Can a Texas Home Care Agency Pay You to Care for a Family Member?

If you care for a parent or other family member at home in Texas, a home care agency can hire and pay you as their attendant in some state programs, making the agency your employer. In Primary Home Care (PHC) and Community Attendant Services (CAS), Texas Medicaid's in-home attendant programs, an adult child can be hired unless the caseworker marks them "Do not hire." A spouse can't be hired in Texas Primary Home Care or Community Attendant Services, though Texas Family Care agencies can hire one.1

Which Texas Programs Let a Home Care Agency Pay a Family Member

You're already doing the care; on the agency route, you don't also have to run payroll.

The first two rows come from Title 26 of the Texas Administrative Code (26 TAC) §277.23 and HHSC's Community Care Services Eligibility Handbook.1 The last two come from HHSC's STAR+PLUS Handbook and its Community First Choice fact sheet.2,3

Who a Texas Home Care Agency Cannot Hire

Under 26 TAC §277.23, an attendant in Texas PHC, CAS or Family Care must not be the spouse of the person served, "except for services in the FC Program"; a legal parent, foster parent, or spouse of a parent of a minor who receives CAS; or anyone the HHSC caseworker marks "Do not hire."1 HHSC's Do Not Hire chart covers:

• someone who has abused, neglected or exploited the person or others, as substantiated by Adult Protective Services4
• the legal or foster parent of a minor child receiving CAS1
• the spouse of a PHC or CAS recipient1
• a household member unwilling to help with any of the tasks the person needs1
• the regular caregiver, when the hours were authorized to give that caregiver relief4
• a particular person the applicant does not want hired as the paid attendant4
• a caregiver who is no longer able or willing to do tasks previously designated as theirs, for those tasks1

Two rows of Texas HHSC's Do Not Hire chart can stop a devoted caregiver: if the hours were approved to give you a break, or your parent doesn't want you hired, a Texas Primary Home Care or Community Attendant Services agency can't hire you.4 Texas HHSC's Do Not Hire chart ends there: "Beyond these limitations, the caseworker will not specify who cannot be hired as the paid attendant."1

What Changes When the Agency Hires You

It can feel strange to apply for a job you've been doing for free. If a Texas PHC or CAS agency hires you:

• You're an agency employee. HHSC says you "will be an employee of a home and community support services agency" and must work the complete schedule the provider and the applicant develop.4
• Some of your care stays unpaid. Tasks marked as yours on HHSC Form 2060 "may not be purchased tasks if this caregiver is the paid attendant."4
• A quit job has a 30-day window. In an ongoing Texas PHC or CAS case, a caregiver who quit a full-time job to give care may be considered, if the caseworker verifies the quit came within 30 calendar days before the requested change.1

Family Care: A Texas Agency Route That Can Pay a Spouse

Family Care provides in-home attendant services to Texans eligible under Title XX of the federal Social Security Act; to qualify, a person must also be ineligible for attendant care funded through Texas Medicaid.1 HHSC tells caseworkers to assess a person for Family Care if they don't meet the criteria for PHC or CAS.4

Since §277.23 exempts Family Care from the spouse bar, a Texas Family Care agency may hire a husband or wife as the paid attendant. Under Family Care's self-directed option the spouse bar comes back, since HHSC exempts only Consumer Managed Personal Attendant Services (CMPAS).1 For every spouse option, see how to get paid to care for your spouse in Texas.

STAR+PLUS and Texas Community First Choice: The Agency and SRO Models

For Texas Community First Choice and STAR+PLUS personal assistance services, HHSC lists three delivery models: the Agency Option, the SRO, and Consumer Directed Services (CDS). In the SRO, "The provider agency is the employer who handles payroll and personnel functions," while the person or their legally authorized representative is a co-employer who selects, trains and supervises the worker.3

The HHSC sources we cite don't say whether a provider agency can hire you, or a spouse, under either Texas model, so ask your STAR+PLUS health plan before choosing one. The plan also authorizes STAR+PLUS hours.2,3

Adult foster care pays a live-in relative. In STAR+PLUS HCBS adult foster care, the provider of a small home serving up to three residents "may be a member's relative, excluding the spouse," must live in the household as the primary caregiver, and contracts with the member's health plan or a plan-contracted agency; the home can be the member's own.2

Under Consumer Directed Services, the person receiving care, or their legally authorized representative, is the employer instead, and can go back to a provider agency at any time.3 CDS bars the person's spouse except in CMPAS, the person's legally authorized representative (including a guardian),8 and the primary caregiver in PHC, CAS or Family Care.1

Pay and Hours on the Texas Agency Route

Texas HHSC ended its base-wage requirement for personal attendants on August 31, 2025; agencies may now pay any rate that meets their business need, at or above the federal minimum wage.6 This is real income for care you already give, so compare what agencies pay.

That $11.65 figure is the BLS May 2025 estimated median hourly wage for Texas home health and personal care aides, not a rate any program pays family caregivers.5 HHSC set its Texas Medicaid attendant rates to support an average wage of $13.00 per attendant hour from September 1, 2025; that is a rate assumption, not your wage.6

In Texas PHC and CAS, the lower 42-hour weekly cap applies to a client with priority status, which requires all three: the person can't do at least one basic task, such as feeding, without hands-on help; no one but the attendant is readily available and willing to help during a scheduled shift; and the caseworker finds that missing a single shift would likely jeopardize the person's health, safety or well-being.4

How to Get a Texas Home Care Agency to Pay You as a Family Member

1. Call the Texas Aging and Disability Resource Center at 855-937-2372. A trained professional will guide you to caregiver services.7
2. Apply for Texas Medicaid if your relative isn't on it. Apply online at YourTexasBenefits.com, or send HHSC's paper application, Form H1200, by mail, fax or in person.9
3. Tell the caseworker you want to be the paid attendant. Ask which tasks will be listed as yours, since those stay unpaid.1
4. Ask agencies about hiring and pay before you choose one. Hiring is the agency's decision.1

Learn More

Find personalized help getting paid through a Texas home care agency at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.