STAR+PLUS Texas: Get Paid To Care For A Family Member

No. Texas Medicaid, like most states, treats the spouse as a legally responsible relative and does not allow spouses to be paid attendants under STAR+PLUS or the HCBS waiver. The rule applies in both the Agency Option and the Consumer Directed Services (CDS) option. Adult children, siblings, in-laws, friends, and most other relatives can be paid, but a spouse cannot. If a spouse is the primary caregiver and you need a way to be paid in Texas, the closest option is VA Veteran Directed Care (if the member is an eligible veteran), which can pay a spouse in some cases. Otherwise, Texas families in this situation often work out an arrangement where a different family member is the formal paid attendant while the spouse continues to provide unpaid care alongside.

STAR+PLUS attendants in Texas typically earn between $10 and $15 per hour in 2026, with the exact rate set by the managed care organization (MCO), the Financial Management Services Agency (FMSA) under CDS, and the service area. The CDS option gives the member some flexibility to set the wage within an MCO-approved range, balancing wage against authorized hours from the budget. This is lower than many other state Medicaid programs (Texas Medicaid reimbursement rates are historically among the lowest in the country) but the work is still meaningful — many family caregivers use it to supplement other income. Attendants are W-2 employees; federal income tax, Social Security, and Medicare are withheld. Overtime kicks in at 40 hours per workweek at 1.5x the regular rate.

This is where Texas differs sharply from states like California: the STAR+PLUS HCBS waiver has an Interest List (formerly called a Waiting List), and getting an HCBS waiver slot can take anywhere from many months to several years depending on the service area and slot availability. The base STAR+PLUS managed care enrollment (the medical coverage portion) is much faster — usually 30-60 days from a complete Medicaid application. But to be paid as a family caregiver, you typically need the HCBS waiver, which is the slow part. Once an HCBS slot is offered, the assessment, MCO enrollment, CDS election, and attendant onboarding usually take another 60-120 days. Add yourself or your loved one to the Interest List as early as possible — even before you think you will need it.

No medical license, Certified Nursing Assistant (CNA), or Home Health Aide (HHA) certification is required to be a STAR+PLUS attendant under the Consumer Directed Services (CDS) option. The training requirements are more administrative than clinical: a criminal-history background check, checks against the Texas Employee Misconduct Registry and Nurse Aide Registry, federal I-9 employment verification, and orientation paperwork through the Financial Management Services Agency (FMSA). The MCO's service coordinator may require the attendant to review basic safety, abuse-reporting, and timesheet procedures. The actual caregiving training is the responsibility of the member, who knows their own routines and needs best. Some MCOs offer optional training videos and resources, but these are not mandatory.

No. CDPAP (Consumer Directed Personal Assistance Program) is a New York Medicaid program — it does not exist in Texas. If you have searched for "CDPAP Texas" or "CDPAP in Texas," you are almost certainly looking for the Texas equivalent of New York's CDPAP. The closest Texas options are: (1) STAR+PLUS with the Consumer Directed Services (CDS) option, which lets adult Medicaid members hire and direct their own attendant, including most family members; (2) Community First Choice (CFC), Texas's state plan personal care benefit, which also offers CDS; and (3) the STAR Kids program with CDS, for children with disabilities. All three function similarly to CDPAP in that the member is the employer, but they have different eligibility rules and provider lists. The biggest practical difference from CDPAP is that Texas pay rates are typically lower and HCBS waiver access requires an Interest List wait.

Under the Agency Option, the MCO contracts with a home care agency that hires and supervises the attendant. The agency picks who is sent to your home, handles all payroll and HR, and supervises care delivery. Under Consumer Directed Services (CDS), the member (or their Designated Representative) becomes the employer: they choose the attendant — typically a family member or friend — they set the schedule and wage within the approved budget, they train the attendant on the specific tasks needed, and they can terminate the attendant. The Financial Management Services Agency (FMSA) handles payroll mechanics in the background. CDS is the route most families take when they want to be paid for caring for a relative. Agency Option is the better fit when no family member is available or when the member prefers an agency to handle the staffing.

Yes. A single attendant can work for multiple STAR+PLUS members — for example, an adult child who cares for both parents, or someone who cares for both a parent and a sibling. Each member is a separate employment relationship through the FMSA, with its own authorized hours and timesheets. Overtime is calculated per workweek across all hours worked for the same FMSA. If you plan to attend more than one member, coordinate with the MCO service coordinators so the combined hours stay within overtime guidelines and the budget plans for each member account for the schedule.

Call 2-1-1 (the Texas Health and Human Services helpline) and ask to be added to the Interest List for the STAR+PLUS HCBS Waiver. You can also contact your local Aging and Disability Resource Center (ADRC) or visit YourTexasBenefits.com. The Interest List is essentially a waiting list — once your name comes up, you will receive a letter inviting you to apply for the waiver, complete the medical assessment, and pick an MCO. Because the wait can be years in some service areas, families are strongly encouraged to add a loved one to the Interest List as early as possible, even if they do not currently need services. There is no cost to be on the list, and you can decline the slot when it is offered if circumstances have changed.