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Get paid to care for a family member in Texas

In Texas, a Medicaid member who uses Consumer Directed Services can often hire a relative as their paid attendant. Spouses, designated representatives and parents of children under 18 are excluded in most programs.

Carevo editorial team Updated October 27, 2026 Source checked by Carevo editorial team, October 27, 2026

In Texas, a relative can be paid to care for you if you receive Medicaid services in a program that has the Consumer Directed Services (CDS) option and you choose to hire them. Texas Health and Human Services (HHSC) excludes some relatives, and your program may add limits.

How family gets paid in Texas

Texas has no separate paid family caregiver program. The route is Consumer Directed Services, which is a way of delivering services you already qualify for through programs such as STAR+PLUS, STAR+PLUS HCBS, Primary Home Care, Family Care and Community Attendant Services, and Texas Home Living. HHSC's FAQ says that when you hire your own service providers as employees, you can often find family, neighbors or friends to work for you, and that depending on your program there may be limits on which relatives can be hired.

You, or your legally authorized representative, are the employer. You hire, train and manage the attendant and set wages and schedules within state guidelines.

Who cannot be hired

HHSC's FAQ asks "Can I hire a family member to be my service provider?" and answers that it depends on your program and other service requirements, so check with your service coordinator, case manager or FMSA. People who cannot be your employee include:

  • the CDS employer;
  • the spouse of the person receiving services, or the employer's spouse, except in Consumer Managed Personal Attendant Services (CMPAS);
  • the designated representative or their spouse; and
  • the parent or legally authorized representative of a person receiving services who is under 18.

The FAQ adds: check your program's requirements, as other restrictions may apply.

The STAR+PLUS handbook defines a designated representative as a willing adult you appoint to help with employer duties. It says they must be a volunteer and cannot be a paid service provider. If you want a family member to be paid, that person cannot also be your designated representative.

What the person receiving care needs

CDS is not a program you apply to on its own. The person getting care needs to be in a Texas Medicaid program that includes the option and have at least one authorized service that can be delivered this way. For STAR+PLUS HCBS, HHSC's eligibility rules include being 21 or older, full Medicaid financial eligibility, a nursing facility level of care determination and an unmet need for a service. See the Texas overview for the interest list and the other steps.

How a relative gets paid

  1. The member or representative chooses CDS and selects a financial management services agency (FMSA).
  2. The FMSA screens the potential provider for employment eligibility, handles payroll files and pays employer taxes, according to the STAR+PLUS handbook.
  3. The relative records time in the electronic visit verification system. HHSC's FAQ says employees are paid at least twice a month.
  4. The member or representative keeps a service back-up plan, because HHSC says you can hire backup providers for times when regular employees are not available.

Pay

We do not state an hourly rate. HHSC's FAQ says you set wages with your FMSA's help, within your program budget, making sure the wage is at least the current minimum wage. The amount depends on your allotted budget.

Where CDS does not apply

In STAR+PLUS, CDS is not available to members living in adult foster care homes or assisted living facilities. It is available to members in their own homes or the homes of family members.

Where to start

Ask your service coordinator or case manager whether your program has CDS and which relatives your program allows. HHSC's CDS page lists the FMSAs and says to email [email protected] for policy questions. Carevo is a connection platform and directory. We do not run CDS, enroll anyone or advise on eligibility. If you also want agency help, see home care in Texas.

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Common questions

Can a family member be paid to care for me in Texas?

Often. HHSC says that under the Consumer Directed Services option you can often find family, neighbors or friends to work for you, though your program may limit which relatives can be hired.

Which relatives cannot be paid under CDS?

HHSC's FAQ lists the spouse of the person receiving services (except in Consumer Managed Personal Attendant Services), the designated representative and their spouse, and the parent or legally authorized representative of a person under 18. It also says to check your program for other restrictions.

Can an adult child be my paid attendant?

An adult child is not on HHSC's list of people who cannot be hired. Confirm with your service coordinator or FMSA, because program rules can add limits.

Who pays the family caregiver?

A financial management services agency (FMSA) that you select processes payroll and taxes. HHSC's FAQ says employees are paid at least twice a month and record their time in the electronic visit verification system.

Do I need to be on Medicaid?

Yes. CDS is a way of receiving services through Texas Medicaid programs such as STAR+PLUS, so the person getting care must be enrolled in a program that includes CDS and have services authorized.

Can I live in assisted living and use CDS?

Not in STAR+PLUS. The STAR+PLUS handbook says CDS is not available to members living in adult foster care homes or assisted living facilities.

Sources

Review status: Carevo checked this page against the primary sources listed above. It has not been professionally reviewed by a registered nurse, licensed social worker, benefits counselor or attorney. See our editorial standards.

This page is general information, not financial, legal or medical advice. Rules and services vary by state and by individual circumstances. Use the official sources and decision-maker named on the page. Carevo is a connection platform, not a care provider.