Paid Family Caregiver Programs in Texas

Written & Reviewed by

Analic Mata-Murray

Managing Editor

Yolanda Taylor

Senior Healthcare Editor

Last updated: May 4, 2026

Bottom line: In Texas, a senior can sometimes have an adult child or other relative paid to help at home, but it is usually not 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. The main exception to ask about is the limited CMPAS program, but it is not the main path for most Texas families.

For help beyond caregiver pay, see our Texas senior benefits guide. You can also use our senior help tools to plan next steps.

Quick start: where to begin

Emergency help now

1. If the senior already has Medicaid and is unsafe at home, call the STAR+PLUS plan now. Ask for urgent service coordination and a long-term services review.
2. If the senior is not on Medicaid, call the Texas ADRC line at 855-937-2372. Ask which long-term care path fits your county and care needs.
3. If services were denied, reduced, or stopped, ask for an appeal right away. If you want services to keep going during review, ask about the deadline on the notice. Many Texas managed care notices use a 10-day or service-change-date deadline.

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 May 6, 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 the senior may be able to choose a self-direction model if the service allows it.

In Texas, Consumer Directed Services, often called CDS, 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 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

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 and STAR+PLUS HCBS, Texas looks at Medicaid status, medical need, and long-term care need. 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. 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. 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

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 may be self-directed can 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. An FMSA 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. If the senior is not already in STAR+PLUS, start with ADRC or Your Texas Benefits.

Reality check: STAR+PLUS HCBS interest-list wording depends on the person’s status. Texas HCBS eligibility rules explain the interest-list process. If the senior already has STAR+PLUS, ask the MCO whether the senior can be assessed now or is being placed on an interest list. Ask for the answer in writing if the case is delayed.

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, activities related to living independently, health-related tasks, and support management. Texas describes PHC and CAS as in-home personal attendant services for people who meet the program rules.

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 approved funds. There is no single statewide take-home wage. HHSC approved new personal attendant payment rates effective September 1, 2025. The PHC rate sheet says the rates support an average attendant hourly wage of $13.00, plus payroll tax and benefit assumptions. These are reimbursement rules, not a promise of a caregiver’s take-home pay.

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?”

Reality check: Authorized hours are based on assessed need. Texas may approve fewer hours than the family already provides for free.

CMPAS: a limited spouse exception to ask about

What it is: Consumer Managed Personal Attendant Services, or CMPAS, is a Title XX, non-Medicaid program. Texas says it serves adults who have physical disabilities, live in their own homes, and 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. It is limited by service area. The current Texas CMPAS manual lists specific counties across several regions, not only one South Texas area.

How it helps: This is the rare place where Texas lists a spouse exception. Texas CMPAS materials also describe an interest list, an income-based copay, and a service cap that may be up to 52 hours per week.

How to apply or use it: Ask ADRC whether the senior’s county is in the CMPAS service area. Then ask whether the interest list is open and whether the spouse rule applies to your case.

Reality check: CMPAS is not a backup for every spouse caregiver in Texas. It is limited, and families should ask about Medicaid and respite options at the same time.

VA options for Texas veterans and their families

What they are: The Veteran-Directed Care fact sheet says veterans can get a flexible budget and hire their own personal care aides, which may include a family member or neighbor. The VA caregiver 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.

Reality check: VA caregiver programs have their own clinical and service rules. VA enrollment alone does not mean the caregiver will get a stipend.

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. Local AAAs connect older adults and caregivers with services such as meals, respite, benefits counseling, and local referrals. Our Texas AAA guide explains how to find the right office.

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 services, 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.

Reality check: Local respite funding can be limited. Ask what is available now and whether there is a waitlist.

How to start without wasting time

1. Figure out whether the senior already has Medicaid. If yes, ask what plan they are in. If no, start with Your Texas Benefits 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 about specific programs. Say 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 before work starts. Texas says 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. Missed clock-ins or bad logs can delay payment.
6. Write down every call. Keep the date, name of the person you spoke with, phone number, and what they told you.

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 background check paperwork.
• If someone will help with employer duties, review the designated representative rules before naming that person.
• Notes about unsafe home situations, falls, wandering, missed meals, missed medicine, or hospital visits.

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. Payroll taxes, FMSA costs, and budget rules apply.
• If the adult child is also the guardian, legally authorized representative, or designated representative, that role can block payment.
• For most Texas seniors, assume a spouse cannot be paid unless Texas confirms CMPAS applies.
• If the person is on Medicare only, that is usually not enough. Medicare does not pay a family member for long-term personal care at home.
• County and plan differences matter. The same question can have a different next step in Dallas, the Rio Grande Valley, Houston, El Paso, or a rural county.

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 one “Texas caregiver wage.” HHSC approved updated attendant rates effective September 1, 2025 through TMHP rate notice materials, and rates can still depend on the program.
• Letting the paid worker also become the legal decision-maker without checking the rule first.
• Missing appeal deadlines. Texas 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.
• Assuming a county respite list, Medicaid waiver list, and managed care review are the same thing. They are not.

Best options by need

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 appeal process first. After that, you can ask for an External Medical Review and/or a State Fair Hearing.

The Texas hearing guide explains appeal steps for STAR+PLUS HCBS denials. If you want services to continue while the case is reviewed, ask by the deadline shown on your notice. Do not wait until the last day if you can avoid it.

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 important in Texas because STAR+PLUS HCBS, CFC, PHC, CAS, respite, and non-Medicaid community services do not all follow the same waitlist rules. If you need help pushing the case forward, contact the HHS Ombudsman 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. These options do not always pay the family member, but they can reduce unpaid caregiving hours and lower stress.

