Texas:
STAR+PLUS Consumer Directed Services (CDS)

Separate STAR+PLUS coverage from the CDS option

STAR+PLUS and its HCBS services have their own eligibility and service-plan rules. CDS lets an eligible participant or legally authorized representative take an employer role for services the program permits to be self-directed. The financial management agency supports payroll and related administration. It does not replace the managed care organization’s service coordinator or decide clinical eligibility.

Texas offers CDS in several programs. A description of Primary Home Care, Community Attendant Services or CMPAS should not be treated as a STAR+PLUS rule. Ask the coordinator to name the exact funding program and the services available under your selected delivery option.

Check the employee’s legal relationship

Family membership alone does not qualify a worker. Texas requires relationship checks, including restrictions on a spouse, legally authorized representative and designated representative. A designated representative helps the employer voluntarily; that role cannot simply be relabeled as paid attendant work. Form 1734 documents relationship information for CDS.

For a parent caring for an adult child, identify whether the parent is also a court-appointed guardian or another excluded representative. For spouses, do not rely on the CMPAS exception when discussing STAR+PLUS. Ask the FMSA to confirm employee eligibility before employment paperwork or wage estimates are finalized.

The entry route determines the waiting question

Texas distinguishes people seeking a STAR+PLUS HCBS slot through an interest list from other qualifying entry routes, including certain existing members and transitions from facilities. A family should not assume that every STAR+PLUS member joins the same queue, or that a place on an interest list means services are approved.

Ask which process applies today: Medicaid eligibility, HCBS screening, interest-list release, plan assessment or employee enrollment. Record the responsible office for each unfinished step. Funding and available slots affect some routes, so an online promise of a fixed approval period cannot describe every application.

Agree a budget before arranging shifts

After CDS is selected, the employer chooses an FMSA and completes required orientation and employer documents. The agency assists with employment checks and payroll setup, while the employer recruits, trains and supervises workers. Discuss a backup plan if the family caregiver is unavailable.

The budget must cover the allowed employment costs, not only the hourly amount a worker hopes to receive. Ask for the proposed wage, approved services, scheduling limits and service start date in writing. An agency’s Medicaid reimbursement figure is not automatically the employee’s gross hourly wage.

Use the program’s timekeeping process

Ask the FMSA which electronic visit verification requirements apply to the authorized service and worker situation, including any documented live-in exception. Living with the recipient does not remove the need for correct payroll records. Keep the service plan, worker approval and submitted time together; contact the coordinator when needs change rather than expanding shifts without authorization.

Your next steps

1. Identify the recipient’s exact Medicaid and STAR+PLUS coverage.
2. Ask the service coordinator about approved CDS services and the entry route.
3. Confirm the proposed worker’s relationship using current CDS requirements.
4. Choose an FMSA and complete employer and employee enrollment.
5. Obtain the budget, start date and timekeeping instructions before billing care.

Explore a pay scenario

The table uses a hypothetical amount of $18.00 per hour. This is not a rate verified for this state. Approved units depend on the assessment and written plan; the table does not establish a maximum or entitlement.

Monthly average = weekly × 52 ÷ 12. Overtime and taxes are not calculated.

Does caregiver pay qualify for IRS Notice 2014-7?

IRS Notice 2014-7 can exclude certain qualifying Medicaid waiver payments from federal gross income when the care recipient lives in the provider’s home. Sharing a home alone is not enough: the payment and program must qualify. This is not an exemption for all caregiver wages, all taxes or all state programs. Ask payroll which payments are covered and check the IRS guidance or a qualified tax adviser. Our calculator does not apply a tax exemption.

Questions families ask

Official sources and review notes

• Texas STAR+PLUS handbook: CDS
• Texas HHS: how CDS works
• Texas HHS: CDS frequently asked questions
• Texas HHS: relationship certification Form 1734
• Texas HHS: STAR+PLUS HCBS eligibility
• Texas HHS: administrative entry procedures

Sources describe the named programs; they do not endorse this website. Rules and provider arrangements can change. Check the linked agency before making a financial decision.