Get Paid to Care for Your Elderly Parent in Texas
Yes — Texas pays family caregivers $10–$15/hour through Community Attendant Services and Consumer Directed Services under Texas Medicaid. Your parent must qualify for Medicaid and need personal care assistance. Adult children and other relatives can be paid providers. Apply through Texas Health and Human Services (call 2-1-1 to start).
Texas is home to over 4 million seniors — and the number of Texans over 65 is growing faster than almost any other state. Medicaid programs in Texas recognize that family caregivers provide the majority of home-based care, and several programs allow recipients to hire and pay family members directly.
The path to getting paid in Texas requires navigating multiple programs, each with different eligibility rules and application processes. This guide breaks it all down clearly.
What Programs Pay Family Caregivers in Texas?
Texas has two main pathways for getting paid to care for an elderly parent: Community Attendant Services (the fastest access route) and Consumer Directed Services through various Medicaid waiver programs (higher potential hours but longer waits).
1. Community Attendant Services (CAS) — STAR+PLUS
Community Attendant Services is a Medicaid benefit available through the STAR+PLUS Managed Care program. It is an entitlement benefit — meaning if your parent qualifies, they receive services without waiting for a slot. CAS covers personal assistance tasks including bathing, dressing, grooming, meal preparation, housekeeping, and medication reminders.
Under the Consumer Directed Services option within STAR+PLUS, your parent can designate you as their caregiver. You are employed through a Financial Management Services Agency (FMSA) that handles payroll, taxes, and timesheets.
2. STAR+PLUS Home and Community Based Services (HCBS) Waiver
For recipients who need nursing home level of care, the STAR+PLUS HCBS Waiver provides more comprehensive home care services. This waiver also has a Consumer Directed Services option allowing family caregiver payment. There is typically a waitlist for this waiver, but CAS services can begin while waiting.
3. Community Living Assistance and Support Services (CLASS) Waiver
The CLASS waiver targets adults with related conditions (not exclusively the elderly) who need HCBS support. It has a Consumer Directed Services option and a longer waitlist. Best suited for younger adults with disabilities and not the primary route for elderly parents.
4. Program of All-Inclusive Care for the Elderly (PACE)
Texas PACE sites in Houston, San Antonio, Dallas, and other cities provide comprehensive care management for Medicaid-eligible seniors. While PACE doesn't directly pay family caregivers, it can reduce overall care burden and supplement family care.
Most Texas Medicaid HCBS waiver slots have significant waitlists — in some cases, years long. However, Community Attendant Services through STAR+PLUS is an entitlement and does not have a waitlist. Applying for CAS is the fastest route to caregiver payment in Texas. Apply for waiver programs simultaneously to get on the list early.
Does Your Parent Qualify?
Texas Medicaid (Medicaid) Income Limits
To qualify for Texas Medicaid as an elderly individual, your parent must generally meet these criteria in 2026:
- Age: 65 or older (or blind/disabled)
- Income: Monthly income at or below approximately $2,742/month (300% of the Federal Poverty Level for SSI-related Medicaid)
- Assets: Countable assets of $2,000 or less for an individual ($3,000 for a couple). The primary home, one vehicle, and personal belongings are excluded.
- Residency: Texas resident and U.S. citizen or qualifying immigration status
If your parent's income exceeds the limit, they may still qualify through a Qualified Income Trust (sometimes called a Miller Trust). This legal arrangement diverts income into a trust to bring countable income below the threshold. An elder law attorney can set one up for approximately $300–$500. Don't give up on Medicaid eligibility without exploring this option.
Functional Need Requirements
Your parent must need assistance with activities of daily living due to age, disability, or illness. A Texas Health and Human Services caseworker conducts an assessment using the Minimum Data Set for Home Care (MDS-HC) to determine the level of need and hours authorized.
How Much Will You Get Paid?
Texas caregiver pay rates under Medicaid programs range from $10 to $15 per hour depending on the program and services involved:
- Personal care attendant services: approximately $10.00–$11.50/hr
- Habilitation services: approximately $10.50–$12.00/hr
- Respite care: approximately $10.00–$13.00/hr
- Additional services (adult day, homemaker): rates vary
Texas's minimum wage is $7.25/hr (the federal minimum), so Medicaid rates represent a meaningful premium. Authorized hours depend on assessed needs — recipients with significant functional limitations may receive 20–40+ hours per week.
