Texas attendant-management choices • Updated September 2026
Who Handles the Attendant? CDS vs Agency Option vs SRO
If you receive Texas personal-assistance services, you may be asked whether an agency should handle the attendant, whether you want to hire and manage the person yourself, or whether you want something in between. This guide shows what each choice means in everyday life, including hiring, schedules, payroll, backup help, and solving problems.
Planned Personal Assistance Services only; license pending.
The short version
Three ways to divide responsibility
Agency Option
The provider manages the workforce.
- Provider recruits and employs attendants.
- Provider handles payroll and employment administration.
- Provider manages substitutes and service delivery.
- The person receiving services still has input.
Consumer Directed Services
The participant becomes the employer.
- Participant recruits, hires, manages, and may dismiss attendants.
- Participant is responsible for backup attendants.
- An FMSA handles specified payroll and tax functions.
- The participant has more control and more employer responsibility.
Service Responsibility Option
Day-to-day control is shared differently.
- Participant selects and supervises attendants.
- Provider remains employer of record.
- Provider handles payroll and business functions.
- Provider remains responsible for substitute-attendant functions.
Side by side
Who does what?
| Responsibility | Agency Option | CDS | SRO |
|---|---|---|---|
| Recruit attendant | Provider | Participant/employer | Participant with provider framework |
| Employer of record | Provider | Participant/employer | Provider |
| Day-to-day supervision | Provider with participant input | Participant/employer | Participant/LAR |
| Payroll/tax administration | Provider | FMSA performs specified financial-management functions | Provider |
| Backup attendant responsibility | Provider | Participant/employer | Provider |
Current Texas references include HHSC PHC service requirements, the Community Care Services Eligibility Handbook, and STAR+PLUS SRO guidance.
Questions to ask before choosing
Control
Do you want to choose and directly supervise the attendant, or would you rather have a provider handle staffing?
Backup coverage
Who will find a substitute when the regular attendant is unavailable? This is one of the biggest practical differences between options.
Employer duties
Are you comfortable taking on hiring, scheduling, supervision, documentation, and other employer responsibilities required under CDS?
Why this matters
More control can be valuable, but it is not automatically easier
CDS can give a person significant control over who provides care and how attendants are managed within program rules. That can be especially meaningful for families who already know a qualified attendant they want to hire. But CDS also shifts major workforce responsibilities to the participant or legally authorized representative.
Agency Option may fit families who want the provider to handle staffing, payroll, substitutes, and workforce administration. SRO sits between those models by giving the participant substantial day-to-day control while leaving core employer and business functions with the provider.
For the bigger program picture, read our Texas PHC & STAR+PLUS Personal Assistance Guide.
Common questions
CDS, Agency Option and SRO FAQ
Does CDS require a person to use Agency Option first?
No. Current Texas guidance states that an eligible applicant may go directly to the CDS option after eligibility and service-planning requirements are met.
Does CDS mean the FMSA is the home-care provider?
No. The FMSA performs financial-management functions for the CDS employer. The participant or legally authorized representative is the employer of the attendant.
Is SRO the same as CDS?
No. Under SRO, the participant manages most day-to-day attendant activities, but the provider remains employer of record and handles core business functions.
Can Valiynt offer these options now?
No. Valiynt is preparing for Texas HCSSA Personal Assistance Services licensure. This guide is educational and does not imply current Medicaid enrollment, program contracting, MCO credentialing, or service availability.
Understand the model before you choose
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