Isaac Prentice
May 31, 2026
Texas is home to millions of older adults and individuals with disabilities who rely on caregivers for daily support. Whether you’re currently providing unpaid care to a family member or exploring caregiving as a professional or entrepreneurial pursuit, there are meaningful pathways in Texas to receive payment for this work.
Quick answer
How can you get paid as a caregiver in Texas? The main options are: (1) Texas Medicaid waiver programs with consumer-directed services options; (2) STAR+PLUS managed care with participant-directed services; (3) working as an HHA or PCA through a licensed Texas agency; (4) building a private-pay caregiving business; and (5) VA caregiver support programs for eligible veteran families.
| Pathway | Who it’s for | Pays through | Key requirement |
|---|---|---|---|
| Texas Medicaid HCBS waiver (CDS option) | Family caregivers of eligible Medicaid recipients | Financial Management Services Agency | Recipient enrolled in qualifying waiver |
| STAR+PLUS consumer-directed services | Family caregivers of eligible STAR+PLUS enrollees | STAR+PLUS managed care plan | Recipient must be STAR+PLUS enrolled |
| Agency HHA/PCA employment | Professional caregivers | Agency employer | HHSC training standards required |
| Private-pay companion care | Independent caregivers | Client families | No certification required for non-medical care |
| VA caregiver programs | Caregivers of eligible veterans | Department of Veterans Affairs | Veteran eligibility criteria apply |
If you’re still weighing roles before choosing a path, our breakdown of CNA vs HHA vs PCA clarifies how each role fits into the broader caregiving landscape.
1. Texas Medicaid HCBS waiver programs
Texas Medicaid offers several Home and Community-Based Services (HCBS) waivers that include a Consumer Directed Services (CDS) option. Under this model:
Texas waiver programs with CDS options include:
| Program | Who it serves |
|---|---|
| Community Living Assistance and Support Services (CLASS) | Adults and children with related conditions |
| Home and Community-Based Services (HCS) Waiver | Individuals with intellectual disabilities |
| Texas Home Living (TxHmL) Waiver | Adults with intellectual/developmental disabilities |
| STAR+PLUS HCBS waiver | Elderly and individuals with disabilities |
Contact the Texas Health and Human Services Commission (HHSC) or a local area agency on aging to determine eligibility and next steps. For broader federal context on self-directed Medicaid care, see the CMS overview of self-directed services.
2. STAR+PLUS consumer-directed services
Texas STAR+PLUS is the Medicaid managed care program for elderly individuals and people with disabilities. Some STAR+PLUS plans offer consumer-directed services, which can allow a family member to be the paid caregiver.
Contact the care recipient’s STAR+PLUS managed care plan directly to ask whether this option is available.
3. Agency employment as an HHA or PCA
Working through a licensed Texas home health agency is the most reliable professional caregiving employment path. This involves:
NCOOA’s home health aide online course and personal care assistant online course provide accessible foundational knowledge. For a clearer picture of what HHAs actually do day-to-day, see our guide on what a home health aide is.
4. Private-pay caregiving business in Texas
Texas has no state income tax and a low regulatory burden for non-medical private care services, making it a strong state for building an independent caregiving business:
NCOOA’s online caregiver courses — including free CPR training and free Basic First Aid training in applicable bundles — provide the knowledge foundation to get started. Mastering the right skills for patient care workers is what separates successful private caregivers from the rest of the market.
5. VA caregiver support programs in Texas
Texas has one of the largest veteran populations in the country. The VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) may provide:
Contact your local VA office or the VA Caregiver Support Line (1-855-260-3274) for eligibility details.
| Program | Spouse eligible? |
|---|---|
| HCBS waiver CDS option | Varies by program — confirm with HHSC |
| STAR+PLUS consumer-directed services | Varies by plan — confirm with managed care plan |
| VA PCAFC | Yes, in many qualifying situations |
| Private pay | Yes — no restrictions |
| Pathway | Typical pay |
|---|---|
| Consumer-directed Medicaid caregiver (CDS) | Rate set by waiver program; typically $9 – $14/hr |
| Agency HHA through Medicaid | $13 – $18/hr |
| Agency PCA through Medicaid | $12 – $16/hr |
| Private pay (self-set) | $15 – $22/hr |
For broader pay context across the country, see our state-by-state look at home health aide salary data.
