Updated September 4, 2026. Quick answer: yes, through Consumer Directed Services (CDS) option, under STAR+PLUS, STAR Kids and other Texas Medicaid programs. Most adult family members can be hired and paid to provide the care. Whether a spouse specifically qualifies is not clearly stated in the materials reviewed this session.
How Texas pays a family caregiver
| Program | Consumer Directed Services (CDS) option, under STAR+PLUS, STAR Kids and other Texas Medicaid programs |
|---|---|
| Can a family member be paid? | Yes. “The CDS option is available to members living in their own homes or the homes of family members.” |
| Can a spouse be paid? | Partial. “the person’s spouse, which does not apply to CMPAS” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
$13.00/hour (statewide average attendant base wage, effective September 1, 2025). “An average attendant base wage of $13.00 per hour with an assumed 14 percent payroll, taxes, and benefits (PTB) for non-residential settings and 15 percent PTB for residential settings”
How it works
A member or LAR elects the CDS option through their MCO service coordinator and picks a Financial Management Services Agency (FMSA) from the MCO’s list; the FMSA trains the member to act as the legal employer, handles payroll and tax withholding, and the member recruits, hires, and sets wages for service providers within an HHSC-funded budget. Most relatives can be hired, but the employer’s own spouse, legally authorized representative, and designated representative cannot, except that a spouse may still be paid under the older Consumer Managed Personal Attendant Services (CMPAS) variant of CDS.
What this doesn’t answer
The $13.00/hour figure is a statewide average base wage target set for attendant services broadly (CDS, CFC, PCS, and related programs) by a 2025 legislative rider, not a fixed rate for every individual CDS employee; actual take-home pay depends on the member’s specific budget, region, and managed care organization.
Sources
- Texas HHSC: STAR+PLUS Handbook, Section 8200 Consumer Directed Services
- Texas HHSC: Form 1726, Consumer Directed Services (CDS) Employer Acknowledgement and Definitions
- Texas HHSC: Information Letter No. 2025–11, Discontinuation of the Attendant Compensation Rate Enhancement Program and Rate Adjustments for Attendant Services, effective September 1, 2025 (June 23, 2025)
Read September 4, 2026.
Same question, other states: Utah · Vermont.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.