Getting paid to care for an aging parent in Texas is not a myth: several real programs reimburse family members for the daily help they already provide.

If you're already showing up every day to help your mom or dad with meals, bathing, and doctor visits, you should know there are real programs that will pay you for that work. Texas has multiple pathways for family members to get paid as caregivers through Medicaid and VA benefits. The pay isn't life-changing, but it's real money: Texas sets its Medicaid attendant rates to support an average wage of $13.00 per hour, or up to about $3,499 per month in Houston through the VA caregiver stipend.,

In This Guide

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Texas Paid Caregiver Programs at a Glance

Program Funding Spouses OK? Typical Pay Waitlist?
STAR+PLUS CDS Medicaid No $13/hr avg No
CAS via CDS Medicaid No Same Ask HHSC
CFC via CDS Medicaid No Same No
CMPAS Non-Medicaid Yes, but narrowly Ask HHSC Offered only in some areas
VA PCAFC Federal (VA) Yes $875-$3,499/mo in Houston, by multiplier Joint application; VA decides
VA Veteran Directed Care Federal (VA) Not addressed; ask VA Varies Only where offered

Every figure and rule in this table is grounded in the sections that follow: the $13/hour average built into the rates and how CDS wages are set, the Medicaid spouse exclusion, the CMPAS spouse exception, the VA PCAFC stipend range and the multipliers that decide where in it a household lands, and Veteran-Directed Care. The CMPAS row carries by far the biggest caveat: read the spouse section below before you plan around it.

Two Paths: CDS vs. Agency Model

When your loved one qualifies for Medicaid attendant services, they choose how those services are delivered. Both can pay a family member, within each program's rules: HHSC's Community Attendant Services rules let a provider agency hire a relative other than the recipient's spouse as the paid attendant, unless the caseworker has marked that person do not hire, and CDS lets your loved one hire an eligible relative directly., The real difference is who becomes the employer and who carries the payroll, taxes, and paperwork. For Community First Choice personal assistance and habilitation there is also a middle option, the Service Responsibility Option, in which the provider agency is the employer handling payroll and personnel while your loved one, as a co-employer, selects, trains, and supervises the attendant.

Path 1: The Agency Model, Someone Else Handles the Paperwork

In the agency model, a home care agency is the employer. Under HHSC's Community Attendant Services rules, a family caregiver who is hired "will be an employee of a home and community support services agency," and choosing whom to hire is the agency's job, not the caseworker's. The agency carries the employer paperwork that CDS would otherwise hand to your family. Your job is simply to provide the care.

Texas doesn't run a formal program that pairs your relative with an agency, so this route depends on working with an agency that hires family caregivers. But where you can, it's a good trade: you get paid for the care you already provide, and someone else absorbs the employer responsibilities. Rules on who can be paid still apply, and they are not the CDS rules. HHSC's CDS list governs who the member may employ under the CDS option; it is not a statement about who may be paid on the agency-managed route. On the agency route, HHSC's CAS rules bar the recipient's spouse and the parent of a minor recipient, and the caseworker can mark particular people "do not hire," such as a household member unwilling to help or a caregiver whose need for relief is the reason the hours were approved. CMS's summary of Texas's Community First Choice plan likewise bars a spouse, and the parents of a child under 18, in the agency models. One more CAS rule catches families off guard: if the agency hires you, the tasks the caseworker recorded as yours as the family caregiver stay unpaid, and you're paid for the purchased tasks. So for CAS and Community First Choice, a spouse can't be paid on the agency route either; the VA and CMPAS routes below are where a spouse should look.

Why families choose the agency model:

  • The agency handles payroll, tax withholding, and employment paperwork for you
  • No employer responsibilities land on you or your loved one
  • The agency manages background checks and compliance

Want to get paid without the paperwork? Chat with Brevy's care navigator to see if the agency route fits your family.

