Texas Caregiver Programs: Paid Family Care, Respite and Support

Texas has several kinds of caregiver support programs. If you're caring for an aging parent or spouse, there are programs that can pay you for your work, give you a break through respite care, connect you with other caregivers, and help you figure out the benefits your loved one qualifies for.1 You don't have to do this alone, and you don't have to pay for everything out of pocket.

In This Guide

• Key Takeaways
• Texas Caregiver Programs at a Glance
• Texas Programs That Pay Family Caregivers
• Respite Care Programs
• Support Groups and Counseling
• Your Local Area Agency on Aging
• Other Caregiver Resources
• Key Phone Numbers and Contacts
• Frequently Asked Questions
• Next Steps

Texas Caregiver Programs at a Glance

Here is how the major Texas caregiver programs compare.2,9,5,6,4,3,10,7,1,8,11

Texas Programs That Pay Family Caregivers

For the step-by-step process, see our guide to getting paid as a family caregiver in Texas.

Medicaid Consumer Directed Services (CDS)

CDS is the do-it-yourself route, where your loved one becomes your employer through Texas Medicaid.2 They are the employer of record and carry the liability: they hire you, set your schedule, set your wages and benefits, train and manage you, and can end your employment. A Financial Management Services Agency (FMSA) registers as their agent with the IRS and the Texas Workforce Commission. The FMSA processes payroll and the tax withholdings and filings, approves and monitors the budget, and runs the background and registry checks.12,2

HHSC lists more than a dozen programs whose services can be self-directed through CDS.2 For an older adult, these are the three to know:

• STAR+PLUS, Texas's Medicaid managed care program for adults13
• Community Attendant Services (CAS) with up to 50 hours per week of personal care (42 for a recipient with priority status)14
• 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 list13

As a state plan benefit, CFC requires the person to be in a state plan eligibility group, need 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, including those who qualify through the higher special income limit Texas uses for institutional care and waiver services; they get attendant services through the waiver instead. That limit also applies to Community Attendant Services, so income over the SSI limit closes CFC without, by itself, closing every attendant-care route.13

CFC personal care and habilitation can be self-directed inside STAR+PLUS and several other programs, but not inside Primary Home Care, Family Care, Community Attendant Services, or CMPAS, so in practice a senior reaches CFC self-direction through STAR+PLUS.2

There is no single statewide CDS wage. Texas sets Medicaid attendant rates to support an average attendant wage of $13.00 per hour, a rate-setting assumption rather than a guaranteed wage, and your loved one, as employer, sets your pay within the CDS budget, at no less than the federal minimum wage.15 Relatives HHSC doesn't name are not excluded, but under CDS the paid worker can't be the employer or the employer's spouse, the person's spouse, the designated representative or their spouse, or the person's legally authorized representative, which includes an adult's court-appointed guardian. In Community Attendant Services, Primary Home Care, and Family Care, the primary caregiver can't be hired under CDS either.16 The spouse bar lifts only in CMPAS.17 These bars govern CDS hiring, so a relative caught by one should ask the service coordinator whether the agency option can pay them.16 For Community First Choice's agency models, the HHSC sources we rely on don't say whether a spouse can be paid, so ask the MCO service coordinator.18 Community Attendant Services' general rule still bars the recipient's spouse.14

One more paid relative route sits in STAR+PLUS HCBS adult foster care. The adult foster care home provider may be the member's relative, excluding the spouse, who lives in the household, is the primary caregiver and is contracted with the member's MCO or an MCO-contracted agency; the home may be the member's own.18

CDS is a way to deliver services, not a separate eligibility path, so your loved one must already be enrolled in Medicaid. When your loved one is their own CDS employer, HHSC says the funds that pay for their services are not counted as their income. Texas's deeming rules reach only a parent or a spouse, so they give no route for a paid adult child's or sibling's wages to be counted in your loved one's eligibility.19 You are still a payroll employee, with taxes taken out of each paycheck.20 As employer, they must train you, including on EVV clock-in and clock-out, and document it on Form 1732,17 and make sure you clear the background checks before you're hired.21 If the employer role is too much, they can leave CDS for a provider agency at any time.22

CMPAS (Consumer Managed Personal Attendant Services)

If your loved one doesn't qualify for Medicaid, CMPAS may be an option. It is a Texas non-Medicaid program for adults with physical disabilities who are able to direct their own care or have someone who can supervise the attendant for them.4 Unlike the Medicaid programs above, a spouse may be employed as the paid attendant through CMPAS. But a relative designated to direct the attendant serves unpaid and can't also be the paid attendant. Rather than a hard income cutoff, the program uses an income-based co-payment, so a family can take part regardless of income.4

