Nevada Structured Family Caregiving Waiver: Nevada 2026 Guide
Nevada’s Waiver for Structured Family Caregiving (SFCG) is a separate Medicaid waiver, approved by CMS with an effective date of January 1, 2025, for people with dementia or a related condition. It supports a family member or other caregiver who lives with the person and provides daily care, so the person can keep living at home rather than moving to a nursing facility.
This guide covers eligibility, paid family caregiving, services, applying and the nursing home connection for the Structured Family Caregiving Waiver. For the full statewide rules on income, assets, spouses and the look-back, see our Nevada Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What the Structured Family Caregiving Waiver is
The SFCG waiver was created under Assembly Bill 208 (2023) and is described in Chapter 2400 of the Nevada Medicaid Services Manual. It offers three services: case management, respite and structured family caregiving. Requests go through the Aging and Disability Services Division (ADSD), and the structured family caregiving service is delivered by enrolled SFCG providers. In the usual structured family caregiving model, an agency supports the live-in caregiver with coaching and regular check-ins and pays a daily rate rather than an hourly wage.
Self-direction puts the member, or a representative, in charge of choosing caregivers, who can often be relatives or friends. Payroll and paperwork usually run through an agency, so the family does not act as an employer alone. Rules on which relatives can be paid differ; many programs allow adult children, fewer allow a spouse.
Who qualifies in 2026
Eligibility for the Structured Family Caregiving Waiver rests on two tests, care need and finances, plus an available slot. In general, an applicant must:
- have a diagnosis of dementia or a related condition;
- meet a nursing facility level of care;
- meet Nevada Medicaid’s financial income criteria;
- need at least one waiver service;
- be at risk of imminent placement in an institution without home and community-based services; and
- live with a caregiver who will provide daily care.
The money test. the Structured Family Caregiving Waiver uses Nevada’s long-term care Medicaid financial rules, which are usually the same income and asset limits used for nursing home Medicaid. Savings, investments and real estate other than the home count; the home, a car, belongings and some burial funds usually do not. Gifts made in the five years before applying can trigger a penalty that delays waiver services, just as it would delay nursing home coverage.
Nevada’s long-term care financial rules apply: in 2026, the income limit is $2,982 a month (300% of the SSI rate) and the single-person asset limit is $2,000.
Nevada’s 2026 long-term care Medicaid numbers, from our state guide:
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (300% of the SSI rate) |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 (federal minimum, which Nevada uses) |
| Spouse at home: resource allowance (CSRA) | $162,660 (Nevada allows the federal maximum) |
| Spouse at home: monthly income allowance | $4,066.50 (Nevada allows the federal maximum) |
| Personal needs allowance (nursing home) | $154 a month |
| Look-back period | 60 months (5 years) |
If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.
Services the Structured Family Caregiving Waiver can cover
Depending on assessed need, the Structured Family Caregiving Waiver can include:
- case management
- respite for the caregiver
- structured family caregiving: payment and support for the live-in caregiver through an enrolled provider
What is usually not covered. Payment is for care tasks in the plan, not for rent, food or household bills. Caregiver pay is generally taxable, with special treatment for some live-in arrangements.
How to apply for the Structured Family Caregiving Waiver
Here is how applying for the Structured Family Caregiving Waiver usually works. Filing the Medicaid application and the waiver request together saves time.
- Contact the ADSD office for your area and request the Structured Family Caregiving Waiver.
- Complete the level of care screening and the Medicaid application.
- A case manager writes the plan of care with you.
- An enrolled SFCG provider meets the caregiver and sets up the arrangement.
- Services start once they are authorized.
Practical tips. Keep copies of everything you send and note the name of each person you speak with. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Supervision needs, confusion and falls matter as much as hands-on help. A denial notice explains the fair hearing process and its deadline.
Waiting lists and timing
The SFCG waiver is new and has a limited number of slots, so openings can be limited.
Because openings can be limited, it usually makes sense to get on any list early, even before needs are urgent. Stopgaps can include state plan home care, adult day centers, PACE where it operates and local aging services. The waiver waiting lists page explains common rules.
How it relates to nursing home Medicaid
SFCG is for people who meet a nursing facility level of care, so it is a direct alternative to a nursing home. If the caregiver can no longer provide care, the person can move to other waiver services or to a nursing facility.
Because participants meet a nursing home level of care, the Structured Family Caregiving Waiver is a substitute for nursing home care, not a step below it. Nursing home coverage cannot be capped, but waiver enrollment sometimes is. Switching settings is possible in both directions: from home to a nursing home if needs grow, and back home with help from Money Follows the Person.
Planning around the Structured Family Caregiving Waiver
Most families come to the Structured Family Caregiving Waiver during a change: a fall, a hospital stay, or a caregiver who can no longer keep up. Planning a little ahead makes each step easier. Begin with a list of daily tasks, the people who handle them, and the gaps that appear when a caregiver is away. That list supports the assessment and shows where paid help would make the biggest difference.
Paperwork usually includes bank statements, income letters, insurance cards, and proof of identity and residence in Nevada. If long-term care Medicaid may be needed later, five years of records will matter, so it helps to keep them now. A durable power of attorney and health care directive, signed while the person can still make decisions, let a family member handle applications and appeals without court involvement.
Finally, review the plan every few months. Needs change, and Nevada’s programs are designed to change with them through reassessments. A running log of health changes helps with every later review.
Tips for families
Discuss the arrangement openly with siblings, and plan for the caregiver’s own job, health and time off. Track tasks and hours from the start. If a relative was paid privately before Medicaid, a written caregiver agreement matters, since undocumented payments can look like gifts. Have a backup plan for illness or vacations.
Working with a Certified Medicaid Planner is often the fastest way through the Structured Family Caregiving Waiver. A planner who handles Nevada cases regularly can spot eligibility problems before the Nevada Division of Welfare and Supportive Services does, organize the records and help plan around any wait. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.
Related pages
- Nevada Medicaid guide
- Nevada Waiver for the Frail Elderly
- Paid family caregivers
- Consumer-directed care
- Caregiver agreements
- HCBS waivers explained
- In-home care and Medicaid
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.