In Texas, an adult child, sibling, or friend can be paid to care for a loved one through Medicaid's Consumer Directed Services; a spouse can be paid through the VA, and through the non-Medicaid CMPAS program only in the narrow circumstances that remain open; and the state funds respite breaks most families never find. If you're caring for an aging parent, spouse, or relative here, you are part of a large, dedicated community of unpaid family caregivers holding up an eldercare system that would otherwise collapse without you. You are not alone, and you are not without options.

This is the guide that ties everything together, the questions families ask first, the programs that actually pay, the respite vouchers most families never knew existed, and the phone numbers that get you to a human being instead of a website. Texas has built one of the larger caregiver-support infrastructures in the South, anchored by Consumer Directed Services (CDS), the state's umbrella term for self-direction across 10+ Medicaid programs, and 28 Area Agencies on Aging covering all 254 counties.

But Texas is also one of the most complicated states to navigate. CDS rules differ by program. Spouses can't be paid through Medicaid (with one important exception). The waitlists for some HCBS waivers stretch years. The pay rate floor is $13.00/hour, but actual take-home varies dramatically by managed-care organization.

This pillar links to the dedicated guides that go deep on each topic. Read this overview first, then bookmark the dedicated articles for the questions that apply to your family.

In This Guide

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How This Guide Is Organized

This pillar contains everything you need to know about being a family caregiver in Texas, organized around the four questions most families ask first.

Your Question Dedicated Guide
How do I get paid for caregiving? How to Get Paid as a Family Caregiver in Texas
How do I get a break from caregiving? Texas Caregiver Respite Care
What programs are available? Texas Caregiver Programs
Where can I find Texas Medicaid info? Texas Medicaid Pillar

This pillar landing summarizes each topic. The dedicated guides go deep with eligibility tables, application walkthroughs, MCO-by-MCO pay rates, and the exact phone numbers and forms.

How Do I Get Paid as a Caregiver in Texas?

The single most-asked question we get from Texas families. The short answer: yes, in most cases, but the pathway depends on whether your loved one is on Medicaid, has a VA disability rating, or qualifies for CMPAS.

The main path is Medicaid CDS (Consumer Directed Services). Texas allows self-direction across 10+ programs, STAR+PLUS, STAR+PLUS HCBS, CAS (Community Attendant Services), PHC (Primary Home Care), Family Care, HCS, TxHmL, CLASS, DBMD, CMPAS, STAR Health, and STAR Kids MDCP. CFC (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, and the only rows carrying no CFC service are CMPAS and the combined Primary Home Care, Family Care, and Community Attendant Services row. Under CDS, the person receiving services (or their legally authorized representative) is the employer of record and assumes the liability that comes with it. They hire, manage, supervise, and train the attendant and set the wages and benefits. An FMSA (Financial Management Services Agency) is the employer's employer agent, the IRS term for an entity that carries out employer duties on the employer's behalf without becoming the worker's actual employer: it runs payroll, withholds federal income tax, Social Security, and Medicare, and reports and pays the employer taxes. Attendants are W-2 employees, not contractors. The FMSA does not hire, supervise, schedule, or dismiss anyone. Those decisions, and the liability behind them, stay with the family.,,

One eligibility trap worth knowing before you plan around CFC. Community First Choice is a Medicaid state plan benefit authorized under Section 1915(k), not a waiver. In STAR+PLUS it reaches members who meet an institutional level of care and functional criteria and who receive SSI or SSI-related Medicaid; members whose Medicaid is medical assistance only (MAO) are excluded. The higher special income limit families hear about (300% of the SSI federal benefit rate) is the pathway to institutional care and to home and community-based waiver services, and it is not a CFC pathway: someone who qualifies for Medicaid that way is not in a state plan eligibility group, so they receive attendant services through the waiver instead.

Who can be hired: adult children, grandchildren, siblings, in-laws, friends, neighbors. Who cannot: the person receiving services, their spouse (the CMPAS exception is below), and the legally authorized or designated representative or that representative's spouse, so a relative who serves as the representative cannot also be the paid attendant. Individual programs can restrict other relatives; Form 1726 defines the relationships.,

The spouse exception is CMPAS (Consumer Managed Personal Attendant Services), a Texas non-Medicaid 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 one place in HHSC's attendant rules where a spouse may be employed as the paid attendant.