• Respite care: Ask the local AAA and Take Time Texas about short breaks for caregivers.
• Adult day services: Ask whether a local day program can provide daytime supervision, meals, and activities.
• Meals and food: If food costs are part of the problem, our guide to food programs for seniors may help.
• Housing costs: If rent or housing is the real crisis, review housing and rent help.
• Utility shutoff risk: If the power, gas, or water bill is overdue, see utility bill help.
• Medicare costs: If premiums or copays are draining the budget, check Medicare Savings Programs.
• Property taxes: Texas homeowners may also want our Texas property tax guide.
• Local charities: If the family needs short-term help while waiting, some charities helping seniors may help with basic needs.

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 finder: search by county or ZIP in the official HHS services finder.
• FMSA directory: compare payroll agencies in the Texas FMSA directory.
• CDS advisor directory: find support consultation contacts if you need extra CDS help.
• Respite: use the Take Time Texas provider search.
• 2-1-1 Texas: call 2-1-1 or 877-541-7905. Texas HHS says the same number can help with benefits questions.
• Managed care 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. Ask every HHS or MCO call center for an interpreter if you need one. You can also use Take Time Texas español for caregiver and respite information.

Rural families should still start with ADRC or the local AAA because Texas organizes many aging services by county and region. Ask for the office that serves the senior’s county, not the nearest large city.

Border families should ask about the same Medicaid and CDS paths as everyone else. If CMPAS comes up, ask whether your county is in the current service area. Do not assume the program is only for one part of Texas or that it is open in every county.

Phone scripts you can use

Call ADRC

“Hello, I’m caring for an older adult in Texas who needs help with bathing, meals, transfers, and safety at home. We want to know if a family member can be paid through Medicaid long-term care or Consumer Directed Services. Can you tell me which program and office we should start with in our county?”

Call a STAR+PLUS plan

“Hello, I’m calling for a STAR+PLUS member who needs more help at home. I want to request a long-term services and supports review. Please tell me how to ask for Consumer Directed Services and whether a family member can be hired as the attendant.”

Ask about CMPAS

“Hello, I was told CMPAS may allow a spouse in some cases. Is CMPAS available in this county? Is there an interest list or copay? What paperwork is needed to see if this person can use the program?”

Appeal a denial or cut

“Hello, we received a notice that hours were denied, reduced, or stopped. I want to file an appeal and ask about keeping services during review. Please tell me the deadline, how to request External Medical Review, and how to ask for a State Fair Hearing.”

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, pero no está disponible para todas las familias ni en todos los casos. Si la persona mayor ya tiene STAR+PLUS, llame al plan y pida una evaluación de servicios de largo plazo. También pregunte por CDS. Si todavía no tiene Medicaid, empiece con Your Texas Benefits o llame al ADRC al 855-937-2372.

Si hay una negación, una reducción de horas o una demora, pida la decisión por escrito y pregunte por la apelación. Si necesita ayuda para comida, vivienda, servicios públicos u otros gastos mientras espera, revise también los recursos de GrantsForSeniors.org para Texas y llame al 2-1-1.

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 the person’s role. The paid worker usually cannot also be the spouse, guardian, legally authorized representative, designated representative, or that person’s spouse. 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 blocks a spouse, and the rule can also apply to common-law marriage. The narrow exception to ask about is CMPAS, but it is limited and not the main path for most Texans.

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 limited service areas and some VA caregiver programs.

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

Consumer Directed Services, or 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 using an agency worker. An FMSA handles payroll and tax paperwork.

How much do family caregivers get paid in Texas?

There is no one Texas rate. Pay depends on the program, approved hours, local plan or service area, and the budget after payroll costs. HHSC approved updated attendant rates effective September 1, 2025, but those rates are reimbursement rules, not a guarantee of take-home pay. Ask the plan or FMSA for the current number in your case.

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

Sometimes. STAR+PLUS HCBS has interest-list rules for some people. State-plan services such as CFC, PHC, and CAS are different from the waiver route. If you are told there is a waitlist, ask what services can start now while you wait.

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

Act fast. Ask for the decision in writing. Use the MCO internal appeal if the case is in managed care. Then ask about External Medical Review and/or State Fair Hearing. If you want services to continue during review, ask about the deadline on the notice right away.

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, without promising approval or payment.

Verification: Last verified May 4, 2026. Next review September 4, 2026.

Corrections: Please note that despite our careful verification process, errors may still occur. Email info@grantsforseniors.org with corrections and we will respond within 72 hours.

Disclaimer: This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, and availability can change. Readers should confirm current details directly with the official program before acting.

About the Authors

Analic Mata-Murray

Managing Editor

Analic Mata-Murray holds a Communications degree with a focus on Journalism and Advertising from Universidad Católica Andrés Bello. With over 11 years of experience as a volunteer translator for The Salvation Army, she has helped Spanish-speaking communities access critical resources and navigate poverty alleviation programs.

As Managing Editor at Grants for Seniors, Analic oversees all content to ensure accuracy and accessibility. Her bilingual expertise allows her to create and review content in both English and Spanish, specializing in community resources, housing assistance, and emergency aid programs.

Yolanda Taylor, BA Psychology

Senior Healthcare Editor

Yolanda Taylor is a Senior Healthcare Editor with over six years of clinical experience as a medical assistant in diverse healthcare settings, including OB/GYN, family medicine, and specialty clinics. She is currently pursuing her Bachelor's degree in Psychology at California State University, Sacramento.

At Grants for Seniors, Yolanda oversees healthcare-related content, ensuring medical accuracy and accessibility. Her clinical background allows her to translate complex medical terminology into clear guidance for seniors navigating Medicare, Medicaid, and dental care options. She is bilingual in Spanish and English and holds Lay Counselor certification and CPR/BLS certification.