How to Get Paid as a Family Caregiver in Texas

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: averaging $13.00 per hour through Medicaid programs, or up to $3,499 per month through VA caregiver stipends.

In This Guide

• Key Takeaways
• Texas Paid Caregiver Programs at a Glance
• Medicaid CDS: The Main Path for Family Caregivers
• Who Can (and Can't) Be a Paid Caregiver
• How Much You'll Get Paid
• How to Become a Paid Family Caregiver: Step by Step
• VA Programs That Pay Family Caregivers
• Taxes, Payroll, and What to Expect
• Frequently Asked Questions
• Next Steps

Key Takeaways

• Yes, family members can get paid to be caregivers in Texas through Medicaid's Consumer Directed Services (CDS) program.
• Adult children, grandchildren, and siblings can be hired. Spouses can't under Medicaid programs.
• Pay averages $13.00 per hour (state reimbursement rate), for up to 50 hours per week.
• No pre-certification training is required. The care recipient trains you on their specific needs.
• If your loved one is a veteran with 70%+ service-connected disability, the VA PCAFC program pays spouses up to $3,499/month in Houston.

Texas Paid Caregiver Programs at a Glance

Two Paths: CDS vs. Agency Model

When your loved one qualifies for Medicaid attendant services, they choose between two delivery models:

Path 1: Consumer Directed Services (CDS) — You Get Hired Directly

CDS lets your parent or loved one become your employer. They hire you directly, set your schedule, and direct the care they receive. A Financial Management Services Agency (FMSA) handles the paperwork and payroll so neither of you has to deal with taxes or employment law.

Why families choose CDS:

• You pick your own caregiver (yourself, a family member, a friend)
• Flexible scheduling — you and your parent decide when care happens
• The care recipient stays in control of who provides their care
• Family members can be paid (adult children, grandchildren, siblings)

Path 2: Agency Model — A Home Health Agency Sends Workers

Under the agency model, your loved one's MCO assigns a home health agency that sends attendants on a set schedule. The agency hires, trains, and supervises the workers.

Why some families choose the agency model:

• No employer responsibilities — the agency handles everything
• Backup coverage if a worker calls out
• Access to a wider pool of trained attendants
• Less paperwork for the care recipient

Which Path Lets You Get Paid?

CDS is the only path that lets family members get paid as caregivers. Under the agency model, the agency's employees provide care — you can't hire yourself through someone else's agency.

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 and no waitlist
• Community First Choice (CFC) with no waitlist (it's an entitlement)
• STAR+PLUS HCBS waiver (broader services, but has a waitlist)

The fastest path is through CAS or CFC, since neither has a waitlist. If your parent is already on Texas Medicaid, ask their service coordinator about switching to CDS. They're required to present the CDS option to every member at least once a year.

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

This is where a lot of families get confused, and where many websites get it wrong.

Can be hired under Medicaid CDS:

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

Cannot be hired under Medicaid CDS:

• Spouses (wife or husband of the care recipient)
• The care recipient's Designated Representative or their spouse
• Court-appointed guardians
• Anyone convicted of a barring offense under Texas Health and Safety Code Chapter 250

What If You're a Spouse?

If you're a spouse providing care, you have two options outside of standard Medicaid:

1. CMPAS (Consumer Managed Personal Attendant Services): This is a state-funded (not Medicaid) program for people with physical disabilities. It's the only Texas attendant program that allows spouses to be paid. Contact HHSC for eligibility details.

2. VA PCAFC: If your spouse is a veteran with a service-connected disability rated at 70% or higher, the VA's Program of Comprehensive Assistance for Family Caregivers pays monthly stipends of $2,187 to $3,499 (in Houston). Spouses are the most common participants.

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. The actual amount you receive depends on your MCO, region, and your loved one's approved budget. At 20-50 hours per week, that works out to roughly $1,040 to $2,600 per month before taxes.

Under CDS, your parent (the employer) sets your actual hourly wage within their approved budget. At least 90% of the total CDS rate must go to worker compensation (wages, payroll taxes, benefits). The remaining 10% covers FMSA administrative fees.

The number of paid hours depends on the care recipient's assessed needs. CAS authorizes up to 50 hours per week, while other programs base hours on the Individual Service Plan.

How to Become a Paid Family Caregiver: Step by Step

The whole process typically takes 30 to 90 days from the initial CDS request to your first paycheck. The background check and FMSA setup are what take the longest. Having your documents ready speeds things up.

One thing most families don't expect: the orientation meeting with the FMSA covers a lot of ground. You'll go through budget development, learn how EVV works, and sign multiple forms. Block out at least two hours for it. And keep copies of everything you sign — you'll reference those forms when questions come up later about authorized hours or pay.

VA Programs That Pay Family Caregivers

If your loved one is a veteran, two federal programs pay family caregivers without the Medicaid spouse restriction.

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 based on the OPM GS-4 Step 1 salary for your area.

In Houston for 2026, that's approximately $2,187/month (Level 1) or $3,499/month (Level 2). Level 2 applies when the veteran is unable to sustain themselves in the community without care.

The veteran must have a service-connected disability rated at 70% or higher and need in-person care for at least 6 continuous months. Spouses, adult children, and other family members can all serve as the Primary Caregiver.

Beyond the stipend, the Primary Caregiver also receives CHAMPVA health insurance (if otherwise uninsured), mental health counseling, and at least 30 days of respite care per year for the veteran.

Apply with VA Form 10-10CG at va.gov or 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, self-directed budget to hire their own caregivers. Unlike Medicaid CDS, spouses can be hired. The budget is individualized based on clinical need. Currently about 6,085 veterans participate nationally.

Contact your local VA Medical Center social worker to check availability 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. The FMSA handles all payroll: federal income tax withholding, Social Security (6.2%), and Medicare (1.45%). 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. Your caregiver income is not counted when determining the care recipient's Medicaid eligibility. You're a separate individual with separate income. The one exception: if you're a spouse and the caregiver income is through CMPAS or VA, combined household income may be considered for other benefits.

Workers' Compensation

Workers' comp is optional in Texas. CDS employers can purchase a policy from their program budget. If they don't, the employer (your parent) bears liability for work-related injuries.

Next Steps

1. Check if your loved one qualifies for Medicaid. Income must be at or below $2,982/month with assets under $2,000. Apply at YourTexasBenefits.com or call 2-1-1.
2. Call the ADRC at 1-855-937-2372. Tell them you want to become a paid family caregiver. They'll help you figure out which program fits and connect you with the right people.
3. If your loved one is a veteran, call the VA Caregiver Support Line at 1-855-260-3274 to ask about PCAFC or VDC.
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. If you're a caregiver who also needs support, check out our guides to Texas caregiver programs and respite care in Texas.

Find home health care near you 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. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.