Once a family learns that Texas Medicaid will pay a relative to provide care, the next question is how: STAR+PLUS offers two delivery options, and the choice shapes who handles paperwork, payroll, and backup coverage. Here is an honest comparison.
The agency option: the agency is the employer
Your family member becomes an employee of a licensed agency like Newport. We run the background check, training, scheduling, EVV visit verification, payroll taxes, and paychecks. At Newport, agency-option caregivers currently earn $13–14 per hour. If your caregiver is sick or travels, the agency can send backup coverage. The family’s administrative load: essentially zero.
- Best for: families who want simplicity, faster setup, and backup coverage
- Trade-off: the agency manages employment details, so the family directs day-to-day care but not the employment itself
Consumer Directed Services (CDS): you are the employer
The member (or a designated representative – often the daughter or son coordinating everything) becomes the employer of record. You hire, train, schedule, and can set the caregiver’s pay rate within program limits. A financial management services agency (FMSA) handles payroll, taxes, and budgets on your behalf.
- Best for: families who want maximum control – especially over who provides care and what they are paid
- Trade-off: more responsibility – employer paperwork, finding your own backup when the caregiver is out, and managing within the budget
Six questions that decide it
- Do you want backup coverage when your caregiver is unavailable? (Agency strength)
- Do you want to control the caregiver’s hourly rate within the budget? (CDS strength)
- Is the would-be caregiver comfortable being employed and supervised by an agency? (If yes, agency is simpler)
- Does anyone in the family have bandwidth to act as employer? (CDS requires it)
- How fast do you need to start? (Agency enrollment is usually quicker)
- Could things change – caregiver moves away, needs increase? (You can switch options later; neither choice is permanent)
You can switch – and we will tell you straight
Families move between options as life changes. Start with our paid-family-caregiver guide, see how Newport enrolls family caregivers, and if CDS is genuinely the better fit for your family, we will say so.
Questions about your situation? Call Newport Home Health at 972-602-3500 — we serve Dallas–Fort Worth, Houston, and San Antonio, and the consultation is free.
