You can get paid to care for your spouse in Texas, but usually not through standard Medicaid, which treats a husband or wife as a caregiver it will not pay. That is the honest starting point, and it is not the whole story: a narrow Texas program that sits outside Medicaid and two Department of Veterans Affairs pathways can put a real spouse on payroll, and knowing which door to knock on is what separates the families who get paid from the ones who give up.

Here is what to know before you spend hours on the phone: the "no" you keep hearing comes from one specific Medicaid rule, and there are real ways around it. This guide walks through each one.

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Can You Get Paid to Care for Your Spouse in Texas?

Let's start with the honest answer, because it saves you time. In most of Texas's paid-caregiver programs, a spouse cannot be the paid caregiver. That is different from the rule for other relatives: an adult child, a grandchild, or a sibling generally can be hired and paid to provide the same care. The husband or wife is the one relationship these programs tend to carve out.

So when a neighbor tells you "Texas pays family caregivers" and you call the state only to be told you don't qualify, you are not misunderstanding anything. Both things are true. The programs do pay family members, and the specific family member the state usually will not pay is a spouse.

The reason is worth understanding, because it also tells you where the exceptions live. The exclusion traces back to a federal Medicaid rule about spouses (covered in the legally responsible relative section below). Programs that fall outside that Medicaid rule, such as a non-Medicaid state program or the VA's caregiver benefits, are exactly the places where a spouse can be paid. Here is how each one works.

The Medicaid Self-Directed Route

Texas Medicaid delivers most in-home attendant care through the Consumer Directed Services (CDS) option. Under CDS, the person receiving care (or their legally authorized representative) becomes the employer of record for their own attendants: they recruit, screen, hire, train, manage, and terminate the workers and set wages and benefits within the funds allocated in the authorized service plan, while a Financial Management Services Agency (FMSA) processes payroll, pays the employer taxes to the IRS and the Texas Workforce Commission, and screens applicants for employment eligibility in the background., CDS is the option that lets a family member draw a paycheck, and it runs across more than a dozen Texas programs, including STAR+PLUS, STAR+PLUS HCBS, and Community Attendant Services (CAS). Community First Choice is not a program row of its own on that list: CFC personal care services and CFC habilitation are self-directable inside STAR+PLUS, STAR+PLUS HCBS, STAR Health, STAR Kids, CLASS, DBMD, HCS, MDCP, and Texas Home Living, while CAS sits on the single row, shared with Primary Home Care and Family Care, that carries no CFC service at all.

The CDS option carves out one relationship, though. The specific people who cannot be hired include the person receiving services; that person's spouse, except in the Consumer Managed Personal Attendant Services program; the person's legally authorized representative (a parent, guardian, managing conservator, or stepparent of someone under 18, or the guardian of a person of any age) and that representative's spouse; and an appointed designated representative and their spouse. So even though CDS is built to pay family, the husband or wife is written out of it. The Texas Health and Human Services Commission guidance is direct on this point: the spouse of the person receiving services cannot be hired as an employee in the CDS option, with one exception described below.

The one Texas exception: CMPAS, and exactly who it is open to

The exception is Consumer Managed Personal Attendant Services, or CMPAS. CMPAS is a Texas non-Medicaid program that provides personal assistance services to people who have physical disabilities and can make their own decisions, and who are able and willing to supervise their attendant or have someone who can supervise the attendant for them. It is the one place Texas's own rules write a spouse back in. HHSC's CDS FAQ lists the spouse of the person receiving services among those who cannot be a CDS employee "except in Client Managed Personal Attendant Services (CMPAS)," and the instructions for HHSC Form 1734 state that if the person is enrolled in CMPAS, the spouse may be employed.,

That exception is real. It is also bounded, and the boundary decides whether this is your door. Under 26 TAC 275.25(c), a person may not receive CMPAS at all if they are Medicaid eligible and live in a managed care service area, unless that person's spouse was already employed as their attendant and they chose to remain in CMPAS when the managed care service area was expanded to include where they live. Texas delivers Medicaid long-term services for adults with disabilities and people 65 and older through STAR+PLUS managed care, which runs across thirteen service delivery areas with managed care organizations serving the program statewide. Put those two rules side by side and there are two very different situations:

  • If you are already Medicaid eligible, CMPAS is a grandfathered arrangement, not a new one. The households the rule protects are the ones where the husband or wife was already the paid CMPAS attendant when managed care reached their area and who chose to stay in CMPAS. If that is you, say exactly that when you call, because you are the case the rule was written for. If it is not, expect to be told no, and put your energy into the VA route below or into paying a different relative through CDS.
  • If you are not Medicaid eligible, the bar in 275.25(c) does not reach you, and CMPAS is a genuine open route. This is the case families most often miss. CMPAS is non-Medicaid and includes a co-payment provision based on income that allows a person to participate regardless of income, so being over the Medicaid limit is not what shuts this door.

Either way, CMPAS carries its own eligibility rules. An applicant must be 18 or older; must be assessed as needing assistance with at least one personal care task and needing an allowable service for at least five hours per week; must reside in an area in which CMPAS services are available; and must have a service plan that does not exceed 52 hours per week. That residence condition is not a formality, since the rule itself assumes CMPAS is not offered everywhere in Texas. Before you build a plan around it, ask your Aging and Disability Resource Center or call 2-1-1 whether CMPAS serves your county (see Who to Call).

One tax note if you do become a paid caregiver through a Medicaid self-directed program: under the IRS's Notice 2014-7, qualified Medicaid waiver payments made to a care provider who lives in the same home as the person receiving care can be excluded from gross income, whether or not the provider is related. That exclusion is specific to Medicaid waiver payments and to a live-in caregiver, so confirm how it applies to your situation with a tax professional before you count on it.

When Texas Says No: the Legally Responsible Relative Rule

If you want to understand why the spouse exclusion keeps showing up, this is the doctrine behind it, and it is a federal rule, not a Texas invention.

Federal Medicaid regulations treat a spouse as a relative with a state-law duty of care. Under the Medicaid state plan personal care services benefit, those services must be provided by someone "who is not a member of the individual's family," and for that benefit a family member means a "legally responsible relative," a category that includes a spouse. In plain terms, the law already expects a husband or wife to care for their spouse, so it will not, by default, pay them to do it.

Self-direction bends that rule, which is why it matters where you look. The federal self-directed personal assistance regulation (section 1915(j)) defines "legally liable relatives" to expressly include a spouse, and it lets a state, at its option, permit participants to hire those relatives as paid providers. In other words, federal law gives each state a choice about whether to pay spouses through self-direction, and states land in different places. Texas, through its CDS option, has not opened that door to spouses. That is a state policy choice, so it can change; if you are told no today, it is worth asking your Texas Medicaid caseworker whether any program you qualify for allows a spouse, rather than assuming the answer is permanent.

The VA Route: PCAFC and Veteran-Directed Care

If your husband or wife is a veteran, the picture changes completely, because the VA's caregiver programs were built to pay family, including spouses.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

PCAFC pays a tax-free monthly stipend to a veteran's approved Primary Family Caregiver, and a spouse can serve in that role. To qualify, the veteran generally needs a VA disability rating (individual or combined) of 70% or higher, must need at least six months of continuous, in-person personal care, and must be enrolled in VA health care.

The stipend is not a flat national figure. It starts from the federal Office of Personnel Management (OPM) General Schedule grade 4, step 1 annual salary for the locality where the veteran lives, divided by 12. In Houston for 2026 that annual salary is $41,989, so the monthly base is about $3,499.

Which multiplier gets applied to that base depends on how the veteran came into the program, and 38 CFR 71.40(c)(4)(i) sets four of them. Under the current program (38 CFR 71.20(a)) the multiplier is 0.625, or 1.00 when the VA finds the veteran "unable to self-sustain in the community." For a legacy participant or legacy applicant (38 CFR 71.20(b) or (c)), the multiplier comes from the sum of the veteran's 2019 clinical ratings instead: 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12, with no self-sustain determination required at all. On the Houston base, that is roughly $3,499 per month at 1.00, $2,187 at 0.625, and $875 at 0.25.

