How to Get Paid by the State to Care for Someone in Texas

To get paid by the state to care for someone in Texas, the person you care for needs to qualify for a Medicaid long-term care program that offers the Consumer Directed Services (CDS) option, and then hire you as their attendant through a state-approved Financial Management Services Agency (FMSA) that runs payroll. The care recipient is technically your employer; Medicaid funds the paycheck; the FMSA handles taxes, background checks, and reporting.

Not every family member can be hired, some programs have long waiting lists, and the process moves through several agencies before the first check arrives. Here is what actually determines whether you get paid, and how quickly.

Which Texas Medicaid Programs Pay Family Caregivers

Two programs handle most paid family caregiving in Texas.

STAR+PLUS Home and Community Based Services (HCBS) is a Medicaid managed care program for adults 21 and older who have disabilities or meet the medical criteria for nursing facility care.¹ Through the CDS option, participants can hire certain family members to provide personal care like bathing, dressing, meal prep, and mobility help. STAR+PLUS HCBS has an interest list, so there may be a wait before services become available.²

Community First Choice (CFC) covers personal assistance with daily activities and health-related tasks for Medicaid-enrolled individuals who meet an institutional level of care.³ CFC is a Medicaid state plan benefit rather than a waiver, which means the state cannot cap enrollment or maintain a waiting list.⁴ If you qualify for CFC, you receive services without sitting on a list. Ask your service coordinator about CFC early.

CDS may also be available through Community Living Assistance and Support Services (CLASS), the Medically Dependent Children’s Program (MDCP), and Texas Home Living (TxHmL). Each has its own eligibility rules, and most have interest lists.

Who the Person Receiving Care Must Be

The person who needs care must meet a medical standard and a financial standard.

Medical Eligibility

They must need help with activities of daily living such as bathing, dressing, eating, toileting, and getting around. A state assessment determines whether they meet the nursing facility level of care standard, meaning their needs are serious enough that they would otherwise qualify for a nursing home.⁵ For STAR+PLUS HCBS, they must also be 21 or older.¹

Financial Eligibility

They must qualify for Texas Medicaid. For 2026, a single applicant’s total countable income cannot exceed $2,982 per month, which equals 300 percent of the federal Supplemental Security Income benefit rate.⁶ Countable assets must be $2,000 or less for a single person, counting things like cash, bank accounts, and stocks. The primary home is typically exempt if its equity value is below $752,000 for 2026, and the equity cap does not apply at all if a spouse still lives in the home.⁷

Who Can Be Hired as the Paid Caregiver

Adult children, siblings, grandchildren, and parents can generally be hired through CDS. Several people are barred across every program:⁸

The care recipient’s spouse (the only exception is the Consumer Managed Personal Attendant Services program)
The legally authorized representative (LAR), including a parent, guardian, managing conservator, or stepparent of a minor, and the guardian of a person of any age
The spouse of the LAR
The designated representative (DR) and their spouse, if one has been appointed

STAR+PLUS HCBS adds one more restriction that catches families off guard: the person already serving as the care recipient’s primary caregiver cannot be hired as the CDS employee.⁸ If your mother has been your primary caregiver for years, she cannot convert that arrangement into a paid role through STAR+PLUS HCBS. A different family member would need to take the paid position.

Every CDS employee must be legally authorized to work in the United States and pass a criminal background check, both handled through the FMSA during hiring.

How to Apply and Start Getting Paid

Plan on weeks to months between the initial application and the first paycheck.

Apply for Medicaid

The care recipient applies for Medicaid through the Texas Health and Human Services Commission (HHSC), online at Your Texas Benefits, by phone, or in person at a local HHSC office.⁹ Have Social Security number, proof of citizenship or immigration status, proof of Texas residency, financial records, and medical records ready.

Enroll With a Managed Care Organization and Ask for CDS

Once Medicaid eligibility is confirmed, the care recipient is enrolled in a Managed Care Organization (MCO). The MCO assigns a service coordinator who assesses the person’s needs and writes a plan of care. This is the moment to specifically request the Consumer Directed Services option. If you don’t ask for CDS, the case is routed to a traditional home health agency and you can’t hire your own family member.

Pick an FMSA and Complete Hiring

After the plan of care is approved with CDS, the care recipient selects a Financial Management Services Agency from a list the MCO or HHSC provides.¹⁰ The FMSA does not need to be in the same county. You then complete employment paperwork through the FMSA: identity verification, work authorization, and the background check. Once everything clears, you can start working and getting paid.

