Self-Direction and FMS in Texas

All states: self-direction map

Texas self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Texas offer self-direction?

Texas has one self-direction model, called the Consumer Directed Services (CDS) option. It is not a program of its own. It is a choice offered inside many Texas Medicaid programs, both managed care and fee-for-service. In every one of them the person receiving services, or their legally authorized representative, becomes the employer of the people who provide the care.

• STAR+PLUS and STAR+PLUS Home and Community Based Services (HCBS): serves adults with disabilities and adults 65 and older in Medicaid managed care. HCBS serves members who qualify for nursing facility care and live in the community. The Texas Health and Human Services Commission (HHSC) runs it through contracted managed care organizations. The member has employer authority and budget authority. Personal assistance services and Community First Choice (CFC) services can be self-directed, and in HCBS so can in-home respite, nursing, therapies, protective supervision and employment services. CDS is not available to members in adult foster care or assisted living.
• STAR Kids, including the Medically Dependent Children Program (MDCP): serves children and young adults with disabilities, and MDCP serves medically dependent children. HHSC runs it through contracted STAR Kids managed care organizations. The member or legally authorized representative has employer authority and budget authority. Personal care services and CFC services can be self-directed, and in MDCP so can respite, flexible family support and employment services.
• STAR Health: serves children and youth in foster care and related groups. HHSC runs it through the STAR Health managed care plan. HHSC lists the CDS option for personal care services and CFC services, with employer authority. We did not find the budget rules specific to STAR Health.
• Primary Home Care (PHC), Community Attendant Services (CAS) and Family Care (FC): fee-for-service attendant programs run by HHSC that serve older adults and people with disabilities who need personal attendant services. The person has employer authority and budget authority. Personal assistance services and support consultation can be self-directed.
• Community Living Assistance and Support Services (CLASS): a 1915(c) waiver run by HHSC that serves children and adults with related conditions (developmental disabilities other than intellectual disability). The person has employer authority and budget authority. Self-directed services include CFC services, respite, nursing, therapies and employment services.
• Deaf Blind with Multiple Disabilities (DBMD): a 1915(c) waiver run by HHSC that serves people who are deaf-blind and have another disability. The person has employer authority and budget authority. Self-directed services include CFC services, intervener, respite and employment services.
• Home and Community-based Services (HCS): a 1915(c) waiver that serves people with an intellectual disability or related condition. HHSC runs it, and local intellectual and developmental disability authorities (LIDDAs) do service coordination. The person has employer authority and budget authority. The HCS handbook limits CDS to people who live in their own home or family home.
• Texas Home Living (TxHmL): a 1915(c) waiver that serves people with an intellectual disability or related condition who live in their own or family home. HHSC runs it with LIDDA service coordination. The person has employer authority and budget authority. Nearly all TxHmL services can be self-directed.

Employer authority means the person recruits, hires, trains, schedules and dismisses their employees. Budget authority in Texas is real but limited. HHSC's CDS questions and answers say the employer sets wages and benefits within the approved budget, at or above minimum wage, but cannot use fewer hours to pay more or use savings to add hours. Employer support costs, such as record keeping equipment, come out of the same budget and are limited to 600 dollars a year.

Who handles financial management services (FMS) in Texas?

A financial management services agency (FMSA) handles FMS for each CDS employer in Texas. There is no single statewide vendor. The person chooses one FMSA from many that hold contracts with HHSC or with the person's health plan. The person, or their legally authorized representative, stays the legal employer, and the FMSA acts as the employer's agent for payroll and taxes.

State rules call this model a vendor fiscal/employer agent. In plain words, the FMSA does the paperwork side of being an employer so the person can focus on choosing and managing staff. HHSC says the FMSA registers with the IRS as the employer's agent, checks that a proposed hire is eligible before hiring, approves the budget, processes payroll, and sends quarterly spending reports. Employees are paid at least twice a month.

• Legal employer: the person receiving services or their legally authorized representative is the CDS employer of record. The FMSA does not employ the workers.
• Fee-for-service programs: the person chooses from the HHSC list for their county. On our last check the HHSC directories listed 26 FMSAs for PHC, 22 for CLASS, 16 for HCS, 15 for TxHmL and 9 for DBMD. Many FMSAs appear on more than one list. See the HHSC FMSA directory page, which links to a county-searchable list for each program.
• STAR+PLUS and STAR Kids: the member chooses one FMSA from the list of FMSAs contracted with their managed care plan. In STAR+PLUS the service coordinator gives the member that list. We did not find a published statewide list of health plan FMSAs, so ask the plan's service coordinator.
• STAR Health: we did not find FMSA details specific to STAR Health. Ask the health plan or HHSC at CDS@hhs.texas.gov.

The HHSC directory labels one list PHC. We did not find a statement on whether the same list covers CAS and Family Care, so check with HHSC before relying on it for those two programs.

