How to Get Paid as a Caregiver in Texas Through Medicaid

You've been bathing, feeding, and managing medications for your aging parent for months — maybe years — without a paycheck. Meanwhile, you've cut your own work hours, drained savings, and watched your health suffer. Texas Medicaid has a program that can actually pay you for this care. Here's exactly how it works and what to expect.

The Program: STAR+PLUS Consumer Directed Services

Texas runs its home and community-based long-term care through the STAR+PLUS managed care program. Within STAR+PLUS, the Consumer Directed Services (CDS) option allows your parent to hire you — their adult child — as their paid caregiver.

Under CDS, your parent (or their representative) becomes the employer of record. They choose who provides their care, set the schedule, and direct the services. A Financial Management Services Agency (FMSA) handles the payroll paperwork, tax withholding, and workers' compensation.

Pay rates in the research range from $10 to $17 per hour; the rate varies by authorized service and managed care organization (MCO).

Who Qualifies

Your parent must meet these requirements to access STAR+PLUS CDS:

• Income: Gross monthly income at or below $2,982 (the 2026 Texas Medicaid income cap). If their income exceeds this, a Qualified Income Trust (Miller Trust) makes them eligible.
• Assets: Countable resources at or below $2,000 for an individual ($3,000 for a couple, both applying).
• Clinical need: They must meet the nursing facility level of care standard — meaning that without home-based services, they would need to be in a nursing home. A physician or MCO nurse completes this assessment.
• Enrollment: They must be enrolled in STAR+PLUS HCBS (waiver services), not just regular STAR+PLUS Medicaid.

As the caregiver, you don't need specific credentials for basic personal attendant services. You do need to pass a background check, complete any MCO-required orientation, and not be your parent's spouse (Texas does not allow spouses to be paid CDS attendants).

The Interest List: Plan for a Wait

STAR+PLUS HCBS is not an entitlement — the state caps enrollment. When slots are full, your parent goes on an "interest list" (the state's term for a waitlist). Current wait times vary by region; the research range is approximately 6 to 18 months. Ask HHSC for the current status of the relevant interest list.

To get on the list, call 2-1-1 (Texas Health and Human Services information line) or submit an interest list request through the YourTexasBenefits portal. Ask HHSC about current routing and transition options; the Money Follows the Person program is a separate route for eligible nursing-facility residents.

During the wait, your parent receives no waiver services and no caregiver payment. This is the period where families burn through savings and emotional bandwidth. If your parent's condition deteriorates to the point of requiring a nursing home, they can apply for Institutional Medicaid (which has no waitlist) as a parallel path.

The Application-to-Paycheck Timeline

Once your parent's name comes up on the interest list:

1. MCO assignment: HHSC assigns your parent to a regional managed care organization.
2. Clinical assessment: The MCO schedules an in-home assessment to confirm nursing facility level of care and determine authorized service hours.
3. Service plan development: The MCO case manager creates an Individual Service Plan (ISP) detailing approved hours, service types, and budget.
4. CDS election: Your parent requests the Consumer Directed Services option (instead of agency-directed services). The MCO connects them with an FMSA.
5. Hiring and onboarding: Your parent "hires" you as their attendant. The FMSA runs your background check, sets up payroll, and explains the time-tracking requirements.
6. First paycheck: Timing varies with FMSA onboarding, required checks, and service-plan activation.

From interest list notification to first paycheck, timing varies with the MCO, FMSA, required checks, and service-plan activation.

What You Can and Cannot Do as a Paid CDS Attendant

Authorized services (depends on your parent's ISP):

• Personal care: bathing, dressing, grooming, toileting
• Meal preparation and feeding assistance
• Mobility assistance and transfers
• Medication reminders (not administration of injections)
• Light housekeeping directly related to the care recipient
• Escort to medical appointments

Not covered under CDS attendant pay:

• Companionship or supervision alone (without physical care tasks)
• Home maintenance, yard work, or errands unrelated to your parent's care
• Skilled nursing procedures unless you hold the required license

You must document every hour worked. Most FMSAs use an electronic visit verification (EVV) system — you clock in and out through a phone app or telephonic system. Missed or undocumented hours don't get paid, and repeated documentation failures can trigger an MCO audit.

The Financial Tradeoff

Getting paid $12-$15 an hour through CDS won't replace a full professional salary. But it converts unpaid labor into documented wage income and can help keep your parent at home instead of in a facility that costs the state $6,600+ per month.

The Texas Medicaid Long-Term Care & Asset Protection Guide walks through the full STAR+PLUS application, CDS election steps, and the Miller Trust setup you'll likely need if your parent's income exceeds the $2,982 cap.

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