Interest Lists and Wait Times

STAR+PLUS HCBS, CLASS, DBMD, HCS, TxHmL, and MDCP all maintain interest lists, and slots open first-come, first-served based on how long each person has waited.² Community First Choice is the exception; because it is a state plan benefit rather than a capped waiver, it cannot have a waiting list.⁴ While waiting on a waiver interest list, ask the service coordinator whether CFC or other state plan services can cover care in the meantime.

How Payment and the FMSA Actually Work

Under CDS, the care recipient is the employer on paper. The FMSA handles the parts most families can’t: processing payroll, withholding and remitting taxes, filing required reports, and running the background check. The care recipient’s job is to set the caregiver’s schedule, assign tasks within the approved care plan, and verify hours.

Your pay comes from the budget in the care recipient’s individual plan of care. The MCO decides how many hours of service the person receives, and the state sets the reimbursement rate. What lands in your paycheck is that approved budget minus payroll taxes and any FMSA administrative fee. Before September 2025, Texas set an assumed average wage of $13 per hour for personal attendant services.¹¹ That wage floor has since been removed, and CDS employers can now set pay at any rate that meets at least the federal minimum wage.

Electronic Visit Verification

Federal law requires Texas to use an Electronic Visit Verification (EVV) system for Medicaid personal care services. As a CDS caregiver, you must clock in at the start of every shift and clock out at the end using the EVV system your FMSA selects. The care recipient, as the CDS employer, is responsible for training the caregiver on the clock-in and clock-out methods and documenting that training on HHSC Form 1732.¹² Missed entries and heavy reliance on manual corrections can flag visits for review and delay pay.

Taxes on What You Earn

Two federal provisions can significantly reduce your tax bill.

The Live-In Exclusion (IRS Notice 2014-7)

Under IRS Notice 2014-7, Medicaid waiver payments to a caregiver who lives in the same home as the care recipient are treated as excludable difficulty-of-care payments and do not count as gross income on your federal return.¹³ The person receiving care must live in your home. Payments for care you provide by driving to their house do not qualify.

FICA Exemptions for Family Employment

Certain family employment relationships fall outside FICA. Domestic services performed by an individual for a spouse, or by a parent for a son or daughter under specific circumstances, may not be taxable employment.¹⁴ A child under 18 working for a parent is also exempt.¹⁵ Even when FICA does not apply, the employer must still issue a W-2. Your FMSA handles the reporting; confirm they are applying the correct exemption for your relationship.

If the Application Is Denied or Hours Are Cut

If HHSC or the MCO denies Medicaid, reduces approved service hours, or refuses the CDS option, the care recipient has the right to a fair hearing. The state must send written notice explaining the decision and how to appeal.¹⁶

If services are already in place and you request a hearing before the effective date of a reduction or termination, current benefits must continue until the hearing decision is issued. This is called aid paid pending, and it prevents a gap in care during the appeal. The state generally has 90 days from the hearing request to issue a final decision.¹⁶ The notice must be in a language you can understand, and the state must offer interpretation and disability accommodations at no cost. Filing before the effective date of a cut is the single most important step to protect continuity of care.

1
Texas Health and Human Services. STAR+PLUS HCBS Program Eligibility
2
Texas Health and Human Services. Interest List Reduction
3
Texas Health and Human Services. Community First Choice (CFC)
4
Medicaid.gov. Community First Choice (CFC) 1915(k)
5
Cornell Law School. 1 Tex. Admin. Code 353.1153 – STAR+PLUS Home and Community Based Services (HCBS) Program
6
Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – Appendix XXXI, Budget Reference Chart
7
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
8
Texas Health and Human Services. How CDS Works
9
Texas Health and Human Services. Long-Term Care
10
Texas.gov. List of FMSAs
11
Texas Health and Human Services. Payment Rates for DBMD Information Letter
12
Texas Health and Human Services. EVV Consumer Directed Services Option
13
Internal Revenue Service. Notice 2014-7
14
Office of the Law Revision Counsel. 26 USC 3121 – Definitions
15
Internal Revenue Service. Family Caregivers and Self-Employment Tax
16
Medicaid.gov. Understanding Medicaid Fair Hearings