Paying Family Caregivers in Texas: Navigating CDS and Other Options
If you are caring for a family member in Texas, you may have asked the question a lot of caregivers eventually ask out loud: Can I get paid for this?
The answer in Texas is more often yes than people realize. The programs that pay family caregivers are not well-known. They do not advertise. They are run by state Medicaid, the VA, and a handful of state-level departments, and the rules vary by program and by the person being cared for.
This guide walks through the main programs available to family caregivers in Texas, what each one covers, and where to start. It is not a substitute for talking to a Texas Medicaid eligibility worker, a VA benefits counselor, or an elder law attorney. It is a map of the territory so you know what to ask for.
Start here: who is the person being cared for?
Every Texas caregiver-payment program is structured around the person receiving care, not the person providing it. Before you can figure out what you might qualify for, you need a clear picture of:
- Are they on Texas Medicaid? If not, would they qualify based on income and assets?
- Are they a veteran, the spouse of a veteran, or the surviving spouse of a veteran?
- What is the level of care they need? Help with bathing, dressing, meals, medication, mobility?
- Do they live in their own home, with family, or in a facility?
The answers to those four questions point you at different programs.
Consumer Directed Services (CDS)
This is the most common path for paid family caregiving in Texas. CDS is a service-delivery option inside several Texas Medicaid programs, including STAR+PLUS HCBS, Community First Choice, and the 1915(c) waivers. It lets the person receiving care hire their own attendant, including in many cases a family member.
Key things to know:
- The person receiving care has to be enrolled in a qualifying Texas Medicaid program first. CDS is the how, not the what.
- The caregiver is paid as the employee of the person receiving care, through a Financial Management Services Agency (FMSA). The FMSA handles taxes, payroll, and compliance.
- Spouses generally cannot be paid through CDS in Texas. Adult children, siblings, and other family members typically can.
- The caregiver does not need a nursing license. They do need to complete the basic training and paperwork the FMSA requires.
To start: call the Texas Health and Human Services Commission at 211 or contact the local Managed Care Organization that runs your parent's STAR+PLUS coverage. Ask specifically about CDS as a service delivery option.
STAR+PLUS Home and Community-Based Services
STAR+PLUS is the Texas Medicaid managed care program for adults with disabilities and adults 65 and older. The HCBS waiver inside STAR+PLUS pays for services that keep someone in their home instead of a nursing facility, and many of those services can be delivered through CDS.
Eligibility is based on income, assets, and a clinical assessment of how much help the person needs. Each Managed Care Organization handles enrollment for its region. The waiting lists for some STAR+PLUS HCBS services can be long, so the sooner the application is in, the better.
Community First Choice (CFC)
CFC is a Medicaid state plan service in Texas that provides personal assistance services to people who meet a clinical level of need. Unlike the waiver programs, CFC does not have a waiting list. If your parent is eligible for Texas Medicaid and meets the clinical criteria, they can access CFC.
CFC services include help with daily activities like bathing, dressing, meal prep, and mobility — and like STAR+PLUS HCBS, these can be delivered through CDS with a family caregiver as the paid attendant.
VA Aid and Attendance
If the person being cared for is a wartime veteran, the surviving spouse of a wartime veteran, or in some cases the spouse of a living wartime veteran, they may qualify for VA Aid and Attendance. This is a pension benefit, not a direct caregiver wage, but it gives the family flexibility in how the money is used, including paying a family member for care.
The 2025 maximum monthly Aid and Attendance benefit for a single veteran needing care exceeds 2,200 dollars, and surviving spouse benefits are also substantial. Eligibility depends on military service, income, assets, and medical need.
The best place to start is a free, accredited Veterans Service Officer through the Texas Veterans Commission. Avoid anyone who charges a fee to "help you apply." Accredited VSOs are free and trained.
What about non-Medicaid families?
If your parent does not qualify for Medicaid and is not a veteran, the paid options are narrower. Some long-term care insurance policies pay family caregivers if the policy allows it. A few employer-sponsored benefit programs include family caregiver stipends. The Texas Lifespan Respite Care Program offers limited respite vouchers that can pay a family caregiver for short stretches.
If you are in this situation, a one-time consultation with a Texas elder law attorney is often worth it. They can look at the family's finances, the parent's care needs, and whether Medicaid planning makes sense in your specific case.
How to actually start
- Call 211 in Texas. Ask for "long-term services and supports" and explain your parent's situation. The intake worker can route you to the right local agency.
- Look up your parent's Managed Care Organization. If they are on Medicaid, they are enrolled with one of a handful of MCOs in their region. The MCO's service coordinator is your single best resource for navigating CDS.
- Contact a Veterans Service Officer. Even if you do not think your parent qualifies, the screening is free and they will tell you if there is a path.
- Document care needs in writing. Every program asks for a clinical picture of what help your parent needs. Keep notes about the activities of daily living your parent struggles with. You will need them.
The system is not easy. Getting paid as a family caregiver in Texas takes paperwork, patience, and usually a few phone calls that go nowhere before you find the right one. But for many families, the money is real, and it is the difference between holding on and burning out.
You are already doing the work. There is a path to being compensated for some of it. It is worth the afternoon to find out which path is yours.
Start free with SeniorThrive and keep the rest of the caregiving picture organized while you sort out the financial piece. Your circle, your parent's care, in one place.
