a State Fair Hearing.

The Texas STAR+PLUS HCBS fair hearing guide says hearings are usually scheduled within 30 days and written decisions are usually sent within 60 days of the request. If you want services to continue while the case is reviewed, ask by the 10-business-day deadline or by the date services end, whichever is later. Texas also says you usually do not have to repay the cost of those continued services unless you acted in bad faith or fraud.

If you are told there is a waitlist, ask a second question: “What non-waiver or state-plan services can start now while we wait?” That is especially important in Texas because STAR+PLUS HCBS interest-list rules are different from state-plan attendant services. If you need help pushing the case forward, contact the HHS Ombudsman Managed Care Assistance team or call 2-1-1 Texas to ask about free legal help.

Plan B / backup options

If paid family caregiving is not available, ask about other Texas supports that can still keep the senior at home. The official Texas community services guide lists options such as Family Care, Day Activity and Health Services, emergency response services, and other supports. The Take Time Texas program can also help you find respite providers. These options do not always pay the family member, but they can reduce the number of unpaid caregiving hours and prevent burnout.

Local resources if verified and useful

• ADRC: statewide long-term care help at 855-937-2372 and the official ADRC page.
• Area Agencies on Aging: county-by-county contacts in the Texas AAA directory.
• Texas HHS county service finder: search by county or ZIP at the official HHS services finder.
• FMSA directory: compare payroll agencies in the Texas FMSA directory.
• CDS advisor directory: find support consultation contacts in the Texas CDS advisor directory.
• Respite: use the Take Time Texas provider search.
• 2-1-1 Texas: call 2-1-1 or 877-541-7905, or use the 2-1-1 Texas website.
• Managed care complaints and appeal help: call the HHS Ombudsman Managed Care Assistance team at 866-566-8989.

For Spanish-speaking, rural, and border families

Texas has a large Spanish-speaking senior population, and many families are more comfortable applying in Spanish. Use Take Time Texas en español and ask every HHS or MCO call center for an interpreter if you need one. Rural families should still start with ADRC or the local AAA because Texas organizes many aging services by county and region. Border families in the lower 19 South Texas counties should also ask whether the regional CMPAS service area applies.

FAQ

Can my adult child get paid to care for me in Texas?

Often, yes. Texas does not ban adult children as a group. The issue is usually role, not family status. Under HHSC Form 1583, the paid worker usually cannot also be the spouse, guardian, other legally authorized representative, designated representative, or that person’s spouse. So an adult child can often be paid if the older adult qualifies for an eligible service, chooses CDS, and the adult child is otherwise hireable.

Can my spouse get paid in Texas?

Usually no. Texas is stricter with spouses than with adult children. The general Texas CDS rule in Form 1583 blocks a spouse, and that form also says the spouse rule includes common-law marriage. The narrow exception Texas lists is CMPAS, a regional South Texas program. For most older Texans statewide, assume the spouse cannot be the paid attendant unless Texas confirms CMPAS applies.

Does the senior need Medicaid?

For most Texas paid family caregiver arrangements, yes. The main routes for seniors are Medicaid long-term services through STAR+PLUS HCBS, Community First Choice, PHC, or CAS. The main non-Medicaid exceptions are CMPAS in South Texas and some VA caregiver programs. If the senior is not on Medicaid yet, start with YourTexasBenefits or ADRC.

What is Consumer Directed Services, and why does it matter?

CDS is the Texas self-direction model. It matters because it is usually the piece that lets the senior or legal employer choose a trusted family member instead of taking whichever worker an agency sends. Texas says the employer chooses the worker, schedules the help, and sets pay within the approved budget. A Financial Management Services Agency does payroll and tax paperwork.

How much do family caregivers get paid in Texas?

There is no one Texas rate. Pay depends on the program, the authorized number of hours, whether the service is in STAR+PLUS or another route, your local plan or service area, and the budget after payroll costs. The best verified way to think about pay is to use official examples, not old blogs. The 2024 PHC/CAS sheet and the 2024 STAR+PLUS sheet show that rates vary even across Texas programs, and HHSC later approved new attendant rates effective 1 September 2025. Always ask the plan or FMSA for the current number in your county.

Is there a waitlist for paid family caregiver help in Texas?

Sometimes. Texas says it maintains a statewide interest list for people not enrolled in STAR+PLUS who want STAR+PLUS HCBS. But Texas also says there is no interest list for people already enrolled in STAR+PLUS who are eligible for STAR+PLUS HCBS. State-plan services such as CFC and other attendant services are different from the waiver route, which is why families should ask what can start now even if one program is full.

What should I do if my hours are cut or the case is denied?

Act fast. Use the MCO internal appeal, then request an External Medical Review and/or State Fair Hearing if needed. The Texas fair hearing guide explains the deadlines and the 10-business-day rule for keeping services going during the review. If you need help, call the HHS Ombudsman at 866-566-8989.

Resumen en español

En Texas, un hijo adulto u otro familiar a veces puede recibir pago por cuidar a una persona mayor, pero normalmente no existe un cheque estatal simple para cualquier cuidador familiar. La ruta real casi siempre pasa por Medicaid y por Consumer Directed Services dentro de programas como STAR+PLUS, Community First Choice, Primary Home Care o Community Attendant Services.

En la mayoría de los casos, el cónyuge no puede recibir pago. La excepción limitada que Texas reconoce está en CMPAS, un programa regional del sur de Texas. Si la persona mayor ya tiene STAR+PLUS, llame al plan y pida una evaluación de servicios de largo plazo y pregunte por CDS. Si todavía no tiene Medicaid, empiece con YourTexasBenefits o llame al ADRC al 855-937-2372.

Si hay una negación, una reducción de horas o una demora, use los pasos oficiales de apelación de Medicaid y comuníquese con la oficina de HHS Ombudsman. Para más recursos de respiro y apoyo, vea Take Time Texas en español.

About This Guide

Editorial note: This guide is written for older Texans, family caregivers, and adult children trying to solve a real care problem at home. It is designed to explain what Texas actually offers, not what national websites wish every state offered.

Verification line: We reviewed official Texas HHS program pages, forms, handbooks, rate sheets, appeals materials, VA caregiver pages, and IRS tax guidance. Policy details were verified through March 2026, and official update pages were checked again on 6 April 2026.

Corrections line: If you spot a program change, send the program name, county, and the official source link to GrantsForSeniors.org through the site contact page so this guide can be updated quickly.

Disclaimer: This article is for general education. It is not legal, tax, medical, or benefits advice. Texas Medicaid, VA, and tax rules can change, and the right next step depends on the senior’s exact facts.