Page Reviewed / Updated - Apr. 2018
In Texas, there are several programs that will pay family members to provide non-medical, hands-on assistance for a loved one. However, one should not assume they will be automatically eligible to participate in one of these programs. Factors such as one’s income, savings, marital or veteran status can all impact eligibility. Furthermore, one might meet all of a program’s requirements but still be put on a waiting list for benefits.
This article will describe the different programs that are available in Texas, how they work and their eligibility requirements. Another option for website visitors is to use the Paid Caregiver Program Search Tool. Doing so, helps caregivers and care recipients find programs for which they are eligible simply by responding to a series of questions.
Texas Medicaid offers a waiver called STAR PLUS. A waiver is a Medicaid program that provides care services to individuals who do not live in nursing homes. The STAR PLUS waiver will pay for caregivers to come to one’s home and provide a variety of supportive services such as assistance with the activities of daily living (bathing, eating, grooming etc.). For certain services, STAR PLUS allows the care recipient to choose their own service provider / caregiver. STAR PLUS allows beneficiaries to choose family members to provide them with care. The state Medicaid program then pays that family member for doing so. The flexibility to choose one’s caregiver is referred to a “consumer directed care”.
Eligibility criteria for the STAR PLUS Waiver require that the program participant have a need for “nursing home level care”. One is limited to countable assets valued at less than $2,000 (their home is exempt) and they must have less than $2,250 per month in income (in 2018). The caregiver can be related to the care recipient (but does not have to be). However, a caregiver cannot be the spouse or the legal guardian of the care recipient. More details on this program and eligibility is available here.
The Community First Choice Program, abbreviated CFC, is also a Medicaid program and like the STAR PLUS Waiver, the program allows for consumer direction of care services, meaning the beneficiary can choose their caregiver and family members can be among those who are eligibility to provide care. However, CFC differs from STAR PLUS in several ways. First, CFC is an entitlement program (if you are eligible, you receive benefits), while STAR PLUS is not an entitlement (there is limited enrollment so one can be eligible and still be wait-listed for benefits). CFC also covers different benefits than STAR PLUS, but the most relevant benefits to this article (personal care) is covered by both programs. Finally, CFC has more restrictive income criteria than STAR PLUS.
In 2018, a single applicant is permitted monthly income of $750 (vs. $2,250 for STAR PLUS). As with STAR PLUS, the applicant must have less than $2,000 in countable assets and they must require the level of care provided in a nursing home. More information on eligibility and options for person over the eligibility limits are discussed here.
Texas’ Community Care for Aged/Disabled (CCAD) program is non-Medicaid (state funded) option that will pay certain family members or other loved ones for providing certain types of care and assistance. The formal service name of the sub-program under the CCAD Program is Client Managed Personal Attendant Services. This benefit works in a similar fashion to the Medicaid programs described above. The care recipient is approved for a certain type and amount of care, they are allowed to choose their caregiver and a 3rd party, fiscal management service mediates payment from the state to the caregiver. One significant difference between this program and the Medicaid programs is that in this program, provided certain conditions are met, spouses can be paid as caregivers.
While this program is not a Medicaid program, the income and assets requirements are very similar to Texas’ Medicaid programs. Eligibility criteria change annually. More information about this program and the eligibility criteria can be found here.
While programs for veterans are not relevant to all Texans, the state has a very large veteran population, at last census, estimated to be over 1.5 million. Therefore, the programs that follow are relevant to many residents.
The Aid and Attendance Pension benefit is another program available in Texas that can be used to pay family members to provide care. At the forefront, it should be mentioned that this program is only relevant for war-time veterans or their surviving spouses who require assistance with their activities of daily living. Spouses cannot be paid as caregivers, but adult children and other relatives can be compensated. How it works is complicated, please bear with us or consult with a Veterans Pension Planner for a further explanation.
The Aid and Attendance Pension benefit is a cash benefit and the amount of financial assistance varies depending on the beneficiary’s current income. Annually, the VA sets a maximum amount of income a beneficiary can have and then the VA supplements the veteran’s income up to the point of the maximum benefit. For example, in 2018, the Maximum Annual Pension Rate (MAPR) for a couple is approximately $25,000. If the couple has $15,000 in income, the VA will give them an additional $10,000.
Importantly, the VA allows families to deduct certain expenses from their income, so in practice they can still be eligible even if their income is considerably higher than $25,000 per year. One expense they can deduct from their countable income is their cost of care. Therefore, an elderly veteran can hire their adult child (or another relative or friend) to provide them with personal care and the amount they pay their caregiver can be deducted from their income. The VA will compensate the veteran an amount equal to what they pay to their caregiver over and above their existing pension benefit. It should be noted that since the VA counts a couple’s income together, this technique will not work to pay a spouse for caregiving.
This technique is complicated and for the purposes of this article we have oversimplified the details. Learn more about Aid and Attendance eligibility.
Another interesting option veterans can use to pay their caregivers is a program called Veterans Directed Home and Community Based Services (VD-HCBS). For veterans who require the level of care on par with what is provided in a nursing home, this program gives them the option to receive that care at home and to pay family members or friends for providing care. In brief, how this program works is that the veteran is provided with a budget for care instead of being provided with care by the VA. The responsibility for finding the care providers, then falls onto the veteran and / or their family. With control of the budget, the veteran is able to hire family members, friends and even their spouses to provide them with the hands-on assistance with the activities of daily living they would otherwise receive in a nursing home.
Any veteran that participates in the VA Medical Center Care system and requires “nursing home level care” is eligible for this program. Notably, veterans with Alzheimer’s usually meet these criteria. However, not every VA Medical Center (VAMC) in Texas offers the VD-HCBS program. Those which do include the Central Texas Health Care System in Temple, the South Texas Veterans Health Care System in San Antonio and the Michael E. DeBakey VA Medical Center in Houston. Worth noting though is that one does not need to live in these immediate areas to participate in the program. However, some travel may be required to initiate the program. Furthermore, one does not need to live in the same state. For example, residents of Eastern Texas may find it easier to work with a participating VAMC in Shreveport, Louisiana. Read more about VD-HCBS.
If your loved one has long term care insurance and if their policy meets certain requirements, it can be used to hire family members as caregivers. Unfortunately, this option is only relevant to a few Texas residents because most long-term care insurance policies are too restrictive. In short, a policy must 1) pay for personal care provided outside of residential care communities and 2) make the payouts to the policyholder directly instead of to a care provider. If these conditions are met, the policyholder / care recipient can choose from whom they wish to receive care and hire a family member to provide it.
One workaround exists, although the process can present some logistical challenges. The family member who wishes to provide care, can start their own home care agency. The family member who requires care then hires that home care agency and the long-term care insurance provider then makes payments directly to the home care agency / family member. To learn more about starting a home care agency in Texas, read here.