Consumer Directed Services in Texas: hire and manage your own attendant

Consumer Directed Services (CDS) is a Texas Medicaid option that lets you hire and manage the people who give you care. You, or your legally authorized representative, are the employer. You train and schedule the attendants, and a financial management services agency (FMSA) handles payroll and taxes.

What CDS is

Texas Health and Human Services (HHSC) says CDS lets people who receive services from Texas Medicaid hire and manage the people who provide their services. In its FAQ, revised February 6, 2026, HHSC lists what that means. You or your legally authorized representative are the employer. You hire, train and manage your own employees. You set wages and schedules within state guidelines, and you can give employees benefits such as vacation days and bonuses. You pick an FMSA to do payroll and federal and state taxes.

HHSC compares this with the traditional agency option, where the agency hires the providers, sets their wages and schedules, and does payroll and taxes.

Where CDS is available

CDS is a way of getting services you already qualify for, not a program with its own eligibility. HHSC lists it in these programs:

• Community Living Assistance and Support Services
• Consumer Managed Personal Attendant Services
• Deaf-Blind with Multiple Disabilities
• Home and Community-based Services
• Medically Dependent Children Program
• Primary Home Care, Family Care and Community Attendant Services
• STAR Health, STAR Kids, STAR+PLUS and STAR+PLUS HCBS
• Texas Home Living

The STAR+PLUS handbook says that in STAR+PLUS, the services you can direct are personal assistance services and Community First Choice personal assistance or habilitation. In STAR+PLUS HCBS, the list also includes in-home respite, skilled nursing, employment assistance, supported employment, physical, occupational and speech therapy, and cognitive rehabilitation therapy. Choosing CDS does not affect your eligibility, and you can pick a different delivery option for any service.

When you can choose CDS

The handbook says you or your legally authorized representative may choose CDS if:

• your program has it;
• at least one service in your authorized plan can be delivered this way;
• you agree to do the employer duties, or to appoint a designated representative to do them;
• you select an FMSA; and
• you have developed, and your service planning team has approved, a back-up plan for each required service.

A designated representative is a willing adult you appoint to help with employer duties. The handbook says they must be a volunteer and cannot be a paid service provider.

What you do as the employer

The handbook says you select one FMSA, budget the funds allocated in your service plan with the FMSA's help, and recruit, screen, hire, train, manage and terminate your providers. The FMSA does initial employer orientation and ongoing training, runs payroll, pays employer taxes and screens potential providers for employment eligibility. The handbook says a monthly administrative fee for the FMSA is paid by the managed care organization and authorized on your service plan.

HHSC's FAQ says to make sure the hourly wage is at least the current minimum wage and does not exceed what your budget allows. We do not state a wage figure here because HHSC does not give one for all programs.

Who can and cannot be hired

HHSC's FAQ says whether you can hire a family member depends on your program and other service requirements, and to 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;
• the designated representative or their spouse; and
• the parent or legally authorized representative of a person under 18.

HHSC adds that your program may have other restrictions. For the family angle, see paid family caregiver in Texas.

Where CDS is not available

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

How to start

1. Ask your service coordinator or case manager whether your program has CDS.
2. Ask the coordinator to explain the agency option, CDS and the service responsibility option.
3. Pick an FMSA from the list on HHSC's CDS page. HHSC also publishes a support advisor choice list.
4. Complete the FMSA's orientation and write your back-up plan.

For policy questions, HHSC says to email [email protected]. See also the Texas program overview.

Carevo is a connection platform and directory. We do not run CDS, choose an FMSA for you or enroll anyone. Providers in the directory are not CDS employees. If you want an agency, see home care in Texas.

More about care in Texas

• All Texas Medicaid programs for care at home
• Paid family caregiver in Texas
• Home care providers in Texas