Path 2: Consumer Directed Services (CDS), You Run It Yourself

CDS puts your loved one in the employer's seat, and that's the literal legal position, not a figure of speech. The person receiving services (or their legally authorized representative) is the employer of record: they hire you, supervise and schedule you, set your wages and benefits, and assume the employer's liability. A Financial Management Services Agency (FMSA) registers as the employer's agent with the IRS and the Texas Workforce Commission, processes payroll and the employment tax deposits, files the required tax forms, and runs the criminal history and registry checks. Under Texas's CDS rules, recruiting, hiring, training, managing, and firing stay with your loved one, who remains the employer of record and assumes the liability.,

Choose CDS if you want full control over who provides care and when, and you don't mind taking on the employer's responsibilities, liability included, to get it.

Why families choose CDS:

Which Path Is Right for You?

Both paths can pay you as a family caregiver. The question is how much of the employer role you want to take on:

The step-by-step below walks through the CDS route, since that's the self-directed path with a defined enrollment process. If the agency route sounds like a better fit, a Brevy care navigator can help you find an agency that pays family caregivers.

CDS is available through several Texas Medicaid programs:

  • STAR+PLUS (the main Medicaid managed care program)
  • Community Attendant Services (CAS) with up to 50 hours per week. HHSC's handbook chapter on the program does not say whether CAS carries an interest list, so ask HHSC or your ADRC before you plan around a start date
  • Community First Choice (CFC), a Medicaid state plan benefit under Section 1915(k) rather than a waiver, so it is not gated behind a waiver interest list; HHSC says people already on a 1915(c) interest list may be able to get CFC if they meet its own eligibility and coverage requirements
  • STAR+PLUS HCBS waiver (broader home and community-based services; ask HHSC whether your loved one would go through an interest list)

CFC is the one item on that list that is not a program row of its own. On the HHSC table of services that can be self-directed, CFC personal care services and CFC habilitation sit inside STAR+PLUS, STAR+PLUS HCBS, STAR Health, STAR Kids, CLASS, DBMD, HCS, MDCP, and Texas Home Living. The only rows that carry no CFC service are CMPAS and the combined Primary Home Care, Family Care, and Community Attendant Services row, so a family on CAS self-directs CAS attendant hours rather than CFC hours.

CFC has its own gate, and it is the one families get wrong. Because CFC is a state plan benefit, the person receiving care has to be in a state plan eligibility group, require an institutional level of care, and, in STAR+PLUS, receive SSI or SSI-related Medicaid. Members whose Medicaid is medical assistance only (MAO) are excluded. That matters because the higher special income limit Texas uses for institutional care and home and community-based waiver services is not a CFC pathway: someone who qualifies for Medicaid that way is not in a state plan eligibility group and receives attendant services through the waiver instead. If a service coordinator tells you CFC is off the table, this is usually why.

CFC is often the fastest path, since a state plan benefit is not gated behind a waiver interest list. If your parent is already on Texas Medicaid, ask their service coordinator about switching to CDS, which HHSC describes as giving more control to members able and willing to take on more of the coordinating work.

Not sure which program fits your family? Chat with Brevy's care navigator for a personalized recommendation.

Who Can (and Can't) Be a Paid Caregiver

This is where a lot of families get confused, so here is exactly who Texas Medicaid allows you to hire.

Can usually be hired under Medicaid CDS, unless a bar below applies:

  • Adult children (the most common)
  • Grandchildren
  • Siblings
  • Nieces, nephews, cousins
  • Friends and neighbors

Cannot be hired under Medicaid CDS:

Being related to the person you care for is not, by itself, a bar: relatives the rules don't name aren't excluded. But if you are already your parent's primary caregiver on CAS, the CDS route is closed to you, so ask the caseworker about the agency route instead. HHSC warns that hiring an ineligible service provider may be Medicaid fraud, so settle eligibility with the FMSA before anyone starts work.

What If You're a Spouse?

If you're a spouse providing care, you have two options outside of standard Medicaid, and they are not equally available to you:

  1. CMPAS (Consumer Managed Personal Attendant Services): a non-Medicaid Texas program for adults with physical disabilities who can direct their own care or have someone who can supervise the attendant for them. It is the only place in HHSC's attendant rules where a spouse may be employed as the paid attendant, and the opening is narrow.

