STAR+PLUS in Texas: using consumer directed services to pay a family caregiver

Which Texas programs let a paid family caregiver work through CDS

Texas does not run a separate "family caregiver" payment. Instead, several Medicaid programs offer the CDS option, and CDS is what lets the person who needs care pick their own worker, including a relative. HHS lists these programs as offering CDS:

• STAR+PLUS and STAR+PLUS Home and Community Based Services (HCBS), the managed care route most adults with disabilities and older Texans use.
• Primary Home Care, Family Care and Community Attendant Services (PHC/FC/CAS).
• Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS) and Texas Home Living (TxHmL).
• Consumer Managed Personal Attendant Services (CMPAS), the Medically Dependent Children Program (MDCP), STAR Health and STAR Kids.

In STAR+PLUS itself, the services you can self-direct are Community First Choice personal assistance and habilitation (CFC PAS/HAB) and personal assistance services. STAR+PLUS HCBS adds more that can run through CDS, among them nursing, respite, protective supervision, therapies and cognitive rehabilitation therapy. HHS advises checking with your program or managed care organization (MCO), because the list of self-directed services can change.

Who qualifies for STAR+PLUS in Texas, and the HCBS interest list

STAR+PLUS is a Texas Medicaid managed care program for adults with disabilities. A person has to be approved for Medicaid first and then fit at least one of these groups:

• 21 or older and receiving Supplemental Security Income (SSI);
• not on SSI but needing the kind of services STAR+PLUS HCBS provides; or
• 21 or older, living in a nursing home and on Medicaid there.

STAR+PLUS HCBS is the part designed to keep people at home who would otherwise need a nursing home. The HHS eligibility handbook (Revision 25-2, effective June 6, 2025) sets four tests: age 21 or older, full Medicaid financial eligibility, an approved medical necessity for nursing facility level of care, and an individual service plan that stays under a cost limit of 202 percent of what HHS would pay for that person's nursing facility care.

The interest list

STAR+PLUS HCBS has an interest list. HHS says to call 1-877-438-5658 to be added for STAR+PLUS HCBS and other waiver programs (HCS and TxHmL requests go to the local intellectual and developmental disability authority instead). The handbook says an assessment can start once a person reaches the top of the list, that someone already on Medicaid and enrolled with an MCO may be able to skip the list through an "upgrade" process, and that a nursing facility resident can move into HCBS through Money Follows the Person.

How to apply

Apply for Medicaid online at YourTexasBenefits or by calling 2-1-1. The CDS FAQ is explicit that you must be enrolled in a Medicaid program before you can enroll in the CDS option.

How consumer directed services work in Texas

Under CDS, the person receiving services, or their legally authorized representative, is the employer. In practice that means:

1. Your case manager or service coordinator explains CDS and switches you to it if you choose. Services you do not self-direct stay with your program provider, and you can go back to agency services at any time by telling your case manager.
2. You choose a financial management services agency (FMSA). HHS publishes a list of FMSAs by program and county; the FMSA need not be in your town, and after the first orientation the work can be done by phone and email.
3. The FMSA checks your worker. You cannot hire anyone until the FMSA confirms the person is eligible and gives permission.
4. Your worker logs time in electronic visit verification (EVV). All CDS employers must be trained on EVV, and the FMSA pays employees at least twice a month.

HHS says it can take up to three weeks from your first FMSA meeting for a worker to start. As employer you recruit, train, schedule and supervise, keep CDS records, arrange backup for critical services, give an annual evaluation and, if needed, let a worker go.

Can a family member be paid through CDS? Who can and cannot be hired

Yes, in most cases. HHS notes that CDS employers "can often find family, neighbors or friends to work for you," and the FAQ revised February 6, 2026 names the people who cannot be your CDS employee:

The FAQ adds that a program may set further limits on relatives, so confirm with your service coordinator, case manager or FMSA before anyone starts work.

The designated representative

A family member who would rather help run things than be the paid worker can be the designated representative. That person must be over 18, pass a criminal history check and not appear on a federal or state Medicaid exclusion list. The role is voluntary and cannot be paid, and the employer stays accountable for the representative's decisions.

Hours

Paid hours are the hours in the service plan. HHS states plainly that you cannot use fewer hours to raise an attendant's pay, and you cannot add hours with money left over in the budget.

How much does a paid family caregiver in Texas earn under CDS?

There is no single CDS wage. With the FMSA's help the employer sets the wage within the program budget, and HHS says the hourly rate may not fall below the minimum wage in force or exceed what the budget can carry. The FMSA can tell you the minimum rate for your service, and HHS posts program rates on its Rate Tables and Long-Term Services and Supports pages. Up to $600 a year (or $50 a month for a budget shorter than 12 months) comes out of CDS funds for employer costs such as record-keeping supplies.

