If you are already bathing, dressing, cooking for and looking after a parent or relative, Texas Medicaid may be able to pay you for that work. Most families have no idea this exists. Here is how it actually works.
Texas Medicaid’s STAR+PLUS program covers personal attendant services for adults who need help with daily activities at home. In many cases the person providing that care can be a family member, and they can be paid for it.
There are two routes. Which one you choose determines who handles the paperwork, who employs the caregiver, and how much work falls on your family.
| Agency Option | Consumer Directed Services (CDS) | |
|---|---|---|
| Who employs the caregiver | The home care agency | The person receiving care, or their representative |
| Who runs background checks | The agency | You arrange it |
| Who handles payroll and taxes | The agency | A financial management agency (FMSA) |
| Who sets the pay rate | The agency | You do, within the approved budget |
| Backup when the caregiver is unavailable | The agency arranges coverage | You find your own |
| Paperwork on your family | Very little | Significant, because you are the employer |
| Time to get started | Usually faster | Usually slower |
Which is right for you? If you want control over pay rate and hiring, and someone in the family has the bandwidth to act as an employer, CDS gives you that. If you would rather someone else handle the background checks, payroll, taxes, scheduling and backup coverage, the agency option is simpler. You can switch later. Neither choice is permanent.
Every paid caregiver, family or not, must pass a criminal background check, registry searches, and reference checks before starting. That is state law, and it applies to your own daughter exactly as it applies to a stranger.
Texas sets a minimum base wage for personal attendants, and the state builds its reimbursement rates around an assumed attendant wage. In practice, family caregivers hired through licensed agencies in Texas typically earn somewhere between the state floor and the mid-teens per hour, depending on the agency and the program.
The bigger factor is usually not the hourly rate. It is how many hours are authorised. That number is set by the health plan’s service coordinator based on an assessment of what the person actually needs. Twenty hours a week at a fair rate is worth considerably more than thirty hours that never get approved.
Broadly, they need to:
If they are not yet on Medicaid, that application comes first. You can start at YourTexasBenefits.com or by calling 2-1-1.
One thing worth doing early. The STAR+PLUS HCBS waiver has an interest list, and it can be long. Getting on it does not require a Medicaid determination first, and it costs nothing. Call HHSC at 1-855-937-2372 to be added. Families who wait until there is a crisis often wait a great deal longer.
Monarch Care Services is a licensed Texas home and community support services agency based in Fort Worth, serving Tarrant County. We are licensed by Texas Health and Human Services under HCSSA licence #025260 to provide personal assistance services.
If you are trying to work out whether your family qualifies, or which route makes sense, call us. We will tell you honestly what we think, including if CDS would suit your family better than working with an agency, and including if we are not currently the right fit. There is no charge for the conversation and no obligation.
Call and tell us your situation. We will walk you through your options in plain English. No pressure, no obligation.
Call (682) 200-9125Or email admin@monarchcaregroup.com
This page is general information about Texas Medicaid programmes and is not legal, financial or medical advice. Programme rules, eligibility criteria and rates change. Confirm current requirements with Texas Health and Human Services at hhs.texas.gov, by calling 2-1-1, or with the person’s STAR+PLUS health plan.