  2. VA PCAFC: If your spouse is a veteran with a VA disability rating of 70% or higher who meets VA's other requirements (see below), the VA's Program of Comprehensive Assistance for Family Caregivers can pay you a monthly stipend set by the federal GS-4, step 1 salary where the veteran lives. In Houston for 2026 that works out, by our arithmetic, to about $2,187 at the standard 0.625 multiplier and about $3,499 at 1.00; a legacy household's multiplier is set by the sum of its 2019 clinical ratings instead, which can reach 1.00 with no self-sustain determination or fall to 0.25 (about $875). See VA Programs That Pay Family Caregivers below.

How narrow the CMPAS opening actually is. Under 26 TAC 275.25, a person may not receive CMPAS if they are Medicaid eligible and live in a managed care service area, unless their spouse was already employed as their attendant and they chose to remain in CMPAS when the managed care service area expanded to include where they live. For a Medicaid-eligible Texan in a managed care service area, then, spouse pay through CMPAS is a grandfathered arrangement rather than a route you can newly enter, and the program runs only in the areas where it is actually offered.

Where CMPAS is open, an applicant must be 18 or older, be assessed as needing help with at least one personal care task and an allowable service for at least five hours a week, live in an area CMPAS serves, and have a service plan of no more than 52 hours a week. The program uses an income-based co-payment rather than a hard income cutoff, so income alone does not disqualify anyone. Two more limits apply. Someone already receiving Community Attendant Services, Primary Home Care, Family Care, or services under a Section 1915(c) waiver isn't eligible for CMPAS while receiving them. And the exception lifts only the spouse bar: if your spouse can't direct their own care and you would be the designated representative who directs it, you can't also be the paid attendant. Contact HHSC for eligibility details.

Please don't leave a job on the strength of CMPAS. If your spouse is not already employed as your attendant under it, the VA route above is the realistic one, and a call to the ADRC will tell you whether CMPAS is even offered where you live before you change anything about your income.

How Much You'll Get Paid

As of September 1, 2025, Texas HHSC attendant reimbursement rates support an average wage of $13.00 per hour. That is an average the rates are built to support, not a guaranteed wage: HHSC ended the requirement to pay attendants a base wage on August 31, 2025, and providers may pay any hourly rate at or above the federal minimum wage. At $13 an hour, 20 to 50 hours a week comes to about $260 to $650 a week before taxes.

Under CDS, your parent (the employer of record), with help from the FMSA, sets your wages and benefits within the allotted budget. HHSC's CDS FAQ says the hourly wage must be at least the current minimum wage and cannot exceed what the program budget has available. The FMSA itself is paid a fee set by HHSC, which it must accept as payment in full for its services.

The number of paid hours depends on the care recipient's assessed needs. CAS caps hours at 50 per week, or 42 for a recipient the caseworker gives priority status, while other programs base hours on the Individual Service Plan.

How to Get Paid by the State for Taking Care of a Family Member in Texas: Step by Step

1
Step 1

Your loved one must be on Texas Medicaid

If they're not yet enrolled, they can apply at YourTexasBenefits.com or by calling 2-1-1. See our guide to applying for Texas Medicaid.

2
Step 2

Ask about the CDS option

Contact your loved one's STAR+PLUS service coordinator or call the Texas Aging and Disability Resource Center (ADRC) at 1-855-937-2372. Tell them you want to use Consumer Directed Services.

3
Step 3

Choose an FMSA

The FMSA handles your payroll, background checks, and tax filings. Pick one from the state-approved directory.

4
Step 4

Complete orientation

The FMSA gives your loved one, as the employer, an initial orientation and ongoing training on employer duties, and it approves and monitors the CDS budget.

5
Step 5

Pass background checks

The FMSA obtains a Texas DPS criminal history check through DPS's secure online website, checks the Nurse Aide Registry and Employee Misconduct Registry before hire and every year, and checks the state and federal exclusion lists monthly. DPS's general published fees are $10.00 for a name-based check done offline and $15.00 for a fingerprint-based check, plus a $10 fingerprinting fee through its FAST service; DPS publishes no price for the online name-based search. Your loved one, as the employer, stays responsible for making sure you meet the requirements.