Read the limit before you count on it, because it is where most families' plans come apart. Under 26 TAC 275.25, a person may not receive CMPAS at all 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 stay in CMPAS when managed care expanded to include where they live. STAR+PLUS covers all 13 service delivery areas. For a Medicaid-eligible Texan today, then, spouse pay through CMPAS is a grandfathered arrangement rather than a door you can newly walk through, and the program runs only in the areas where it is actually offered. If your spouse is not already your paid CMPAS attendant, the VA programs below are the realistic route.

Where CMPAS is open, an applicant must be 18 or older, need 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. Rather than a hard income cutoff, the program uses an income-based co-payment, so income alone does not disqualify anyone.

Pay floor: Effective September 1, 2025, the HHSC attendant reimbursement rate supports an average $13.00/hour wage in STAR+PLUS, with 14% PTB (payroll taxes & benefits) for community-based care. Actual take-home pay varies by managed-care organization (MCO) and region, because each MCO sets attendant wages within the HHSC rate. Under CDS, the family-employer can adjust wages within budget limits, with at least 90% of the total CDS rate going to provider compensation. The FMSA's monthly fee comes out of that service rate before you allocate wages and benefits, so budget from the rate you are given, not the headline hourly figure.

Hours: capped at approximately 50 hours per week under most attendant programs (CAS specifically caps at this level). CFC has its own service-plan-driven hour caps; HCS, CLASS, and DBMD have higher allotments for individuals with intellectual/developmental disabilities.

No mandatory training: Texas does not require pre-certification training for CDS attendants. The care recipient (or LAR) trains the attendant on their specific needs.

Background checks are required by the FMSA before pay starts. EVV (Electronic Visit Verification) is mandatory for all Medicaid personal care services, including services delivered through CDS. 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 VA pathway: if your loved one is a veteran with 70%+ service-connected disability, the Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays family caregivers, including spouses, a tax-free monthly stipend. It is the OPM GS-4, step 1 annual rate for the veteran's locality pay area divided by 12, then multiplied by one of the four factors set in 38 CFR 71.40(c)(4)(i). Houston's 2026 GS-4 step-1 annual salary is $41,989, a monthly base of about $3,499, so the stipend there runs about $3,499 at the 1.00 factor, about $2,187 at 0.625, and about $875 at 0.25.

Which factor applies depends on how the household came into the program. Under the current program (38 CFR 71.20(a)) it is 0.625, or 1.00 when 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 factor 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. On that legacy route no self-sustain determination is required at all, so a legacy household rated 21 or higher reaches the full 1.00 on the rating sum alone. A veteran who meets both routes is paid whichever amount 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 the VA has on record. The legacy schedule runs eight years from October 1, 2020 and lapses October 1, 2028. If you are not sure which route you are on, ask your VA Caregiver Support Coordinator before assuming the lower number.

Veteran-Directed Care (VDC) provides a separate flexible budget that can be paid to family caregivers, including spouses.

→ The full step-by-step, with eligibility checklists, program-by-program tables, MCO contact info, and tax handling: How to Get Paid as a Family Caregiver in Texas.

How Do I Get a Break? (Respite)

Caregiver burnout is real, measurable, and unfortunately common, and Texas has more respite resources than most families realize. The hardest part is finding them.

Take Time Texas (apps.hhs.texas.gov/taketimetexas) is the HHSC-operated statewide respite directory, a searchable database of in-home, adult day, and institutional respite providers.

The Texas Lifespan Respite Care Program (delivered to the public as Take Time Texas) funds substitute respite care so a family caregiver can take a break, it pays for the fill-in care, not the family caregiver's own time. It is part of the federal Lifespan Respite Care Program administered by the Administration for Community Living (ACL), and families access it through their local Area Agency on Aging or ADRC. Any voucher or reimbursement amount and its rules are set locally and vary by area, so call your local agency for current amounts and eligibility.

