If your parent gets long-term care from Texas Medicaid, Consumer Directed Services (CDS) can let your parent hire and manage their own caregivers, including an eligible adult child.,,

Under Texas CDS, your parent (or your parent's guardian) becomes the legal employer of each family member hired, and a Financial Management Services Agency (FMSA) pays the employees and files employment taxes. A few roles rule a relative out, such as being your parent's guardian, so check the list below before anyone applies. The Texas Health and Human Services Commission (HHSC) puts the trade plainly: CDS "allows you more control over your program services if you're able and willing to take more responsibility for coordinating the services."

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Which Family Members Can't Be Hired Under Texas CDS

Family members can be hired. The handbook for STAR+PLUS, the program in which your parent's managed care organization authorizes the services and hours, says a CDS employer may hire "family members, friends and other persons they know, in compliance with program and CDS rules." HHSC's CDS rules, on its How CDS Works page and on Form 1726 (which your parent signs), rule out these people:

If you take the designated-representative role to help with your parent's Texas CDS paperwork, you can no longer be your parent's paid CDS attendant, and neither can your spouse. Have a sibling or friend be the DR instead.

Two more bars come from the background check. The CDS rules bar hiring anyone convicted of an offense listed in Texas Health and Safety Code §250.006(a), or of a §250.006(b) offense within the past five years, and anyone listed as revoked in the Nurse Aide Registry, as unemployable in the Employee Misconduct Registry, or on a Medicaid exclusion list.

HHSC warns that "hiring an ineligible service provider may constitute Medicaid fraud." Spouses have one narrow exception, CMPAS, a non-Medicaid program that offers personal assistance services to people who have physical disabilities and can make their own decisions. A Medicaid-eligible Texan in a managed care service area can't get CMPAS unless the spouse was already the attendant, and the person chose to stay in CMPAS, when managed care reached the area. Our guide to getting paid to care for your spouse in Texas covers the routes that do pay a spouse.

How to Hire a Family Member Through Texas CDS, Step by Step

This is the STAR+PLUS order, from HHSC's handbook. If your parent gets Primary Home Care or Community Attendant Services instead, the caseworker sets the hours, so ask that caseworker how CDS starts.

  1. Get Medicaid first. Your parent must be enrolled in a Medicaid program before enrolling in CDS. See how to apply for Texas Medicaid, or call the Texas Aging and Disability Resource Center at 1-855-937-2372 for help.
  2. Ask the service coordinator for CDS. The health plan's service coordinator goes over Form 1582 with your parent. A parent who can't complete the Form 1582 self-assessment must appoint a designated representative (DR). Your parent then signs Form 1583 (who may be hired) and Form 1584 (the choice of CDS).
  3. Pick an FMSA from the plan's list of contracted agencies.
  4. Write a back-up plan on Form 1740 for days you can't work. It can name unpaid family or friends, and the service coordinator must approve it before CDS can start.
  5. Do the orientation. Within five business days of the CDS choice (or of eligibility, for new applicants), the plan refers your parent to the FMSA for a face-to-face orientation at home. Forms 1735, 1726 and 1728 go back to the FMSA within five business days after the orientation.
  6. Run your background checks. Your parent collects your details on Form 1725, and the FMSA pulls your Texas criminal history within two working days; the report must be dated within 30 days before your hire. The FMSA also checks both registries and the exclusion lists, then says on Form 1729, within three working days of getting all your paperwork, whether you can be hired.,
  7. Build the budget. Your parent drafts a budget for each CDS service with the FMSA's help, and the FMSA must approve it in writing before services begin.
  8. Sign your hiring forms. You sign Form 1732-EMR within five days of being hired. Form 1732 records your training and an evaluation at least once a year, and a copy goes to the FMSA within 30 days of signing.
  9. Get a start date. Once your parent and the FMSA tell the service coordinator CDS is ready, the coordinator sets the start date.

On cost, the Texas Department of Public Safety (DPS) crime records FAQ lists, as of 2026, $10 for an offline name-based check and $15 for a fingerprint check, plus an additional $10 fingerprinting fee when using its FAST fingerprinting service; it publishes no price for the online search the CDS rule uses. The CDS employer budgets the criminal history check cost, except for a worker providing only Community First Choice personal assistance or habilitation.

Keep a copy of every form you sign. Your parent can switch back to an agency at any time.

What Your Parent Takes On as the CDS Employer

Under Texas CDS, the legal duties of an employer land on your parent, not on you or the FMSA. It helps to know what your parent is signing before your first shift.

