Texas STAR+PLUS: How to Get Paid as a Family Caregiver — A Step-by-Step Guide
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Texas STAR+PLUS: How to Get Paid as a Family Caregiver — A Step-by-Step Guide
Texas does things its own way. That’s true of its culture, its size, and — as you might have guessed — its approach to paying family caregivers.
If you’re caring for a parent, a grandparent, or a relative with a disability in Texas, you’ve probably heard whispers that some families get paid for this work. Those whispers are true. But the path in Texas looks different from California’s IHSS or New York’s CDPAP. It runs through a system of managed care and specific programs with names like STAR+PLUS and Community First Choice.
This guide will walk you through every option, in plain language. By the end, you’ll know exactly which door to knock on.
(Remember: I’m not a Medicaid caseworker or an attorney. Rules change, and individual circumstances vary. Use this as your map, then confirm details with the Texas Health and Human Services Commission or a benefits counselor.)
The Texas Landscape: An Overview
Texas runs most of its long-term care Medicaid through managed care organizations (MCOs) . Instead of applying to a single state office and everything flowing from there, you’ll work with an MCO — essentially a health plan contracted by the state to manage your loved one’s care.
The main programs that can pay family caregivers in Texas are:
- STAR+PLUS Home and Community Based Services (HCBS) Waiver — for adults with disabilities and seniors who need help with daily living.
- Community First Choice (CFC) — an entitlement program (no waitlist) that can pay family members for personal care services.
- Primary Home Care (PHC) — a state-funded, non-Medicaid option for low-income Texans who don’t qualify for Medicaid but still need help.
- Family Care Program (FCP) — a smaller program specifically designed to pay family caregivers for attendant care.
We’ll walk through each one.
Who Can Get Paid, and Who Can’t
Texas has clear rules about which family members can be paid and which cannot.
Can be paid:
- Adult children caring for a parent
- Siblings
- Grandchildren
- Nieces, nephews, and other relatives
- A trusted friend or neighbor, in some programs
Cannot be paid (in most cases):
- A spouse — Texas considers spouses legally responsible for providing care without compensation.
- A legal guardian — the guardian is expected to arrange care, not be the paid provider. (There are exceptions in some programs; we’ll note them.)
- A parent of a minor child with a disability, in most programs — parents are expected to care for their minor children without pay. However, parents of adult children with disabilities can be paid attendants.
This spouse exclusion is a hard line in Texas. If you’re caring for your husband or wife, you won’t be able to get paid through these Medicaid programs. But don’t stop reading. There may still be options, which we cover in the “If You Don’t Qualify” section at the end.
Program 1: STAR+PLUS HCBS Waiver
STAR+PLUS is Texas’s Medicaid managed care program for adults with disabilities and people aged 65 and older. Within STAR+PLUS, the HCBS waiver is the piece that can pay for services at home — including paying a family member.
Who Qualifies
- The care recipient must qualify for Medicaid financially. For seniors and people with disabilities in Texas, this means income below roughly $2,829 per month (2024 figure) and countable assets under $2,000 for an individual or $3,000 for a couple. The home they live in and one vehicle are exempt.
- They must need help with activities of daily living — things like bathing, dressing, toileting, eating, and transferring — at a level that would qualify them for nursing home care.
- They must live at home, in a family member’s home, or in certain community settings (not a nursing home or assisted living facility).
How the Payment Works
If approved, the care recipient gets a service plan that includes a certain number of hours per week for a personal attendant. Through a service option called Consumer Directed Services (CDS) , the recipient can hire and manage their own attendant — including you, the adult child or other relative.
You become an employee of the care recipient. A Financial Management Services Agency (FMSA) handles the payroll, withholds taxes, and cuts your paycheck. You’re paid hourly, and it’s a W-2 job.
The Waitlist — and Why You Should Get On It Now
This is important and hard to hear: the STAR+PLUS HCBS waiver has an interest list — Texas’s term for a waitlist. The wait can be long, often measured in years, especially for certain waiver slots.
The interest list is maintained by the Texas Health and Human Services Commission (HHSC). Getting on it is free. You fill out a form, or call 1-877-438-5658, and your loved one’s name goes on the list. When a slot opens up, HHSC contacts you.
Do not let the waitlist discourage you from applying. While you’re waiting, other programs — like Community First Choice — may be able to help.
Program 2: Community First Choice (CFC)
Community First Choice is different from the HCBS waiver in one critical way: it is an entitlement program, which means there is no waitlist. If your loved one qualifies, they get the services.
Who Qualifies
- The care recipient must be on Medicaid.
- They must need help with activities of daily living, but the threshold is slightly lower than the waiver — they don’t have to meet nursing-home-level care.
- They must live at home or in a family home.
Can Family Members Get Paid?
Yes. Through the Consumer Directed Services (CDS) option under CFC, the care recipient can hire you as their personal attendant. The same rules about who can and can’t be paid apply (adult children and other relatives yes, spouses and guardians generally no).
The process is similar to the waiver path: you’re hired by the care recipient, and an FMSA handles payroll, taxes, and W-2s.
What Services Are Covered
CFC covers help with:
- Bathing, dressing, grooming, toileting
- Eating and meal preparation
- Mobility and transfers
- Light housekeeping related to the care recipient’s needs
- Supervision to ensure safety
If your loved one is on Medicaid and needs daily help, this is often the fastest path to getting paid — no waitlist, no years of uncertainty.
Program 3: Primary Home Care (PHC)
Primary Home Care is a state-funded program — not Medicaid — for Texans who are low-income but may not qualify for full Medicaid. It provides personal care services to help people stay at home.
Key Differences
- PHC is funded by Texas state dollars, not federal Medicaid money.
- The income limits are slightly different from Medicaid, and some people who don’t qualify for Medicaid may qualify for PHC.
- The program covers personal care tasks — bathing, dressing, grooming, feeding, light housekeeping — similar to CFC.
- Family members can be hired as attendants in some PHC arrangements, but the rules depend on the specific provider agency.
PHC is administered through local Area Agencies on Aging (AAA) and community-based organizations. It’s worth calling your local AAA to ask: “Do you have Primary Home Care slots available, and can a family member be the paid attendant?”
Program 4: Family Care Program (FCP)
The Family Care Program is a smaller, more targeted option specifically designed for families who are already providing care and want to continue doing so with some financial support.
FCP provides attendant care services that can be delivered by a family member. It’s not available in every county, and availability fluctuates. But when it’s available, it is one of the more straightforward ways for a relative to get paid.
To find out if FCP is available where you live, contact your local Texas Health and Human Services office or your local Area Agency on Aging and ask directly about the Family Care Program.
How to Apply: A Step-by-Step Path
Step 1: Get on the STAR+PLUS HCBS Interest List (if not already).
Call 1-877-438-5658 or visit the Texas HHSC website to add your loved one’s name. Even if the wait is long, this is your ticket to the most comprehensive coverage.
Step 2: Apply for Medicaid (if not already enrolled).
Call 2-1-1 or visit your local HHSC benefits office. You can apply online at YourTexasBenefits.com. Get this started even if you think the income is too high — let the state make the official determination.
Step 3: Ask about Community First Choice.
If your loved one is on Medicaid, ask their managed care plan or HHSC about CFC services with the Consumer Directed Services option. Say: “I want to be my parent’s paid attendant through Consumer Directed Services under Community First Choice. What do I need to do?”
Step 4: Contact your local Area Agency on Aging.
Find yours through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-252-9240. Ask about Primary Home Care and the Family Care Program availability.
Step 5: If you hit a wall, ask for a benefits counselor.
Many Area Agencies on Aging offer free benefits counseling. They can look at your exact situation and tell you which programs you’re most likely to qualify for. This is not something you have to figure out alone.
How Much Does It Pay?
Wages for family caregivers in Texas programs typically range from $9 to $12 per hour, depending on the program, the region of Texas, and the specific managed care organization. This is lower than California or New York, and it’s honest to say that upfront. No one is getting rich through these programs.
But what they offer — beyond the money — is a W-2 wage, Social Security credits, workers’ compensation coverage, and the recognition that your work is real work. For many families, that combination is life-changing.
A note on live-in caregivers: If you live with the person you’re caring for, your wages may be exempt from federal income tax under the IRS “live-in caregiver” rule. Check with a tax professional and your FMSA to ensure this is set up correctly.
If You Don’t Qualify: Private Alternatives
If public programs don’t fit your situation, don’t walk away empty-handed. There are still paths worth exploring.
- Long-term care insurance: Check if your loved one has a policy. Many cover in-home care by family members.
- Personal Care Agreement: A formal contract between you and the care recipient, drafted with an elder law attorney. This can provide you a wage from their private funds and protect against Medicaid penalties later.
- VA benefits: If your loved one is a veteran, the VA’s Veteran-Directed Care program and Aid & Attendance pension are worth immediate investigation. Texas has a large veteran population, and local VA offices are generally familiar with these programs.
- Texas Paid Sick Leave: Some Texas cities have local paid sick leave ordinances, though these are more limited than state-level paid family leave in other states. Check if your city has applicable rules.
Common Mistakes Texas Families Make
- Not getting on the interest list because the wait is long. The time will pass anyway. Get on the list.
- Assuming a spouse can be paid. In Texas, spouses are almost universally excluded. Come to terms with this early and explore whether another relative can serve as the paid attendant.
- Confusing the STAR+PLUS regular plan with the HCBS waiver. The regular STAR+PLUS managed care plan does not automatically include waiver services. You need to specifically ask about the HCBS waiver and CDS option.
- Not calling 2-1-1. Texas 2-1-1 is a free, statewide service that connects you to health and human services information. It’s a good first number to call when you don’t know where to start.
Your Texas Action Plan
- Today: Call 1-877-438-5658 to get on the STAR+PLUS HCBS interest list.
- This week: Apply for Medicaid at YourTexasBenefits.com or call 2-1-1.
- Ask about CFC: If already on Medicaid, contact the managed care plan and ask about Community First Choice with Consumer Directed Services.
- Call your local AAA: Find them at 1-800-252-9240. Ask about Primary Home Care and Family Care Program availability.
- If you’re caring for a veteran: Contact the local VA office and ask about Veteran-Directed Care.
Resources for Texas Families
- Texas Health and Human Services (HHSC): hhs.texas.gov
- STAR+PLUS HCBS Interest List: 1-877-438-5658
- Texas 2-1-1: Call 2-1-1 or visit 211texas.org
- YourTexasBenefits.com: Online Medicaid application portal
- Texas Area Agencies on Aging: 1-800-252-9240
- VA Caregiver Support Line: 1-855-260-3274
The Bottom Line
Texas may not have a single, sleek program like California’s IHSS. But it has multiple pathways, and one of them — Community First Choice — has no waitlist. That alone puts it ahead of many states.
You’ll need patience. You’ll make phone calls. You’ll probably get transferred and asked to hold. But every call moves you closer to a paycheck for work you’re already doing.
You deserve that. And Texas, in its own sprawling, complicated way, does have a system to recognize it. Now you know the doors.
Ready to explore other states? Our state-by-state paid caregiver guide covers every option across the country.
Last updated: [06/26]
Disclaimer: WiseCareNest provides educational content. This is not legal or benefits advice. Consult with a qualified professional for your specific situation.