Texas also has a Service Responsibility Option (SRO) in its managed care programs. Under SRO a contracted agency employs the attendant and handles payroll and taxes, while the member or representative selects, trains and supervises the attendant. SRO does not use an FMSA, and HHSC does not call it CDS.

Who can be a paid caregiver under self-direction in Texas?

A CDS employer in Texas can hire family members, neighbors or friends, but not everyone. HHSC says the paid employee cannot be the CDS employer, the spouse of the person receiving services, the spouse of the employer, the designated representative or that person's spouse. For a person under 18, a parent or legally authorized representative cannot be the paid employee either.

• Spouses: a spouse of the person receiving services cannot be paid under the CDS option in the Medicaid programs on this page. HHSC notes one exception in a separate attendant program, Consumer Managed Personal Attendant Services (CMPAS).
• Parents of minors: a parent or legally authorized representative of a person under 18 cannot be the paid employee. This matters most in STAR Kids and MDCP, where most members are children.
• Designated representatives: a designated representative is an unpaid volunteer aged 18 or older who passes a criminal history check. That person cannot be a paid service provider for the person.
• Living in the same home (HCS and TxHmL): a CFC service provider may permanently live in the same home as the person served, according to an HHSC information letter. The spouse rule and the parent of a minor rule still apply. In August 2026 HHSC announced it had removed the old live-in restriction from its CDS forms.
• Guardians of adults: we did not find a clear answer on whether a court-appointed guardian of an adult can be the paid employee when the guardian is not the CDS employer. Ask the FMSA or HHSC.

We did not find a published weekly hour cap or overtime rule for CDS employees in the sources we read. Hours are set by the person's service plan and budget, and the employer cannot add hours with unused budget money.

Does EVV apply to self-directed workers in Texas?

Yes. Electronic visit verification (EVV) applies to CDS employees in Texas for personal assistance, Community First Choice and other listed in-home services. The FMSA selects the EVV system, and the CDS employer and employees must use the one it selects. A claim without an accepted EVV visit can be denied or recouped, which can delay an employee's pay.

• Whose system: the FMSA picks either the state-provided EVV system, HHAeXchange, which is offered at no cost, or a proprietary system that the state has approved.
• Who does what: the CDS employer chooses a responsibility option on Form 1722. If the form is not turned in, the FMSA defaults the employer to Option 3.
• Does pay depend on it: the EVV policy handbook says that without an accepted visit Medicaid cannot reimburse the FMSA for payroll, and CDS employees may be paid late. Repeated noncompliance can lead to a corrective action plan or removal from the CDS option.
• PHC, CAS and Family Care: in July 2026 HHSC announced that three CDS billing codes in these programs need an EVV claims match for dates of service on or after August 1, 2026, with unmatched claims denied. We did not find a later notice confirming or delaying that start.

We did not find an EVV exemption for live-in or family CDS employees in the CDS section of the handbook. We did not search the whole handbook, so do not treat that as a firm no. Ask the FMSA or HHSC EVV Operations before assuming either way.

What is changing next for self-direction in Texas?

The share of visits that can be recorded with an alternative device drops from 50 percent to 25 percent on September 1, 2027. A second drop, to 5 percent, follows on September 1, 2028. The limit applies to CDS employers as well as provider agencies, so employers and FMSAs who rely on alternative devices should plan to shift visits to other clock in and clock out methods.

These dates come from the clock in and clock out methods section of the HHSC EVV policy handbook. Handbook sections are revised from time to time, so check the current version before you plan around a date.

We did not find any FMSA procurement or vendor transition ahead. FMSAs enroll through contracts with HHSC or the health plans, not through a single statewide award, so there is no one contract to rebid. Recent changes that are already in effect include the August 2026 form updates for HCS and TxHmL described above and the August 1, 2026 EVV claims matching start that HHSC announced for PHC, CAS and Family Care.

Texas self-direction sources

• Texas HHS: Consumer Directed Services (CDS)
• Texas HHS: CDS questions and answers (PDF)
• Texas HHS: FMSA directories by program
• Texas HHS: STAR+PLUS handbook, Consumer Directed Services
• Texas HHS: EVV policy handbook, section 17000, EVV CDS employer policies
• Texas HHS: EVV policy handbook, section 7000, clock in and clock out methods
• Texas HHS: Information Letter 2025-04 (HCS and TxHmL service providers living in the home)
• Texas HHS provider news: CDS services added to EVV claims matching (July 17, 2026)
• Texas HHS provider news: Consumer Directed Services publication updates (August 12, 2026)

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• Why Do Self-Directed Participants Choose Your FMS as Their Fiscal Intermediary?
• Self-direction in every state (map)
• Texas EVV requirements

Other states with a choice of FMS vendors

Alaska, Colorado, Georgia, Idaho, Kentucky, Louisiana, Maryland, Minnesota, North Carolina, Utah. See every state on the self-direction map.

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.