Training

"You are the employer, so you will train your employees," HHSC's CDS FAQ says. The topics come from Form 1732 and the program's addendum to Form 1735, so the required training is set by your parent's program. If the program requires CPR certification, the employer must keep it current.

Electronic Visit Verification

Texas requires Electronic Visit Verification (EVV) for Medicaid personal care, including CDS. You clock in and out with a phone app, the home landline or an alternative device. On Form 1722 your parent chooses who fixes missed clock-ins, and those fixes must be made within 95 calendar days. CDS employers complete EVV training at the start and every year after.

Liability and workers' compensation

On Form 1728, the employer is "solely responsible and liable for any negligent acts or omissions" by the employer, the employee, other service providers or the DR. The form also says workers aren't employed by HHSC or the FMSA. Your parent marks whether they subscribe to Texas workers' compensation through the Texas Department of Insurance and, if not, what covers a work injury (or that nothing does). The FMSA must help get coverage if your parent asks.

What that means for your family: if your parent checks that there's no protection against work injuries, then a back strain from lifting your parent has no coverage lined up for it. That's worth settling with the FMSA before you start, not after you're hurt.

Pay, Hours and Taxes

Under Texas CDS, your parent sets your wage within the budget, with the FMSA's help, and it must be at least minimum wage. Texas HHSC's base-wage requirement for personal attendants ended August 31, 2025. Effective September 1, 2025, HHSC's attendant rates assume an average wage of $13.00 an hour, but that is a rate-setting assumption, not a wage anyone must pay you.

Typical pay: about $11.65 an hour (estimate based on home care aide wages in Texas, BLS, May 2025). It reflects wages for home health and personal care aides, so CDS pay may differ.

Hours come from the service plan, not from you. In STAR+PLUS the health plan authorizes them, and the employer can't stretch or shrink authorized hours by changing your hourly wage. In Texas Primary Home Care and Community Attendant Services, the limit is 50 service hours a week, or 42 for a priority client.

You're paid as an employee. The FMSA processes payroll, calculates withholdings and files the required tax forms, and in STAR+PLUS the health plan pays the FMSA's monthly service fee., Your parent is still ultimately responsible for payroll taxes if the FMSA fails to pay. Texas has no state income tax. For federal tax treatment, ask the FMSA and a tax preparer, and see our guide to W-2 versus 1099 for paid family caregivers.

Frequently Asked Questions

Will my CDS pay count against my parent's Medicaid?

Not as your parent's income. HHSC says CDS funds used to pay workers are not reported as income, and a paid caregiver who isn't the spouse is a separate person whose wages aren't counted in the parent's eligibility.

Which Texas programs offer CDS?

HHSC lists the programs with a Texas CDS option, including STAR+PLUS HCBS; Primary Home Care, Family Care and Community Attendant Services; HCS; Texas Home Living; and CMPAS. A Texas CDS employer follows that program's rules on who can be hired, so check with the FMSA about your parent's program.

Can Mom use CDS in assisted living?

Not in STAR+PLUS. In Texas, STAR+PLUS CDS is open to members living in their own homes or a family member's home, not in adult foster care homes or assisted living facilities. For other programs, ask your parent's caseworker or service coordinator.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in TexasLearn how to get paid as a family caregiver in Texas through Medicaid CDS, CAS, VA programs, and CMPAS. Covers pay rates, eligibility, and step-by-step process. CaregiverHow to Get Paid to Care for Your Spouse in TexasCan you get paid to care for your spouse in Texas? Medicaid's self-directed option won't pay you, but two narrow Texas programs and a VA caregiver stipend can. CaregiverCaregiver Programs Available to You in TexasFind caregiver programs in Texas including Medicaid paid caregiver options, respite care, support groups, and free resources for family caregivers in 2026. MedicaidTexas STAR+PLUS Waiver ProgramTexas STAR+PLUS covers Medicaid managed care for seniors 65+. The HCBS income limit is $2,982/month, and 12,100 people were on its interest list in August 2026. CaregiverElectronic Visit Verification for Family CaregiversElectronic visit verification records six things per visit. Federal rules require location only at clock-in and clock-out; your state may require more. CaregiverTexas CMPAS: Can a Family Member Be the Paid Attendant?Texas CMPAS provides attendants for adults with physical disabilities, and a spouse or other relative can be hired under its rules. Who qualifies, how to start.

Find personalized help setting up CDS to pay a family caregiver in Texas 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.

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