Quick Answer
Yes, in some situations. In Texas, the main paths are Medicaid's Consumer Directed Services, which lets an eligible person hire certain relatives as their attendant; VA pension benefits such as Aid and Attendance, which pay the veteran or surviving spouse, who can then pay a family caregiver; and a written private caregiver agreement paid from the family's own funds. Long-term care insurance usually won't pay family members.
In This Guide
Key Takeaways
- →Medicaid Consumer Directed Services lets eligible members hire many relatives, but generally not a spouse or legal guardian.
- →Texas attendant pay averages about $13 an hour after rate increases in September 2025.
- →VA Aid and Attendance pays the veteran or surviving spouse, who can use it to pay a family caregiver.
- →A written caregiver agreement protects everyone when the family pays a relative privately.
- →Long-term care insurance usually excludes family caregivers; check the policy.
Many family members are already providing hours of unpaid care every week, often while cutting back on work. It's reasonable to ask whether any of that can be paid. In Texas, it sometimes can, depending on the person's benefits and finances.
The Ways Family Caregivers Get Paid
| Path | Who it fits | Who pays |
|---|---|---|
| Medicaid Consumer Directed Services | People eligible for Texas Medicaid long-term services | Medicaid, through a financial management agency |
| VA Aid and Attendance or Housebound pension | Wartime veterans and surviving spouses with care needs and limited net worth | The VA pays the veteran or spouse, who pays the caregiver |
| Private caregiver agreement | Families paying from their own funds | The person receiving care, or the family |
| Long-term care insurance | Policyholders, but family care is usually excluded | Rarely an option; check the policy |
Medicaid Consumer Directed Services
Consumer Directed Services (CDS) is an option in several Texas Medicaid programs, including STAR+PLUS Home and Community Based Services. It lets the person receiving care, or their representative, act as the employer: they hire, schedule and supervise their own attendant. A financial management services agency handles payroll and taxes.
Who can be hired
Many relatives can be hired, such as adult children, siblings, grandchildren and other family members, as well as friends and neighbors. Texas CDS rules generally don't allow hiring the person's spouse or legal guardian. Ask the health plan's service coordinator to confirm for your situation.
Pay
Texas ended its fixed minimum wage for attendants in Medicaid programs on August 31, 2025, and set new rates intended to support an average of about $13 an hour. Actual pay depends on the program and the employer's budget.
How to start
- The person must first be eligible and approved for services. See our Texas Medicaid STAR+PLUS guide.
- Ask the service coordinator for the Consumer Directed Services option.
- Choose a financial management services agency and complete the employer orientation.
- Hire the attendant, who must pass background checks and complete required training.
VA Benefits
The VA's Aid and Attendance and Housebound benefits are added to a VA pension for wartime veterans and surviving spouses who need help with daily activities. The VA pays the money to the veteran or spouse, who can use it however they choose, including to pay a family member who provides care. Eligibility depends on service, care needs, and income and net worth. See our Aid and Attendance guide for 2026 amounts and how to apply.
Private Caregiver Agreements
When a parent has savings and wants to pay a son or daughter for care, a written caregiver agreement makes the arrangement clear and fair to everyone. It typically spells out the duties, hours, hourly pay and how time is recorded.
- Pay a reasonable rate for the work, and keep time records.
- Payments may create employment tax obligations. Talk to a tax professional.
- If Medicaid might be needed later, payments to family can be treated as gifts unless they're properly documented. Have an elder law attorney draft or review the agreement.
- Agree as a family, so other relatives aren't surprised later.
What Long-Term Care Insurance Usually Won't Do
Most long-term care insurance policies exclude care from family members, and many require care from a licensed agency. A few policies, mostly cash or indemnity policies, pay a set amount regardless of who provides care. Read the policy's exclusions or call the carrier. Our guide to using long-term care insurance for home care covers how most policies work.
Family Care vs. Agency Care
| Family caregiver | Agency caregiver | |
|---|---|---|
| Knows your loved one | Deeply | Gets to know them over time |
| Backup when sick or on vacation | Family must arrange it | Agency provides coverage |
| Training and supervision | Varies | Trained, background-checked, supervised |
| Strain on the relationship | Can be significant | Family returns to being family |
| Insurance claims documentation | Usually not accepted by LTCI | Accepted by LTCI when the agency is licensed |
Many families combine the two: a family member covers some hours while an agency covers mornings, nights or the family caregiver's days off. If you're the family caregiver and you're running on empty, see our respite care guide.
Frequently Asked Questions
Can a family member get paid to be a caregiver in Texas?
Sometimes. The main options are Medicaid Consumer Directed Services for people eligible for Texas Medicaid long-term services, VA pension benefits such as Aid and Attendance that the veteran can use to pay a relative, and a private caregiver agreement paid from family funds.
Can a spouse be paid as a caregiver under Texas Medicaid?
Texas Consumer Directed Services rules generally don't allow a person to hire their spouse or legal guardian as their attendant. Other relatives, such as adult children, can often be hired. Confirm with the health plan's service coordinator.
How much do Medicaid CDS attendants get paid in Texas?
After rate changes on September 1, 2025, Texas set attendant rates intended to support an average wage of about $13 an hour. Actual pay depends on the program and the employer's budget.
Does long-term care insurance pay family caregivers?
Usually not. Most policies exclude care from family members and require a licensed agency. Some cash or indemnity policies are more flexible, so check the policy.
Can VA Aid and Attendance pay a family caregiver?
The VA pays Aid and Attendance to the veteran or surviving spouse, who can use the money as they choose, including to pay a family member for care.
Related Reading
If you're a family caregiver who needs a few hours of backup, we can help, with private pay or long-term care insurance. Call (346) 689-2339.
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