Two rules protect a legacy household. A veteran who meets both the current and the legacy criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, as long as the veteran stays at the address on record. The legacy schedule runs eight years from October 1, 2020 and lapses October 1, 2028. Because the rate follows the veteran's locality, the amount where you live may differ. Beyond the stipend, a Primary Family Caregiver can also receive caregiver training, mental health counseling, at least 30 days of respite care a year, and CHAMPVA health coverage if not otherwise insured.

Veteran-Directed Care (VDC)

Veteran-Directed Care is a separate VA program, run through the VA's Geriatrics and Extended Care services. It gives an enrolled veteran a flexible budget to hire and supervise their own workers so they can keep living at home. Crucially for spouses, veterans in VDC may hire family, friends, or neighbors, including a spouse, and unlike the VA pension and Aid and Attendance benefit, VDC has no prohibition on paying a spouse to provide the care. A veteran works with an options counselor at an Aging and Disability Network Agency (often an Area Agency on Aging), and a financial management services provider handles the employer paperwork.

Aid and Attendance for a Veteran or Surviving Spouse

Aid and Attendance (A&A) is worth understanding, but it works differently from the two programs above, so it is easy to misread.

A&A is not a paycheck written to the caregiving spouse. It is an increased monthly VA pension for a qualifying wartime veteran or surviving spouse who needs another person's help with daily activities such as bathing, dressing, and eating. The money goes to the veteran or the surviving spouse, and the household can then spend it on care, including care a spouse provides. It requires that the person already qualify for a VA pension, which is income- and net-worth-tested (the 2026 net worth limit is $163,699).

The dollar amounts help show the scale. The VA sets these ceilings as annual maximums, and the monthly payment is simply the yearly award divided by 12. For 2026 (rates effective December 1, 2025 through November 30, 2026), a veteran with no dependents who qualifies for Aid and Attendance can receive up to $29,093 a year, or roughly $2,424 a month, and a veteran with one dependent up to $34,488 a year. A surviving spouse with no dependents can receive up to $18,697 a year through the Survivors Pension with Aid and Attendance. Eligibility also requires qualifying wartime service and a demonstrated need for aid and attendance under the VA's criteria. If the goal is putting a spouse on payroll, PCAFC or Veteran-Directed Care is usually the more direct route; A&A is best thought of as extra pension income the family can put toward the cost of that care.

How to Get Paid to Care for Your Spouse in Texas: How to Apply and Who to Call

There is no single application for "paying a spouse," because the answer runs through different agencies. Work down this list in order and you will land in the right place.

1
Step 1

If your spouse is a veteran, start with the VA

This is the clearest path to paying a spouse. Call the VA Caregiver Support Line at 1-855-260-3274 to ask about PCAFC, and ask your local VA Medical Center's social worker whether Veteran-Directed Care is available in your area.,

2
Step 2

Ask about CMPAS, and lead with where you stand on Medicaid

CMPAS is the one Texas attendant program whose rules let a spouse be hired, but it is closed to a person who is Medicaid eligible and lives in a managed care service area unless that person's spouse was already the paid attendant when managed care expanded there. So open the call with those two details: whether you are on Medicaid, and whether your husband or wife was already being paid as your attendant. Call your Aging and Disability Resource Center (ADRC) at 1-855-937-2372, or call 2-1-1 Texas, and ask whether CMPAS serves your county.

3
Step 3

Call your Area Agency on Aging

Texas's 28 area agencies on aging serve people 60 and older along with their family members and caregivers, offering information and referral, benefits counseling, care coordination, and caregiver support services. In Texas, reach them at 1-800-252-9240. Nationally, you can find your local agency through the Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov.