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.4 Texas Medicaid managed care is organized into 13 service areas, with at least two STAR+PLUS health plans in each one.23 The same rule also shuts CMPAS to anyone already receiving Primary Home Care, Family Care, Community Attendant Services, Residential Care, Adult Foster Care, or a Section 1915(c) waiver.4

Family Care

Family Care provides in-home personal attendant services to people eligible under Title XX of the Social Security Act, and to qualify your loved one must be ineligible for attendant care funded through Medicaid. Texas's attendant rule bars a spouse in Primary Home Care and Community Attendant Services but makes an exception for Family Care, so the provider agency may hire a spouse or another relative as the paid attendant. Hours are capped at 50 a week, or 42 with priority status. If Family Care is self-directed through CDS, the spouse and the primary caregiver cannot be the paid worker.5

VA Caregiver Programs

The VA offers two caregiver programs:

Program of Comprehensive Assistance for Family Caregivers (PCAFC): Pays a monthly stipend: the OPM GS-4 step-1 annual rate for the veteran's locality pay area, divided by 12, times a multiplier. Houston's 2026 rate of $41,989 gives a base of about $3,499 a month by our arithmetic (VA publishes no Houston dollar stipend).3

• Current program (38 CFR 71.20(a)): 0.625, about $2,187/mo, or 1.00, about $3,499/mo, if VA determines the veteran is unable to self-sustain in the community.3
• Legacy participant or applicant (38 CFR 71.20(b) or (c)): set by the sum of the veteran's 2019 clinical ratings, with no self-sustain determination required. A sum of 21 or higher pays 1.00, 13 to 20 pays 0.625, and 1 to 12 pays 0.25 (about $875/mo). This schedule lapses October 1, 2028.3

A veteran who meets both is paid whichever amount is higher.3 A 70% rating is necessary but not sufficient: VA also requires a discharge or medical discharge date, a need for at least 6 months of continuous, in-person personal care, and enrollment in VA health care. The caregiver must be 18 or older and either family or someone who lives, or will live, full time with the veteran. Primary caregivers can also get CHAMPVA coverage if no other plan covers them, plus mental health counseling and at least 30 days of respite a year.3

Veteran Directed Care (VDC): Gives enrolled veterans a flexible budget, managed by the veteran or their representative, to hire their own workers, who can include family, friends, or neighbors. It's open, where available, to enrolled veterans eligible for community care who meet the clinical criteria.10

Respite Care Programs

Texas Lifespan Respite Care Program (Take Time Texas)

The state's main respite program helps family caregivers of a person of any age with a chronic health condition or disability get a break, through your local AAA or ADRC. Any voucher amounts and rules are set locally and vary by area.7

To find a respite provider near you, visit Take Time Texas. The directory lists providers without endorsing them, so check licensure yourself.24

Medicaid-Funded Respite

If your loved one is on the STAR+PLUS HCBS waiver, it covers in-home and out-of-home respite.25

NFCSP Respite Through Your AAA

Your local AAA may also offer respite directly through the National Family Caregiver Support Program.1 Under federal law, a family caregiver gets this respite only if the older person they care for is frail: unable to do at least two activities of daily living without substantial help, or needing substantial supervision because a cognitive or other mental impairment makes their behavior a serious health or safety hazard.26

VA, Hospice, and Adult Day Respite

VA respite is open to enrolled veterans who meet the clinical criteria, where available; respite from a community agency, adult day health care center, or nursing home also requires community care eligibility. A copay may be charged based on service-connected disability status and financial information, but veterans with a compensable service-connected disability are exempt.27 If your loved one is on hospice, Medicare covers most of the cost of up to five consecutive days of respite in a hospital or skilled nursing facility. Adult day care is another usual form of respite: the 2025 national median for adult day health care was $95 a day, a national figure rather than a Texas one, so ask each provider for a quote.28

Support Groups and Counseling

Alzheimer's Association Texas Chapters

The Alzheimer's Association runs separate chapters across Texas, each covering its own area, and its care consultations, caregiver support groups, and education programs are free.8

Six chapters are confirmed on the Association's site, which may not be a complete roster:8

• Houston & Southeast Texas (alz.org/texas)
• Dallas & Northeast Texas (alz.org/dallasnetexas)
• San Antonio & South Texas (alz.org/sanantonio)
• Capital of Texas / Austin (alz.org/texascapital)
• North Central Texas (alz.org/northcentraltexas)
• West Texas, serving Amarillo, El Paso, Lubbock, the Permian Basin, and San Angelo (alz.org/westtexas)