6
Step 6

Get hired and trained

Your loved one can't hire you until the FMSA gives permission. Complete the hiring paperwork: W-4, I-9, and several state forms, including Form 1732-EMR, the Employee Misconduct Registry acknowledgment you have to sign within five days of being hired. Your parent (the employer), not the FMSA, provides your initial, ongoing, and annual training, covering the topics on Form 1732 plus whatever their program requires through its Service Provision Requirements Addendum to Form 1735. That training, your parent's management of you, and a performance evaluation at least once a year after your hire date are all documented on Form 1732: you both sign and date it, you get a copy, and your parent sends a copy to the FMSA within 30 calendar days after the date the form is signed.

7
Step 7

Start working

Log your hours through Electronic Visit Verification (EVV), which has been required for all Texas Medicaid personal care services, including services delivered through CDS, since January 1, 2021. You clock in and out on one of three HHSC-approved methods: a downloadable application for use on a smartphone or device with internet connectivity, a home phone landline, or an alternative device. The mobile method is the only approved one when a visit begins or ends out in the community. The FMSA pays you on a regular payroll schedule.

Nothing starts until the FMSA has given written notice that you are eligible, and the FMSA will not pay for hours worked before that notice, so have your documents ready.

The FMSA gives your loved one, as the employer, an initial CDS orientation, and it approves and monitors the CDS budget. Keep copies of everything you sign; you'll reference those forms when questions come up later about authorized hours or pay.

The EVV deadline that turns a missed clock-in into unpaid hours. If you forget to clock in or out, the visit has to be corrected through what HHSC calls visit maintenance, and somebody has to own that job: on Form 1722 the CDS employer chooses whether they handle visit maintenance themselves or the FMSA does it. Either way, the correction, including manually entering a visit you never clocked, must be completed within 95 calendar days of the date you delivered the service. After that the EVV system locks the transaction, and it can only be touched if the payer approves a Visit Maintenance Unlock Request, and payers won't approve one just because someone forgot to clock in or out and nobody fixed it within the 95 days. Check your visits every month rather than finding out when a paycheck comes up short.

VA Programs That Pay Family Caregivers

If your loved one is a veteran, two federal programs can pay a family caregiver, and one of them, PCAFC, pays spouses.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

This is the highest-paying option. The VA pays a monthly stipend directly to the Primary Family Caregiver. The base is the OPM GS-4, step 1 annual salary for the veteran's locality divided by 12, not an hourly rate. 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 household came into the program, and there are two routes. Under the current program (38 CFR 71.20(a)), the multiplier is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community." For a legacy participant or legacy applicant (38 CFR 71.20(b) or (c)), the multiplier comes instead from the sum of the veteran's 2019 clinical ratings: 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12. On that route the full 1.00 needs no self-sustain determination at all.

VA and OPM publish no Houston dollar figure, so these are our arithmetic from OPM's pay table, before any offsets. On the Houston base, the rungs are roughly $3,499/month at 1.00, $2,187/month at 0.625, and $875/month at 0.25.

Two protections matter if your household is a legacy one. 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 is held at no less than what the caregiver was eligible to receive the day before October 1, 2020, for as long as the veteran stays at the address on record. The legacy schedule runs eight years from October 1, 2020, so it lapses October 1, 2028. If you are not sure which route you are on, ask your VA Caregiver Support Coordinator before you assume the lower number.

A 70% rating is only the first screen. VA lists four things that must all be true of the veteran: a VA disability rating of 70% or higher, a discharge or date of medical discharge from the military, a need for at least six months of continuous, in-person personal care, and enrollment in VA health care. Even then, you and the veteran apply together and VA's process decides eligibility. On your side, you must be at least 18 and either a family member (a spouse, son, daughter, parent, stepfamily or extended family member) or someone who lives, or is willing to live, full time with the veteran.