NFCSP (National Family Caregiver Support Program / Title III-E) is delivered through Texas's 28 AAAs. It funds five service categories: information about available services, assistance gaining access to those services, individual counseling plus support groups and caregiver training, respite care, and supplemental services on a limited basis. Four groups of caregivers are eligible, and most families only know about the first two: adult family members or other informal caregivers of someone 60 or older; adult family members or other informal caregivers of a person of any age with Alzheimer's disease or a related disorder; older relatives who are not parents, age 55 or older, caring for a child under 18; and older relatives, including parents, age 55 or older, caring for an adult aged 18 to 59 with a disability. Texas AAA services are targeted to those with the greatest economic and social need. Call 1-800-252-9240 to be routed to your local AAA.

Medicaid respite is built into many of the same programs that pay caregivers, STAR+PLUS, CAS, HCS, CLASS, DBMD all have respite as a service category. If your loved one is already enrolled, ask the service coordinator to add respite to the plan of care.

VA respite is available for veterans enrolled in VA healthcare, up to 30 days/year of in-home, adult-day, or institutional respite. The VA Caregiver Support Line (1-855-260-3274) routes to the local Caregiver Support Coordinator who arranges it.

Adult Day Services in Texas are licensed by HHSC and can be Medicaid-funded under STAR+PLUS or paid out-of-pocket (adult day health care runs near a national median of $95/day, with Texas costs typically lower). Many programs serve people with dementia specifically.

Hospice respite, if your loved one is on hospice, Medicare/Medicaid covers up to 5 consecutive days of inpatient respite, repeatable, a benefit built into hospice coverage that often goes unused.

Faith-based respite and neighborhood respite networks also exist in Texas. So does PACE (Program of All-Inclusive Care for the Elderly), though it belongs on this list only sideways: its day health care can free up your daytime hours, but PACE is all-inclusive care that is mutually exclusive with STAR+PLUS and every other HHSC program, not a respite benefit you add on. It also reaches only three service areas, El Paso (Bienvivir Senior Health Services, 915-562-3444), Amarillo and Canyon (The Basics at Jan Werner, 806-374-5516), and Lubbock (Silver Star Health Network, 806-740-1500), and enrolling requires being 55 or older, having chronic medical problems and functional impairments, meeting nursing facility medical necessity criteria, choosing PACE, and qualifying for SSI or Medicaid under the institutional special income limit.

→ The full respite playbook, with funding-rail-by-funding-rail tables, voucher application walkthroughs, and the AAA directory: Texas Caregiver Respite Care.

What Caregiver Programs Exist in Texas?

Beyond pay and respite, Texas runs an array of programs that don't cut a check directly to the family but provide real, dollar-equivalent value: training, counseling, equipment, home modifications, emergency response systems, and tax credits.

Federal NFCSP through 28 AAAs, the workhorse, delivering information, access assistance, counseling, training, respite, and limited supplemental services to four eligible groups of caregivers.

State-funded Lifespan Respite vouchers through AAAs.

Take Time Texas state respite directory.

Medicaid CDS across STAR+PLUS, STAR+PLUS HCBS, CAS, PHC, Family Care, HCS, TxHmL, CLASS, DBMD, STAR Health, and STAR Kids MDCP, the self-direction layer that lets the family hire its own caregiver. CFC is not a separate program row there: CFC personal care services and CFC habilitation self-direct inside STAR+PLUS, STAR+PLUS HCBS, STAR Health, STAR Kids, CLASS, DBMD, HCS, MDCP, and Texas Home Living, not inside CMPAS or the combined PHC, Family Care, and CAS row.,

CMPAS, non-Medicaid, for adults with physical disabilities, and the only route where a spouse may be the paid attendant, though a Medicaid-eligible Texan in a managed care service area can use it only if their spouse was already the attendant before managed care arrived.

