Consumer Directed Services (CDS) in Texas — How Families Hire and Pay Their Own Caregivers

Consumer Directed Services is the Texas Medicaid option that puts families in the driver’s seat. Instead of receiving care from a stranger assigned by an agency, CDS lets the person receiving care choose their own caregiver — and that caregiver can be a paid family member.

What Is CDS?

A service delivery option within existing programs (primarily STAR+PLUS). The care recipient becomes the employer of record. A Financial Management Services Agency (FMSA) handles payroll, taxes, and compliance.

CDS vs. Agency-Based Care

Agency model: agency assigns a stranger. CDS: your family chooses, hires, schedules, and directs. Most families choose CDS because they want a trusted relative providing care.

Which Programs Offer CDS

STAR+PLUS HCBS (most common — Dallas MCOs include Superior, Molina, Amerigroup, UnitedHealthcare), CLASS (waitlist likely), MDCP (restrictions for parents of minors), DBMD, and Home Living Waiver.

The Employer/Attendant Split

The employer and paid attendant cannot be the same person. The care recipient directs care; the family member provides it. Or one family member manages, another provides hands-on care.

Who Can Be a CDS Attendant

Adult children, siblings, parents, grandchildren, other relatives. Spouses cannot be paid attendants in Texas.

How to Enroll

Active Medicaid + eligible program (usually STAR+PLUS) → HCBS assessment → Choose CDS option → MCO connects you with FMSA → Designate employer and attendant → Background checks → Begin care.

Learn if CDS is right for your family → Contact CareChoice in Dallas