4
Step 4

If a spouse cannot be paid, look at other relatives

If none of the above fits, remember that Texas Medicaid CDS will pay an adult child, grandchild, or sibling for the same care. That may mean a different family member goes on payroll while you keep providing hands-on care. Our Texas family caregiver pay guide covers that route in full.

One practical note: when you call, say plainly that you are the spouse and you want to be paid. The programs that exclude a spouse will tell you quickly, which saves weeks of paperwork, and the programs that allow it (CMPAS and the VA benefits) will route you to the right intake person.

Frequently Asked Questions

Can I get paid to care for my husband or wife in Texas?

Yes, but the route depends on your situation rather than on standard Texas Medicaid, which excludes a spouse under its self-directed (CDS) option. The fastest way to find your path is to work the contacts in order: if your spouse is a veteran, start with the VA's PCAFC stipend or Veteran-Directed Care; if not, ask about CMPAS, the one Texas attendant program whose rules let a spouse be hired, bearing in mind that it is closed to a person who is Medicaid eligible and lives in a managed care service area unless that person's spouse was already the paid attendant. Follow the who-to-call steps below and you will land in the right intake line.,

Why can other relatives get paid but not a spouse?

Because of a federal Medicaid rule. Federal regulations treat a spouse as a "legally responsible relative" with a state-law duty of care, so many Medicaid benefits exclude a husband or wife as a paid provider even though they allow an adult child, grandchild, or sibling., Programs outside that Medicaid rule, such as CMPAS and the VA's caregiver benefits, are where a spouse can be paid.

How much does the VA pay a spouse caregiver in Texas?

Through PCAFC, the monthly stipend is the federal GS-4, step 1 annual salary for the veteran's locality divided by 12, multiplied by one of four factors. In Houston for 2026 that monthly base is about $3,499, so the stipend is about $2,187 at the 0.625 multiplier that applies under the current program, or about $3,499 at 1.00 when the VA finds the veteran unable to self-sustain in the community. A legacy participant or legacy applicant is set instead by the sum of the veteran's 2019 clinical ratings: 1.00 at 21 or higher, 0.625 at 13 to 20, and 0.25 (about $875 in Houston) at 1 to 12, so a legacy household can reach the full amount without a self-sustain determination. A veteran who qualifies both ways is paid whichever amount is higher. The amount differs by where the veteran lives.

Is Aid and Attendance a paycheck for the caregiving spouse?

No. Aid and Attendance is an increased VA pension paid to a qualifying veteran or surviving spouse who needs help with daily activities, not a wage paid to the caregiver. The household can use that pension income toward care, including care a spouse provides. To pay a spouse directly, PCAFC or Veteran-Directed Care is the more direct route.

What is CMPAS and how do I apply?

Consumer Managed Personal Attendant Services (CMPAS) is a Texas non-Medicaid program for people who have physical disabilities, can make their own decisions, and can supervise their attendant or have someone who can supervise for them. It is the one Texas attendant program whose rules let a spouse be hired. The catch is who it is open to: under 26 TAC 275.25(c) a person may not receive CMPAS if they are Medicaid eligible and live in a managed care service area, unless that person's spouse was already employed as their attendant and they chose to remain in CMPAS when managed care expanded to their area. So for most Medicaid-eligible Texans this is a grandfathered arrangement. If you are not Medicaid eligible, that bar does not apply, and because CMPAS uses an income-based co-payment rather than an income cutoff, a person can participate regardless of income. To apply, ask your ADRC at 1-855-937-2372 or call 2-1-1 whether CMPAS serves your county.

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: The National GuideCan you get paid to care for your spouse? Spouses are often excluded from Medicaid pay, but some states, the VA PCAFC program, and Aid and Attendance do. CaregiverHow to Get Paid as a Family Caregiver: The 50-State GuideHow to get paid to care for a family member in 2026: Medicaid self-direction, VA caregiver programs, personal care agreements, plus all 50 state guides.

Find personalized help figuring out whether you can get paid to care for your spouse 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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Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.