VA Programs, PCAFC stipends, VDC flexible budgets, and respite for service-connected veterans.,,

Alzheimer's Association Texas chapters, six regional chapters cover the state: Houston & Southeast Texas, Dallas & Northeast Texas, North Central Texas, San Antonio & South Texas, Capital of Texas (Austin), and West Texas (Amarillo, El Paso, Lubbock, the Permian Basin, San Angelo). Each offers care consultations, support groups, and family education at no charge, and the Association's national 24/7 helpline (800-272-3900) reaches a live person in more than 200 languages.

Federal tax provisions, Credit for Other Dependents, Medical Expense Deduction, Dependent Care Credit (if you pay for adult day care while you work). Texas has no state income tax, so federal-only.

FMLA, federal Family & Medical Leave Act gives employees of qualifying employers up to 12 weeks of unpaid, job-protected leave to care for a parent, spouse, or child with a serious health condition. Texas does not have a state-level Paid Family Leave program.

Caregiver income impact on Medicaid, CDS is a way of delivering services, not a separate eligibility path, your loved one must already be enrolled in a Medicaid program before enrolling in CDS. HHSC is explicit that the program funds the CDS employer uses to pay workers are not reported as, and not considered, income. And because Texas deems only a spouse's income and resources to an adult applicant, the wages of a paid adult child or sibling do not count in the care recipient's eligibility determination. Those wages are still W-2 income to the caregiver.

→ The full programs roster, organized by funding source and eligibility: Texas Caregiver Programs.

Why Texas Looks Different From Other States

Texas has a few state-specific features that frequently confuse families coming from other states or comparing options online:

1. CDS is a uniquely Texas umbrella term. Most states call this "consumer direction" or "self-direction." In Texas, CDS spans 10+ Medicaid programs under one operational framework, run through FMSAs that handle payroll/taxes for all of them. This is broader than most states' self-direction architecture.

2. Spouses cannot be paid under Medicaid CDS, and the CMPAS exception is narrower than it sounds. Many states (Florida, California, Washington) permit spouses through their HCBS waivers. Texas does not, in any standard Medicaid program. The non-Medicaid CMPAS exception is real, but a person who is Medicaid eligible and lives in a managed care service area may not receive CMPAS at all unless their spouse was already employed as their attendant when managed care reached them.,

3. Take Time Texas + the Lifespan Respite Care Program exist. Texas runs both a statewide respite directory and a Lifespan Respite program that funds fill-in care through local Area Agencies on Aging, a combination not every state offers.,

4. EVV is mandatory and strict. All Medicaid personal care services in Texas are subject to Electronic Visit Verification, an approved clock-in and clock-out at the start and end of every shift. A missed clock-in is fixable, but only for a while: visit maintenance, including manually entering a visit an employee failed to clock, has to be completed within 95 calendar days of the date of service, after which the EVV system locks the transaction and it can be corrected only if the payer approves a Visit Maintenance Unlock Request. Some families find EVV intrusive; it is non-negotiable for Medicaid pay.

5. Texas has no state income tax, and no state Paid Family Leave. Federal FMLA is the only protected leave; tax savings come exclusively from federal credits and deductions.

What This Pillar Doesn't Yet Cover

We are continuously expanding this pillar. Topics planned for 2026:

  • Kinship caregivers, grandparents raising grandchildren, with state TANF and federal SSI/SSDI specifics for Texas.
  • Adult Day Services finder, county-by-county directory of licensed adult day centers.
  • PACE deep-dive, Texas has three PACE sites, all confined to designated service areas; we will publish a dedicated guide.
  • Nursing home placement decision guide, when CDS hours run out and the family must consider facility care.
  • CMPAS application walkthrough, the spouse-pay path is narrow and largely grandfathered; we will publish a step-by-step.
  • Caregiver tax filing guide, IRS Notice 2014-7 in detail, plus federal credit stacking.

If your situation isn't covered above, call the HHSC Benefits line at 1-800-252-8263 or your AAA at 1-800-252-9240, they are the two phone calls that answer the large majority of caregiving questions in Texas.

Where to Get Help: Key Texas Caregiver Contacts

These are the phone numbers that reach a person who knows the Texas system. Two calls, your Area Agency on Aging and the HHSC benefits line, resolve most caregiving questions in the state.