How to Apply: Step-by-Step
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Apply for Texas Medicaid
Apply online at YourTexasBenefits.com, by calling 2-1-1, or in person at your local HHSC benefits office. Gather your parent's Social Security number, proof of income (Social Security letters, pension statements), proof of assets, and medical documentation of care needs. Processing takes approximately 30 days. -
Request Home Care Services Assessment
Once enrolled in Medicaid, ask your HHSC caseworker to assess your parent for Community Attendant Services. A caseworker will visit the home to evaluate functional needs and determine authorized service hours. -
Request Consumer Directed Services Option
Tell your caseworker that your parent wants to use the Consumer Directed Services (CDS) option — this is how you become the paid caregiver. Your parent becomes the "employer of record" and you become the employee. This must be explicitly requested; it is not always offered automatically. -
Select a Financial Management Services Agency (FMSA)
Your parent chooses an approved FMSA from the Texas HHSC list. The FMSA serves as the employer of record for payroll, processes timesheets, and issues your paychecks. Common Texas FMSAs include Palco Inc., PPL (Public Partnerships, LLC), and others. -
Complete Employment Paperwork
You complete standard employee paperwork including I-9 (employment eligibility), W-4 (tax withholding), and any FMSA-specific onboarding documents. A background check is required. Your parent completes documentation naming you as their designated representative. -
Complete Required Training
Texas CDS requires both your parent and you to complete Consumer Direction training — typically available online. The training covers your rights and responsibilities as employer and employee, how to document care, and how to submit timesheets. -
Begin Care and Submit Timesheets
Once all paperwork is complete and approved (typically 3–4 weeks), you begin providing authorized services. Submit timesheets electronically through your FMSA's system every two weeks. Payment is issued by direct deposit or check.
Other Programs for Texas Caregivers
VA Veteran-Directed Care
Texas has major VA medical centers in Houston, San Antonio, Dallas, and other cities, all participating in the Veteran-Directed Care program. If your parent is a veteran, they may receive a monthly budget of $2,000–$4,500 to hire and pay you as their caregiver. This is entirely separate from Medicaid and does not affect Medicaid eligibility. Contact the VA social worker at your parent's nearest VA medical center to inquire about enrollment.
VA Aid and Attendance
Veterans and surviving spouses may qualify for VA Aid and Attendance — a pension benefit that provides $1,000–$2,300/month above the base pension to help pay for care. While it doesn't pay you directly, it substantially increases your parent's available funds for care. A Veterans Service Organization (VFW, American Legion, DAV) can help apply at no cost.
Caregiver Agreement (Private Pay)
Your parent can pay you through a formal written Caregiver Agreement at fair market rates, regardless of Medicaid status. This requires a written contract specifying services, hours, and pay rate; a contemporaneous time log; and payment at market rates. An elder law attorney should draft the agreement to ensure it's valid for Medicaid planning purposes.
Tax Implications for Texas Caregivers
When you are paid through a Texas CDS program, your FMSA handles payroll taxes and issues you a W-2 at year-end. Key points:
- FICA taxes: Social Security and Medicare are withheld from your paycheck (and matched by the FMSA on your parent's behalf)
- Federal income tax: Withheld based on your W-4 election
- Texas has no state income tax — a meaningful advantage for Texas caregivers compared to most other states
- W-2 issuance: Your FMSA sends your W-2 by January 31 each year
The IRS difficulty-of-care exclusion for live-in caregivers may apply if you share a home with your parent. Consult a tax professional to determine whether this exclusion applies to your specific arrangement under a Texas CDS program.
Estimate Your Parent's Care Costs
See how Texas Medicaid programs could work for your family — use our free care cost calculator.
Use the Care Cost CalculatorFrequently Asked Questions
Yes. Texas offers Consumer Directed Services (CDS) through several Medicaid programs, allowing recipients to hire adult children and other relatives as paid caregivers. Your parent must qualify for Texas Medicaid and enroll in a program with a self-direction option — Community Attendant Services through STAR+PLUS is the most accessible starting point.
Texas family caregiver pay through Medicaid programs ranges from approximately $10 to $15 per hour depending on the program and service type. Personal care attendant rates typically start around $10–$11.50/hr. Texas has no state income tax, which improves net take-home pay compared to other states.
Community Attendant Services (CAS) is a Texas Medicaid benefit under the STAR+PLUS Managed Care program that provides personal care assistance for activities of daily living. Unlike most waiver programs, CAS is an entitlement — there is no waitlist. With the Consumer Directed Services option, your parent can pay you as their personal care attendant.
The main programs are: Community Attendant Services (CAS) through STAR+PLUS Managed Care, the STAR+PLUS Home and Community Based Services (HCBS) Waiver, and the Community Living Assistance and Support Services (CLASS) Waiver. All have Consumer Directed Services options allowing family caregiver payment.
Community Attendant Services through STAR+PLUS does not have a waitlist and is generally the fastest route to caregiver payment. Most other Texas Medicaid HCBS waiver programs do have waitlists, sometimes lasting months to years. Apply for CAS first for immediate access while simultaneously applying for waiver programs to get on the waiting list.
Yes, through a private Caregiver Agreement. Your parent pays you directly at fair market rates under a written contract. This requires a signed agreement specifying services and pay rate, contemporaneous time logs, and payment at rates consistent with what a professional would charge. An elder law attorney should draft the agreement, especially if Medicaid may be needed in the future.
Yes. Texas veterans enrolled in VA healthcare can access the Veteran-Directed Care program at VA medical centers in Houston, Dallas, San Antonio, and other Texas cities. This provides a monthly care budget your veteran parent can use to hire and pay you as their caregiver — independent of Medicaid.
Start by applying for Texas Medicaid at YourTexasBenefits.com or by calling 2-1-1. Once your parent is enrolled, request a home care assessment and specifically ask the HHSC caseworker to enroll your parent in the Consumer Directed Services option. Your parent then selects a Financial Management Services Agency (FMSA) to process payroll, and you complete employee enrollment paperwork.