For context only, two public reference points (these are not CDS rates):

As employer, you can also offer benefits such as paid days off and bonuses within the budget, and you can buy a workers' compensation policy from program funds.

Veteran caregiver payments and taxes on CDS wages

VA programs

• A monthly VA stipend. VA pays approved caregivers from its Program of Comprehensive Assistance for Family Caregivers, known as PCAFC. To qualify, a caregiver has to be at least 18 and either related to the veteran (husband or wife, child, parent, step-relative or extended family) or living with the veteran full time. The veteran needs a combined or individual VA rating of 70 percent or more, VA health care enrollment, and hands-on help with personal care expected to last six months or longer without a break. Apply online, by post on VA Form 10-10CG, or through the caregiver support team at a VA medical center; the support line number is 855-260-3274.
• Veteran Directed Care. Where it operates, this gives an enrolled veteran who meets clinical criteria a spending budget, and VA notes the workers hired with it may include relatives or neighbors.

Taxes

According to the CDS FAQ, program money spent on your services is not treated as income to the person receiving care, and the FMSA registers with the IRS as employer agent to deposit payroll taxes. On the worker's side, IRS Notice 2014-7 covers Medicaid section 1915(c) waiver pay to a provider who looks after the recipient in a home they share, and lets that pay be left out of gross income. Whether pay from a different kind of Medicaid program qualifies turns on that program's purpose and design, per the IRS Q&A, so check with your FMSA or a tax preparer about how your W-2 is prepared.

Where to get help in Texas: AAA, ADRC and adult protective services

• Area Agencies on Aging: call 1-800-252-9240 to reach your local AAA. HHS lists caregiver support services, benefits counseling, care coordination and in-home support for people 60 and older, their families and caregivers.
• Aging and Disability Resource Centers: 1-855-937-2372 connects you to your area's ADRC.
• Interest list for STAR+PLUS HCBS: 1-877-438-5658.
• Texas Abuse Hotline (Department of Family and Protective Services): 1-800-252-5400, 24 hours a day, or TxAbuseHotline.org. DFPS takes reports of abuse, neglect, self-neglect and exploitation of people 65 or older and adults with disabilities living at home. In an emergency call 911.

Private care when CDS is not an option

Many families are still on the interest list, are over the Medicaid income limits, or need more hours than a service plan covers. CaregiverConnect is a marketplace for that private arrangement. Posting a care request costs a family nothing, and when they hire someone from it they employ that person themselves. That makes them a household employer under IRS Topic 756: Social Security and Medicare tax applies once one worker's cash pay for 2026 hits $3,000, with exceptions when the worker is your spouse, your child younger than 21 or, in most cases, your parent. Caregivers can list themselves free and answer those posts. CaregiverConnect is not a Medicaid provider, not an FMSA and not a home care agency, and nobody is signed up for STAR+PLUS or CDS through it. Read how the site works, and see optional paid upgrades.

Texas pages on the site: caregiver jobs in San Antonio, caregiver jobs in La Feria, find caregivers in Houston and find caregivers in Garland. For the hiring steps, see our private hiring checklist; for an overview of other states' programs, see the Medicaid family caregiver overview and the Florida paid family caregiving guide.

Frequently asked questions

Sources

1. Texas HHS, Consumer Directed Services Option: Frequently Asked Questions (revised 02/06/26)
2. Texas HHS, Consumer Directed Services (programs offering CDS)
3. Texas HHS, STAR+PLUS (eligibility groups, how to apply)
4. Texas HHS, STAR+PLUS HCBS Program Eligibility handbook section 1200 (Revision 25-2)
5. Texas HHS, Interest List Reduction (interest list phone number)
6. Texas HHS, Care for people 60 and older (Area Agencies on Aging)
7. Texas DSHS, Resources and support services (ADRC phone)
8. Texas DFPS, Report abuse (Texas Abuse Hotline)
9. DOL Wage and Hour Division, minimum wage by state (page revised July 1, 2026)
10. O*NET OnLine local wage table, Texas, SOC 31-1120 (Bureau of Labor Statistics, 2025)
11. VA.gov, PCAFC caregiver stipend: eligibility and how to apply
12. VA Geriatrics and Extended Care, Veteran Directed Care eligibility
13. IRS Q&A on Notice 2014-7, Medicaid waiver pay and gross income
14. IRS tax topic 756, payroll taxes for household workers