Area Agencies on Aging (AAA) Information and referral, benefits counseling, care coordination, and caregiver support for people 60 and older and their family members and caregivers. The 28 AAAs are also where NFCSP caregiver services, including respite, are delivered. 1-800-252-9240 hhs.texas.gov (Area Agencies on Aging)
Aging and Disability Resource Center (ADRC) Long-term care navigation and program screening, serving all 254 Texas counties. 1-855-937-2372
HHSC Medicaid & Benefits / 2-1-1 Texas Medicaid and benefits questions; dial 2-1-1 (or 1-877-541-7905) for 24/7 community-resource referrals. 1-800-252-8263 211texas.org
VA Caregiver Support Line VA caregiver programs, PCAFC, and respite; staffed Monday through Friday, 8 a.m. to 8 p.m. ET. 1-855-260-3274 caregiver.va.gov
Alzheimer's Association 24/7 Helpline (national) Around-the-clock support, crisis assistance, and local-resource referrals in more than 200 languages. This is the Association's national line, not a chapter number; agents can also register you for free support groups and education programs. 1-800-272-3900 alz.org helpline
Take Time Texas The statewide respite-provider directory, searchable for in-home, adult day, and institutional respite. apps.hhs.texas.gov/taketimetexas

The Bottom Line

  1. Yes, you can probably get paid, through Medicaid CDS (adult children, siblings, in-laws) or VA programs (including spouses). The one Texas exception for spouses, CMPAS, is effectively closed to Medicaid-eligible Texans in a managed care service area unless the spouse was already the paid attendant before managed care arrived.,
  2. Take Time Texas + Lifespan Respite vouchers exist, most families never use them. Call your AAA at 1-800-252-9240 and ask.
  3. EVV is mandatory. If you cannot or will not clock in and out on an approved method for every shift, Medicaid CDS is not the right path, and a visit left unfixed for 95 calendar days locks.
  4. Layer the payors. Medicaid CDS for daily care + AAA Lifespan Respite voucher for breaks + VA PCAFC if applicable + federal tax credits, most families qualify for 3+ at once.
  5. The system is more generous than it looks, but only if you find it. Texas funds caregiver supports across at least 5 distinct funding streams. The hardest part of using them is knowing they exist.

Quick Navigation

Topic Where to Read
Get paid through Medicaid CDS How to Get Paid
Get paid through VA (spouses OK) How to Get Paid
Take a break (respite) Respite Care
Lifespan Respite voucher Respite Care
All Texas caregiver programs Caregiver Programs
Texas Medicaid eligibility & application Medicaid Texas
STAR+PLUS HCBS waiver STAR+PLUS Waiver
Texas Medicaid managed care plans Managed Care Plans
Spend down for nursing home Medicaid Spend Down
Long-term care Medicaid (nursing home) LTC Medicaid
Caregiver burnout signs Burnout & Support

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. CaregiverTexas Caregiver Respite CareFind respite care in Texas through Medicaid, VA benefits, and state programs. Learn about in-home, adult day care, and facility-based options for caregivers. CaregiverTexas Caregiver ProgramsFind caregiver programs in Texas including Medicaid paid caregiver options, respite care, support groups, and free resources for family caregivers in 2026. CaregiverCaregiver Burnout: Signs and SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. MedicaidTexas Medicaid: The Brevy Pillar GuideTexas Medicaid for seniors: 2026 income and asset limits, the STAR+PLUS managed-care program, HCBS waivers, Medicare Savings Programs, and how to apply.

Texas has built a real caregiver-support system over the last two decades, but it is decentralized across HHSC, MCOs, AAAs, and the VA. The phone numbers throughout this guide route you to humans who know the system. Start with one phone call. The rest of this pillar is here when you need it.

Find personalized help with Texas caregiving at brevy.com.

Your next step Make one call to start: reach your Area Agency on Aging at 1-800-252-9240 and ask about caregiver support, the Lifespan Respite voucher, and NFCSP services, then work down the funding streams in this guide from there.

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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.