Structured Family Caregiving
Structured family caregiving (SFC) is a Medicaid-funded model that supports a live-in caregiver, often a family member, who provides daily care to an older adult or a person with a disability. Instead of an hourly wage, the caregiver receives a daily stipend, along with training, coaching and support from a professional team. It is offered in a limited number of states, usually through home and community-based services waivers. This guide explains how SFC works, who qualifies and how it compares with other ways family caregivers get paid.
Figures change periodically. Double-check current amounts before relying on them.
The short version
- In SFC, a caregiver who lives with the person receiving care provides personal care, supervision and help with household tasks.
- The caregiver receives a tax-advantaged daily stipend paid through a provider agency, plus support from a nurse or care manager and a caregiver coach.
- The caregiver may be an adult child, other relative, friend and, in some states, a spouse.
- SFC is usually part of a 1915(c) waiver or similar program, so the person must meet Medicaid’s financial rules and a nursing-home level of care, and there may be a waiting list.
- SFC is offered in a limited number of states, sometimes under other names, and program details vary.
How SFC works
- The person qualifies for the Medicaid program that includes SFC.
- A caregiver is identified who lives with the person, or will, in either the person’s home or the caregiver’s home.
- An SFC provider agency enrolls the caregiver, checks the home, and assigns a professional team.
- The team supports the caregiver with training, regular home visits, coaching and help with problem solving.
- The caregiver documents daily care, often through an electronic system, including notes on health and well-being.
- The agency pays the caregiver a daily stipend, based on the level of care the person needs.
What the caregiver does
SFC caregivers typically provide:
- help with bathing, dressing, grooming, toileting and mobility;
- supervision, including overnight;
- meal preparation and help with eating;
- medication reminders;
- housekeeping and laundry;
- transportation and escort to appointments;
- support for behavioral symptoms, such as wandering in dementia.
The professional support team
A key feature of SFC is support for the caregiver. Teams commonly include:
- a registered nurse who monitors the person’s health and helps the caregiver manage medical needs;
- a care manager or coach who helps the caregiver with stress, problem solving and planning;
- training on topics such as safe transfers, dementia care and infection prevention;
- access to respite, so the caregiver can take breaks.
Stipend levels
The daily stipend usually depends on the level of care the person needs, often in tiers. The agency receives a daily rate from Medicaid and pays part of it to the caregiver as a stipend. Payments to a live-in caregiver under a Medicaid waiver may be excludable from federal income under IRS guidance on “difficulty of care” payments (IRS Notice 2014-7), which is why programs often describe the stipend as tax-free. Caregivers should confirm their own tax situation with a tax professional.
Who qualifies
The person receiving care
- meets the state’s Long-Term Care Medicaid financial rules: asset limit (often $2,000 for one person), income rule (often $2,982 a month in 2026 for waivers), spousal protections and the look-back;
- meets a nursing-home level of care or the program’s functional criteria;
- has a willing, qualified caregiver who lives with them;
- may need to be enrolled in the specific waiver or program, which may have limited slots.
The caregiver
- is at least 18;
- lives with the person;
- passes background checks;
- completes training;
- is able to provide the care needed;
- is not the person’s legal guardian in some states, or meets extra safeguards.
Which states offer SFC
SFC is available in a limited number of states, often through an aging or disability waiver, and some states run similar programs under names such as caregiver homes, adult family care or adult foster care. The list changes as states add or end programs. Each state guide describes the programs available where published, and the state Medicaid agency or Area Agency on Aging can say whether SFC is offered.
SFC compared with other options
| Structured family caregiving | Consumer-directed care | Personal care agreement | |
|---|---|---|---|
| Who pays | Medicaid, through an agency | Medicaid, through a fiscal intermediary | The care recipient, from own funds |
| Pay form | Daily stipend | Hourly wage | Hourly or set rate |
| Caregiver must live with person? | Yes | Usually no | No |
| Professional support | Nurse and coach | Support broker (varies) | None required |
| Spouse can be paid? | In some states | In some states | Generally no |
Benefits and challenges
Benefits
- Recognizes the full-time nature of live-in care.
- Professional support reduces caregiver stress and isolation.
- Helps people stay at home, avoiding or delaying nursing home care.
- The stipend can help a caregiver who has reduced work hours.
Challenges
- Limited availability.
- Stipends may be less than full-time wages.
- Requires living together, which is not right for every family.
- Documentation and home visits take time.
A simple example
Joyce, 79, has moderate dementia and lives with her son Kevin. Kevin had been working full time and worried about leaving her alone. Joyce qualifies for her state’s aging waiver, which includes SFC. Kevin enrolls as her structured family caregiver. A nurse visits monthly, a coach checks in every two weeks, and Kevin logs daily notes on a tablet. He receives a daily stipend at the tier matching Joyce’s needs and uses waiver respite days to take short breaks. Joyce stays at home.
Getting help
The state Medicaid agency or Area Agency on Aging can say whether SFC is offered. A Certified Medicaid Planner can help the care recipient qualify financially, which is often the biggest hurdle.
Frequently asked questions
Is the stipend taxable? Payments under a Medicaid waiver to a live-in caregiver may be excludable under IRS Notice 2014-7. Ask a tax professional.
Can I be paid for SFC and also work another job? Usually yes, as long as the person’s care needs are met.
What if the person moves to a nursing home? SFC ends. The person would receive nursing home Medicaid if eligible.
Can more than one family member share the role? Some programs allow a primary and a backup caregiver.
Key terms
- Stipend: a daily payment to the caregiver, rather than an hourly wage.
- Tier: a payment level based on the care recipient’s needs.
- Provider agency: the organization that enrolls, supports and pays SFC caregivers.
- Caregiver coach: a professional who supports the caregiver with problem solving and stress.
Common mistakes
- Assuming SFC is available everywhere.
- Moving in together before confirming the program’s requirements.
- Not keeping up with daily documentation.
- Not using respite, leading to burnout.
Questions to ask a provider agency
- What stipend tier would apply, and how is it decided?
- How often will the nurse and coach visit?
- What training is required, and when?
- How is daily care documented?
- What respite is available?
- What happens if the caregiver can no longer continue?
A second example: a friend as caregiver
Benny, 70, has a developmental disability and early dementia, and his longtime friend Ray has offered to have Benny live in his home. In a state where SFC allows non-relatives, Ray enrolls as Benny’s structured family caregiver after a home check, background check and training. The agency’s nurse helps Ray learn to manage Benny’s medications, and the coach helps him plan for difficult days. Ray receives a daily stipend at the tier matching Benny’s needs.
How SFC fits with other services
SFC usually covers personal care, supervision and household help provided by the live-in caregiver. Other waiver services, such as adult day care, respite, medical equipment and home modifications, may be added to the service plan, as long as they do not duplicate what the stipend covers. Medicare and Medicaid continue to pay for medical care. The care manager can explain what may be combined in the state’s program.
Is SFC right for your family?
SFC tends to work well when the caregiver already lives with the person or plans to, is committed to providing daily care for the long term, and welcomes coaching and home visits. It may not fit when the caregiver needs a full-time outside job, when the home cannot be made safe, or when the person needs skilled nursing around the clock.
If SFC itself is not offered, look for a similar live-in caregiver option under another name in the state guide.
Planning for the caregiver’s future
A caregiver who leaves a job to provide SFC care should think about the long term: health insurance, retirement savings and what happens when caregiving ends. Some caregivers keep part-time work, continue retirement contributions, or look into marketplace or Medicaid health coverage for themselves. A frank conversation within the family about expectations and backup plans helps keep the arrangement fair to everyone.
Related guides
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.