Can I get paid to care for my spouse in Texas?
Not directly in Texas today — but read on.
Texas's programs generally will not pay a husband or wife directly — the old Medicaid rules treat a spouse's care as a family duty rather than a job. That is not the end of it. Other relatives usually can be paid, and the rules do change.
Who can be paid instead
- An adult son or daughter — the most common paid caregiver in every state.
- A sibling, a grandchild, a niece or nephew, or an in-law.
- A close friend or neighbor, in most self-directed programs.
- A spouse in a different program year — Texas's rules are reviewed regularly, and we watch them.
What Texas pays family caregivers
$15/hr
Your exact pay is set by the program and your care plan. We'll tell you your real number before you enroll.
Source: Texas Medicaid program data · Updated September 2026
What Texas's rule actually says
no — spouses cannot be paid attendants in Medicaid CDS programs; reported exception: state-funded CMPAS may allow a spouse
The programs this runs through in Texas: Consumer Directed Services (CDS), STAR+PLUS HCBS, CLASS & MDCP Waivers. Who runs them: Texas Health & Human Services Commission (HHSC); interest lists 877-438-5658 (CLASS/MDCP) and 800-964-2777 (STAR+PLUS HCBS)
4.4 million people in Texas are 65 or older. Most of them are cared for at home, by a relative — usually without being paid for it.
How to start in Texas
Call 877-438-5658 to join the CLASS or MDCP interest list, or 800-964-2777 for the STAR+PLUS HCBS interest list; benefits applications go through YourTexasBenefits.com or 2-1-1 Texas.
self-directed, but every CDS employer must use a financial management services agency (FMSA) for payroll, taxes, and background checks
See if you qualify →Spouse questions in Texas, answered
Can I get paid to care for my husband or wife in Texas?
Generally not directly. The published rule: no — spouses cannot be paid attendants in Medicaid CDS programs; reported exception: state-funded CMPAS may allow a spouse Other relatives can usually be paid, and that is worth checking.
Why do some states allow this and others don't?
Medicaid has long treated care between spouses as a family duty rather than paid work. Self-directed programs changed that in many states by making the person who needs care the employer — they choose their own worker, and in some states that can be a spouse. It is a state-by-state policy choice, not a federal rule.
How much would I earn in Texas?
Reported pay in Texas runs around $15/hr, though your exact rate is set by the program and the care plan.
Does my spouse need Medicaid first?
Yes. These are Medicaid programs, so your spouse has to qualify for Texas Medicaid and need long-term care help. Many families assume they earn too much and never apply. The rules for long-term care are not the same as regular Medicaid — check before you rule yourself out.
Is there a waitlist in Texas?
severe — STAR+PLUS HCBS interest list wait is 'many years' (~5,034 reported); CLASS ~48,169 and MDCP ~27,012 on interest lists with waits reported up to ~13-15 years
How do we start?
Call 877-438-5658 to join the CLASS or MDCP interest list, or 800-964-2777 for the STAR+PLUS HCBS interest list; benefits applications go through YourTexasBenefits.com or 2-1-1 Texas.
Sources: hhs.texas.gov · medicaidplanningassistance.org · Updated September 2026. Rules change — always confirm with the program.
Where most Texas caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in Texas — pick yours for the local picture.
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