Beyond the stipend, a Primary Family Caregiver may also get CHAMPVA health care benefits if you don't already qualify under another health care plan, at least 30 days of respite care per year, and free legal and financial planning help related to the veteran's needs. Mental health counseling is open to Secondary Family Caregivers too. The stipend is paid only by direct deposit, set up through VA's customer engagement portal.

You and the veteran apply together through VA; for help, call the VA Caregiver Support Line at 1-855-260-3274., For a broader look at all VA care options, see our guides to VA Aid and Attendance and VA senior care benefits in Texas.

Veteran Directed Care (VDC)

VDC gives veterans a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers, and the federal Administration for Community Living says enrolled veterans may hire family, friends, or neighbors. On a spouse specifically VA's page says nothing either way, so ask the options counselor before you plan around it. An enrolled veteran is eligible if they're eligible for community care, meet the clinical criteria, and VDC is available where they live.

VA medical centers run VDC through local aging and disability network agencies, such as area agencies on aging and aging and disability resource centers, so ask your VA medical center whether it's offered in your area.

Taxes, Payroll, and What to Expect

You're a W-2 Employee

Under CDS, you're hired as a W-2 employee, not an independent contractor. Taxes are taken out of your paychecks, and the FMSA, as your loved one's employer agent, runs payroll and pays and reports the employer taxes. HHSC's employer manual doesn't spell out which taxes are withheld, so ask the FMSA and a tax preparer whether you may qualify for the IRS Notice 2014-7 exclusion. You'll receive a W-2 by January 31 each year. Texas has no state income tax.

Does Your Income Affect Your Parent's Medicaid?

No. This is the question that stops most families before they even call, and there are two halves to the answer, both reassuring.

Your wages don't count against your parent. Texas Medicaid "deems" another person's income or resources to an applicant, meaning it counts them as available, only for a spouse or, for a child under 18, a parent. You're neither, so as an adult child, grandchild, or sibling you're treated as a separate individual and your paycheck never enters their eligibility determination.

Neither does the money that pays you. HHSC is explicit that the funds a CDS employer directs to pay their workers are not reported as, and not considered, income to the person receiving services. Your parent isn't taking on income by becoming your employer.

The one relationship where deeming does apply is a spouse's, and a spouse can't be hired under Medicaid CDS in the first place. So the question only arises on the two spouse-eligible routes, CMPAS and the VA programs, where a spouse's earnings do sit in the couple's combined income for benefits that count it.

One clarification worth having, because it trips families up: CDS is a way of delivering services, not a way of qualifying for them. Your loved one has to already be enrolled in a Medicaid program before they can enroll in CDS, which is why step 1 above is the application, not the CDS request.

Workers' Compensation

In Texas, workers' compensation is a subscription a CDS employer may or may not carry, and the employer has to tell you whether they have it. HHSC's liability form also makes the employer (your parent) alone responsible for negligent acts by the employer, the employee, or the designated representative.

Frequently Asked Questions

Can family members get paid to be caregivers in Texas?

Yes. Through Medicaid's Consumer Directed Services (CDS) option, adult children, grandchildren, siblings, and other family members can usually be hired as paid caregivers, though some programs add bars, such as the primary caregiver in Community Attendant Services., In CAS, a home care agency can also hire a relative other than a spouse, unless the caseworker has marked that person do not hire, and only for the purchased tasks. A spouse is excluded under the CDS option; a spouse can be paid through the VA, or through the non-Medicaid CMPAS program in the narrow cases where it is still open to them.,

How much does Texas Medicaid pay family caregivers?

Since September 1, 2025, Texas has set its attendant rates to support an average wage of $13 an hour. Under CDS, your actual wage is set by your loved one, as the employer, within their approved CDS budget. Authorized hours can be up to 50 per week through CAS, or 42 for a recipient with priority status.

Can a spouse get paid to be a caregiver in Texas?

