Getting paid to care for a parent in Texas

Who can be the paid caregiver

Under the Consumer Directed Services (CDS) option you can hire adult children, grandchildren, siblings, other relatives, friends and people who live in the home. Four things disqualify a person, per HHSC Form 1726 (April 2026), the form you sign before hiring: (1) Your parent's court-appointed guardian cannot be the paid attendant - the form bars 'the guardian of a person of any age.' If you took guardianship of your parent, you are locked out of the paycheck. Ask a Medicaid elder law attorney about alternatives, such as a less restrictive arrangement or another family member serving as guardian, BEFORE going to guardianship court. (2) Your parent's designated representative cannot be the paid attendant, and the designated representative's spouse cannot be hired either. (3) In Primary Home Care, Community Attendant Services and Family Care only, the person identified as your parent's 'primary caregiver' cannot be the paid attendant. This does NOT apply in Community First Choice or STAR+PLUS HCBS, so if you are the day-to-day caregiver, ask to be assessed for Community First Choice rather than CAS. Ask the case worker directly how they will record the primary caregiver on your parent's plan. (4) Anyone with a conviction listed in Texas Health and Safety Code Chapter 250 is barred, with no exceptions for family. You are responsible as the employer for running that criminal history check; the FMSA processes the paperwork and payroll. Parents of a minor child are also excluded, which does not apply when you are caring for your own parent.

The spouse question

In the Medicaid attendant programs - STAR+PLUS HCBS, Community First Choice, Primary Home Care and Community Attendant Services - a husband or wife cannot be the paid attendant. HHSC Form 1726 spells this out: the paid service provider must not be 'the employer or the employer's spouse.' A 2025 bill that would have changed this, HB 2938, was referred to House Human Services on March 19, 2025 and died there without a vote. Three real exceptions: (1) Consumer Managed Personal Attendant Services (CMPAS). Form 1726 says outright that 'the spouse may be employed in Consumer Managed Personal Attendant Services (CMPAS) for the CDS option.' This is official, not a rumor. CMPAS is a small state-funded program in limited service areas, and your parent has to be able to direct their own attendant (or have someone else supervise for them), so it does not fit everyone - call the local CMPAS contractor to see if it operates in your county. (2) Family Care (FC), the state-funded attendant program. 26 TAC 277.23 says an attendant must 'not be the spouse of the individual who receives the service, except for services in the FC Program.' Family Care is not Medicaid, pays for fewer hours, and has its own interest list, but a spouse can be the attendant there. (3) Veteran-Directed Care, if your parent is a veteran - that program lets the veteran hire a spouse.

Waitlist reality

Split picture, and the fast doors are real. Community First Choice attendant and habilitation care is a Medicaid state plan entitlement - if your parent has Medicaid and meets a nursing-facility level of care, there is no waiting list. Primary Home Care and Community Attendant Services are also entitlements with no interest list; Community Attendant Services even covers some people whose income is too high for regular Medicaid. Family Care, the state-funded program, is the one in this group that does have an interest list. The full STAR+PLUS HCBS waiver - the one that adds respite, home modifications, adaptive aids and more on top of attendant hours - has a statewide, first-come first-served interest list, confirmed on HHSC's Interest List Reduction page. HHSC publishes monthly counts but does not publish an official average wait; families and elder law sources consistently report waits running several years. Treat it as years, get on the list now (877-438-5658), and do not sit and wait: start your parent on Community First Choice or Community Attendant Services in the meantime, because you can be paid through the CDS option in those programs the same way.

Other doors in Texas

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

1. 1. Apply for Medicaid for your parent at YourTexasBenefits.com or call 877-541-7905 (2-1-1, option 2). 2026 waiver limits: about $2,982/month income and $2,000 in countable assets for a single person.
2. 2. Ask 2-1-1 to connect you to your local HHSC Community Care Services Eligibility office and request an assessment for Community First Choice or Community Attendant Services — these start fastest, with no statewide waitlist.
3. 3. Call HHSC at 877-438-5658 to put your parent on the STAR+PLUS HCBS interest list now (or generate a referral via 'Find Services' at YourTexasBenefits.com) — the wait is years, so join early even while using CFC/CAS.
4. 4. Once your parent is enrolled and getting attendant hours, tell the STAR+PLUS plan's service coordinator (or HHSC case worker) you choose the Consumer Directed Services (CDS) option.
5. 5. Pick a Financial Management Services Agency (FMSA) from the state list; the FMSA runs your background check, sets you up as the employee (Forms 1725/1726), and processes your paychecks.

Where to start: Texas Health and Human Services — dial 2-1-1 (or 877-541-7905) and ask for long-term care/community care services; STAR+PLUS HCBS interest list line: 877-438-5658; online: YourTexasBenefits.com

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.