Alzheimer's Texas (txalz.org), a separate Central Texas nonprofit, also provides information, referrals, and caregiver support programs.8

The Association's national 24/7 Helpline, 800-272-3900, offers confidential support, crisis assistance, and referrals to local resources in over 200 languages.8

Your Local Area Agency on Aging

Texas's 28 Area Agencies on Aging are a good first call for caregivers.1 They deliver the Older Americans Act's National Family Caregiver Support Program: information about services in your area, help getting access to them, individual counseling, help organizing support groups, caregiver training, respite care, and limited supplemental services.1 No one can be turned away because of income, and the program reaches four groups: caregivers of adults 60 and older, caregivers of a person of any age with Alzheimer's disease or a related disorder, relatives 55 or older (other than parents) caring for a child under 18, and relatives 55 or older, including parents, 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.1,6 Call 1-800-252-9240 to reach your local AAA.9

Other Caregiver Resources

Aging and Disability Resource Centers (ADRCs)

ADRCs cover all 254 Texas counties, and a trained professional there guides you to caregiver services and helps you work through long-term care funding, intake, and eligibility.9 Call 1-855-937-2372 (855-YES-ADRC).

2-1-1 Texas

Dial 2-1-1 or visit 211texas.org for free, anonymous 24/7 referrals; choose Option 1 for community programs in your area.9 For help getting around, see our guide to senior transportation in Texas.

Federal Tax Breaks and Family Leave

Texas has no state income tax, so the income-tax breaks below are federal.29 If you claim a parent as a dependent, the Credit for Other Dependents is worth up to $500, and it's non-refundable.30 Medical expenses are deductible only if you itemize and only above 7.5% of adjusted gross income, and paying a spouse or relative for long-term care doesn't count unless they're licensed for that service. The Child and Dependent Care Credit covers care you pay for so that you can work, for a dependent or spouse who can't care for themselves and lives with you more than half the year.31

The federal Family and Medical Leave Act gives eligible employees up to 12 workweeks of unpaid, job-protected leave in a 12-month period to care for a spouse, son or daughter, or parent with a serious health condition.32 No federal law guarantees paid family and medical leave for private-sector workers, so ask your employer what paid leave it offers.33

PACE (Program of All-Inclusive Care for the Elderly)

PACE bundles primary and specialty medical care, prescriptions, day health care, in-home services, hospital and skilled nursing care, transportation, and meals into one program run by a single care team.11 To qualify you must be 55 or older, have chronic medical problems and functional impairments, meet nursing facility medical necessity criteria, live in a designated PACE service area, and choose PACE. For Medicaid to pay, the person must also be eligible for SSI or for Medicaid under the institutional special income limit. Medicare-only enrollees can join by paying a monthly premium, and others can pay privately.11

HHSC counts three PACE sites, in effect three organizations (Bienvivir runs two El Paso sites): Bienvivir Senior Health Services in El Paso, (915) 562-3444; The Basics at Jan Werner serving Amarillo and Canyon, (806) 374-5516; and Silver Star Health Network in Lubbock, (806) 740-1500.11 PACE is mutually exclusive with STAR+PLUS and every other HHSC program, so enrolling means leaving those behind.11

Electronic Visit Verification (EVV)

Texas has required electronic visit verification for all Medicaid personal care services, including services delivered through CDS, since January 1, 2021. You clock in and out with one of three HHSC-approved methods: a mobile app on a smartphone or internet-connected device, a home landline, or an alternative device, and only the mobile app is approved when a visit begins or ends in the community.34

A missed clock-in can be fixed through visit maintenance within 95 calendar days of the date of service, a window HHSC may extend as needed. After that the visit locks, and payers approve an unlock only for an unresolved EVV system error or an HHSC exception such as a natural disaster, not for a forgotten clock-in.34 Our EVV guide walks through the fix.

Key Phone Numbers and Contacts

Keep these Texas caregiver helplines and resources within reach.9,35

Next Steps

• If your loved one is on Medicaid (or might qualify), ask about CDS through their service coordinator, or read our guide to getting paid as a family caregiver in Texas.
• If your loved one is a veteran, call the VA Caregiver Support Line at 1-855-260-3274.9
• If you need a break, contact your local AAA at 1-800-252-9240 about respite vouchers.
• If you need someone to talk to, call the Alzheimer's Association 24/7 Helpline at 800-272-3900.
• If you're not sure where to start, call the ADRC at 1-855-937-2372 or chat with Brevy.

Learn More

Find personalized help connecting with Texas caregiver programs 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.