You do not need a license to be a caregiver in Texas if you are hired privately by a family to provide non-medical help like companionship, meals, errands, or assistance with bathing and dressing. The answer changes if you work for a licensed home health agency or want to work as a certified nurse aide: those roles come with training, testing, and background check requirements set by state and federal law. What follows breaks down which rules apply to which kind of caregiving work.
Private, Non-Medical Caregiving Needs No State License
Texas does not require any license or certification for a caregiver hired directly by a family for non-medical tasks. This covers most of what people picture when they think of in-home help: cooking, light housekeeping, running errands, companionship, and assistance with everyday activities like bathing, dressing, or moving around the house. As long as the arrangement is private and does not run through an agency, the state treats it as an informal employment relationship with no gatekeeping credential required to start.
No license does not mean no exposure. A private caregiver who causes harm through negligence can still face civil liability, and the family that pays you becomes a household employer under federal tax rules once wages cross a modest threshold. Those obligations are covered further down. The point for licensing purposes is simply that Texas has no professional credential standing between you and this type of work.
Working for a Licensed Home Health Agency
The requirements shift once you want to work for a Home and Community Support Services Agency (HCSSA). The Texas Health and Human Services Commission licenses these agencies under Texas Health and Safety Code Chapter 142.1Texas Administrative Code. Texas Administrative Code Title 26, Part 1, Chapter 558, Section 558.1 – Purpose and Scope The license belongs to the agency, not to you as an individual caregiver, but the agency cannot employ you unless you meet the state’s standards for training, background checks, and demonstrated competency.
Services provided by unlicensed personnel inside an HCSSA operate under the delegation of a registered nurse or physical therapist.2Texas Health and Human Services. How to Become a Licensed HCSSA Provider A home health aide working for an agency is not independently licensed, but functions under clinical supervision, and the agency is on the hook for making sure every staff member meets state standards.
Home Health Aide Training Requirements
To work as a Home Health Aide (HHA) for a licensed agency, you must complete a training and competency evaluation program before providing care. Texas requires a minimum of 75 hours of training. At least 16 of those hours must be supervised clinical experience in a home, hospital, nursing facility, or lab setting, and at least 16 hours of classroom instruction must be completed before the clinical portion begins.3Cornell Law School. 26 Tex. Admin. Code 558.701 – Home Health Aides
The curriculum covers a range of practical skills:
- Infection control, including universal precautions and basic sanitation
- Recognizing emergencies and following response procedures
- Personal care: bathing, oral hygiene, skin and nail care, toileting
- Reading and recording vital signs
- Safe transfer techniques, ambulation, range of motion, and positioning
- Respecting client rights, privacy, property, and emotional needs
Programs run by community colleges, vocational schools, and some agencies typically cost between $400 and $1,200. After training, you must pass a competency evaluation. An aide who receives an unsatisfactory rating in more than one required subject area does not pass.4eCFR. 42 CFR 484.80 – Condition of Participation: Home Health Aide Services
If the agency is certified to provide Medicare home health services, federal rules add 12 hours of in-service training every 12 months, supervised by a registered nurse. The training can take place while you are providing patient care.5eCFR. 42 CFR 484.80 – Condition of Participation: Home Health Aide Services The agency documents it, but falling behind puts your job at risk.
Certified Nurse Aide Certification
Certified Nurse Aides (CNAs) go through a more formal credentialing process than HHAs. You complete a state-approved Nurse Aide Training and Competency Evaluation Program (NATCEP), then pass a two-part state exam covering nursing knowledge and hands-on skills. The clinical portion requires you to demonstrate randomly selected patient care tasks in front of an evaluator.
A contracted testing vendor administers the exam, and the combined fee for the skills and written portions runs roughly $125 to $150. Some training programs include the fee in tuition. Nursing facilities that receive Medicare or Medicaid funding are sometimes required to offer nurse aide training at no cost to employees, so ask about employer-sponsored options before paying out of pocket.
Since July 2023, Texas processes nurse aide certification through the Texas Unified Licensure Information Portal (TULIP) rather than paper forms. You create an account, upload your documentation, and track your application through the portal.6Texas Health and Human Services. Nurse Aide Registry TULIP also handles licensure for nursing facilities, assisted living facilities, and HCSSAs.7Texas Health and Human Services. TULIP Online Licensure Application System Once certified, you appear on the public registry employers check before hiring. Most other states offer reciprocity for Texas CNAs in good standing, though each state sets its own additional requirements.
Criminal Background Checks
Texas Health and Safety Code Chapter 250 requires criminal history checks for anyone offered employment at facilities and agencies serving elderly or disabled individuals, which includes HCSSAs licensed under Chapter 142. The check happens after a job offer or contract application but before you begin direct-contact work, unless you already hold a separate professional license under Texas law.
Certain convictions disqualify a person from direct contact with clients. The law targets offenses involving harm to vulnerable populations, including assault, theft, and exploitation. Agencies that fail to verify eligibility face administrative penalties from HHSC.
Getting Paid Through Consumer Directed Services
Texas Medicaid offers a Consumer Directed Services (CDS) option that lets the person receiving care act as the employer. The participant, or their legally authorized representative, recruits, hires, trains, and manages their own service providers, who become the participant’s employees rather than employees of an agency or the state.8Texas Health and Human Services. Consumer Directed Services Option Frequently Asked Questions
CDS participants often hire family members, friends, or neighbors. Caregivers hired this way do not need a state-issued professional license for non-clinical tasks. A Financial Management Services Agency (FMSA) handles payroll and tax paperwork for the CDS employer, but hiring and day-to-day supervision stay with the person receiving services.9Texas Health and Human Services. 5200, Consumer Directed Services Caregivers under CDS are not employees of the FMSA, the managed care organization, or any state or federal agency.
What Families Hiring Privately Should Know
If you are the one hiring a caregiver rather than becoming one, the absence of a license requirement does not mean the arrangement is free of rules. Pay a caregiver $3,000 or more in cash wages during 2026 and you must withhold and pay Social Security and Medicare (FICA) taxes. Pay household employees a combined total of $1,000 or more in any calendar quarter and you owe Federal Unemployment Tax (FUTA) on the first $7,000 of each employee’s wages.10Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide
The IRS treats a caregiver who works in your home, on your schedule, using your supplies as a household employee in nearly every case. The common-law test looks at whether you control what work is done and how it is done. A caregiver who shows up at set times, follows your instructions on meals and medication reminders, and uses your household supplies is an employee, not an independent contractor.11Internal Revenue Service. Independent Contractor (Self-Employed) or Employee?
Misclassifying the relationship creates real problems. The family becomes liable for unpaid employment taxes, penalties, and interest. The caregiver loses Social Security credits and unemployment coverage. Either party can file IRS Form SS-8 to request a formal determination of worker status if there is a dispute.12Internal Revenue Service. About Form SS-8, Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding