Key takeaway
Texas has multiple ways to pay family caregivers. Your path depends on medical need, income/assets, veteran status, and whether you choose consumer direction.
- Medicaid: STAR+PLUS Waiver and Community First Choice (CFC) allow hiring family (spouses not allowed).
- State-funded: CCAD/CMPAS can pay family and, in some cases, spouses.
- Veterans: Aid & Attendance and Veteran Directed Care can fund in-home help (VDC can pay spouses).
- Private: Long-term care insurance may reimburse family caregivers if the policy allows.
Overview
In Texas, several programs pay family members to provide non-medical, hands-on care at home. Most options require the care recipient to meet a nursing home level of care and to qualify financially (income and assets). Depending on the program, you can choose a family caregiver through consumer-directed services. Spouses are generally excluded under Medicaid, but may be allowed under certain state-funded or VA programs.
Programs that pay family caregivers in Texas
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| STAR+PLUS Waiver (Medicaid) | Age 65+ or 21+ with a disability; needs nursing-home level care; typical 2024 limits: income ≤ ~$2,829/mo, assets ≤ $2,000; limited slots (may have waitlist). | Consumer direction lets you hire family (e.g., adult child, grandchild); spouses are not allowed as paid caregivers. |
| Community First Choice (CFC) (Medicaid State Plan) | Medicaid-eligible and needs nursing-home level care; stricter income limits (SSI-related, ~≤ $943/mo for individuals); entitlement (no waitlist if eligible). | Allows hiring family caregivers except spouses under consumer-directed services. |
| Consumer-Managed Personal Attendant Services (CMPAS) (CCAD, state-funded) | Low-income seniors/adults with disabilities; financial criteria similar to Medicaid; availability may vary by region. | Can pay family or friends and, in some cases, spouses when conditions are met. Uses a fiscal agent for payroll. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with activities of daily living and meets VA pension income/asset rules. | Increases pension to cover care costs; can pay adult children/relatives. Spouse cannot be paid directly from this benefit. |
| Veteran Directed Care (VDC) (VA program) | Veteran in VA health care who needs nursing-home level care and lives in an area served by a participating VA Medical Center. | Provides a flexible care budget to hire caregivers, including family and spouses; availability limited by VAMC participation. |
| Long-Term Care Insurance (Private) | Policy must cover in-home care and pay benefits to the policyholder (cash/indemnity-style). | If policy terms allow, the care recipient can hire and pay a family caregiver; if not, a licensed agency may be required. |
Texas Medicaid programs
Texas Medicaid offers two primary ways to pay family caregivers for in-home support: the STAR+PLUS Waiver and Community First Choice (CFC). Both use consumer-directed services so the care recipient can choose and manage their attendant. Spouses are not permitted as paid caregivers in these Medicaid options.
STAR+PLUS Waiver
STAR+PLUS is a long-term services and supports waiver for adults who need a nursing-home level of care but want to live at home. It funds personal attendant care and related supports through managed care organizations.
- Age 65+ or 21+ with a qualifying disability.
- Meets nursing-home level of care per assessment.
- Financial limits apply (income/assets caps); limited enrollment can create waitlists.
- Family can be hired as the attendant; spouses and legal guardians are not eligible to be paid.
Community First Choice (CFC)
CFC is part of the Medicaid state plan and provides similar in-home attendant services. Unlike waivers, CFC is an entitlement—if you qualify, you receive services without a waitlist.
- Must be Medicaid-eligible and meet an institutional level of care need.
- Income limits are stricter (SSI-related) than STAR+PLUS; asset limits similar.
- Allows hiring family attendants except spouses via consumer direction.
State-funded option: CCAD — CMPAS
Community Care for Aged/Disabled (CCAD) includes Consumer-Managed Personal Attendant Services (CMPAS), a Texas state-funded service that works like Medicaid consumer direction. Families choose their attendant and a fiscal agent handles payroll.
Attendant hours are authorized after an assessment. The family selects and supervises the caregiver; a fiscal agent pays them.
Can pay family or friends and, in some cases, spouses when specific conditions are met.
Who qualifies
- Low-income seniors or adults with disabilities who need personal attendant services.
- Financial criteria are similar to Medicaid and updated annually; funding and availability may vary by region.
Veterans’ programs
Veterans and surviving spouses may leverage VA benefits to fund in-home care and pay family caregivers. Two major paths are the Aid & Attendance pension add-on and Veteran Directed Care (VDC).
Aid & Attendance Pension
A&A increases a qualifying veteran’s (or surviving spouse’s) monthly pension to cover care needs. The payment is to the veteran, who can use it to pay a family caregiver.
- Eligibility: wartime service, limited income/assets, and a need for help with activities of daily living.
- Caregiver pay: can reimburse adult children and relatives for care costs.
- Restriction: a spouse cannot be paid directly via A&A because household income is counted together.
Veteran Directed Care (VDC)
VDC provides a VA-funded monthly care budget that the veteran manages to hire caregivers, including family and spouses. Not all VA Medical Centers in Texas offer VDC; availability is limited to participating centers.
- For veterans who meet nursing-home level of care in the VA health system.
- Self-directed model with support from a financial management service for payroll.
- Spouses may be paid caregivers under VDC.
Long-term care insurance
If the care recipient owns a qualifying long-term care insurance policy, benefits may be used to pay a family caregiver for in-home personal care, subject to policy terms.
What to check in the policy
- Coverage includes in-home personal care, not just facilities.
- Benefits pay the policyholder directly (cash/indemnity model), enabling payment to a chosen family caregiver.
If the policy pays only licensed agencies, one workaround is for the family caregiver to operate a licensed home care agency and have the policy pay that agency for services.
How to apply in Texas (step-by-step)
- Identify the likely path: STAR+PLUS, CFC, CCAD/CMPAS, VA benefits, or LTC insurance.
- Gather documents: ID, proof of income/assets, medical records and medications list, veteran service records (if applicable).
- Start with the right agency:
- STAR+PLUS or CFC: contact Texas Health & Human Services or your local Medicaid office/ADRC for an assessment.
- CCAD/CMPAS: contact HHSC or your regional Aging & Disability Resource Center to request CMPAS.
- VA paths: talk to a VA clinician/social worker or a VAMC program coordinator about A&A or VDC.
- LTC insurance: call the insurer to confirm caregiver payment rules and documentation requirements.
- Complete required assessments (functional level of care and financial eligibility).
- Choose consumer direction (if available) and select your family caregiver; enroll with the fiscal agent for payroll.
- Begin services and submit time sheets as required; keep care logs for audits and renewals.
Texas paid caregiver FAQs
Can a spouse be paid as a caregiver in Texas?
Not under Medicaid options like STAR+PLUS and CFC. However, CCAD/CMPAS can sometimes pay spouses, and VA VDC can pay spouses.
What’s the difference between STAR+PLUS and CFC?
Both allow consumer-directed attendants, but STAR+PLUS is a capped waiver that can have waitlists; CFC is an entitlement if you qualify and typically has stricter income limits.
How long does approval take?
Timelines vary by program and region. STAR+PLUS may involve waitlists; CFC and CMPAS can be faster when eligible. VA timelines depend on VAMC capacity and documentation.
Can I be paid to care for my parent in Texas?
Yes. Many programs allow adult children to be paid caregivers, including STAR+PLUS, CFC, CMPAS, A&A (via pension), and VDC.
Does FMLA pay me to be a caregiver?
No. FMLA provides job-protected leave but does not provide pay. Use it alongside the programs above if needed.