Not through Texas Medicaid's attendant programs in most cases. A spouse can't be the member's own employee under the CDS option, and on the agency route HHSC's CAS rules and Texas's Community First Choice plan bar the recipient's spouse as the paid attendant too., VA PCAFC does pay a spouse. Veteran-Directed Care lets the veteran hire their own workers, but VA's page doesn't address a spouse, so ask rather than assume. The non-Medicaid CMPAS program also allows a spouse to be the paid attendant, but a person who is Medicaid eligible and lives in a managed care service area may not receive CMPAS unless their spouse was already employed as their attendant when managed care expanded to their area, so for a Medicaid-eligible Texan in a managed care service area it is a grandfathered arrangement rather than an open route.

Do I need special training or certification?

Texas puts your training in the employer's hands. The person receiving services (or their designated representative) provides your initial, ongoing, and annual training, and the specific topics you have to be trained on are set by their own program through the Service Provision Requirements Addendum to Form 1735, alongside the topics listed on Form 1732. You'll also be trained on how to clock in and out for Electronic Visit Verification, and that training gets documented on Form 1732 too., For how training rules differ by payment route, see our guide to paid family caregiver training.

Where to Get Help in Texas

Texas Aging and Disability Resource Center (ADRC) A trained professional points you to caregiver services and helps with long-term care funding, intake, and eligibility, in all 254 Texas counties. 1-855-937-2372 www.hhs.texas.gov/services/aging/long-term-care/aging-disability-resource-centers
VA Caregiver Support Line Helps with PCAFC and Veteran-Directed Care questions and finding your local VA Caregiver Support Coordinator (staffed Monday-Friday, 8 a.m. to 8 p.m. ET). 1-855-260-3274 www.caregiver.va.gov/support/support_benefits.asp
Financial Management Services Agency (FMSA) Directory Helps with choosing the state-approved agency that runs your payroll, background checks, and tax filings once you enroll in CDS. www.hhs.texas.gov/providers/long-term-care-providers/consumer-directed-services-cds/fmsa-agencies

Next Steps

  1. Check if your loved one qualifies for Medicaid. The $2,982/month figure you'll see quoted everywhere is the 2026 special income limit, and HHSC's 2026 chart uses it for Medicaid institutional care, home and community-based waiver services, and Community Attendant Services alike. It is not a universal Medicaid cutoff. It is measured against countable income, not gross: HHSC's Appendix XXXVI states that "[t]he special income limit applies only to a person's countable income," so do not rule your parent out by holding their gross monthly income up against it. Countable resources are capped at $2,000 for an individual ($3,000 for a married couple living together).,, Community First Choice runs on a different track, since it is a state plan benefit that reaches members with SSI or SSI-related Medicaid. Apply at YourTexasBenefits.com or call 2-1-1.
  2. Call the Texas ADRC (see Where to Get Help above). Tell them you want to become a paid family caregiver, and they'll help you figure out which program fits and connect you with the right people.
  3. If your loved one is a veteran, contact the VA Caregiver Support Line to ask about PCAFC or Veteran-Directed Care.
  4. Choose an FMSA from the state directory and schedule your orientation.

For a broader view of all Texas Medicaid options, see our guide to Texas Medicaid programs for seniors.

Learn More

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. CaregiverCaregiver Resources in Texas: The Brevy Pillar GuideFamily caregivers in Texas: how to get paid through Medicaid CDS and VA programs, how to get respite, what state programs exist, and who to call. Updated 2026. 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. CaregiverRespite Care in Texas: A Guide for Family CaregiversFind respite care in Texas through Medicaid, VA benefits, and state programs. Learn about in-home, adult day care, and facility-based options for caregivers. VA BenefitsVA Senior Care Benefits in TexasVA senior care benefits in Texas cover home care, nursing homes, and Aid and Attendance up to $34,488 a year for a veteran with a spouse. How to apply in 2026. MedicaidTexas Medicaid Programs for SeniorsTexas Medicaid programs for seniors 65+ include STAR+PLUS, CAS, HCBS waivers, and PACE. Find out what each one covers, who qualifies, and how to enroll.

Find personalized help getting paid as a Texas family caregiver 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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