Structured Family Caregiving (SFC)
What Is Medicaid’s Structured Family Caregiving (SFC) Program?
Structured Family Caregiving (SFC) is a Medicaid-funded program designed to support primary live-in caregivers for individuals who are elderly, disabled, or living with Alzheimer’s disease or related dementia. The caregiver—who may be a family member, spouse in some states, or even a close friend—receives a tax-free stipend for providing daily supervision, personal care, and homemaker services. In addition to financial support, caregivers receive training, ongoing coaching, emotional support, and access to respite services when they need a break.
The arrangement requires the caregiver and care recipient to live in the same home, either the caregiver’s or the recipient’s. While often a relative provides the care, this is not always required. In 2025, SFC is available in only 11 states, with North Dakota offering a similar “Family Personal Care” program.
Which States Currently Offer Structured Family Caregiving?
As of 2025, SFC programs are available in: Connecticut, Georgia, Indiana, Louisiana, Massachusetts, Missouri, Nevada, North Carolina, Ohio, Rhode Island, and South Dakota. North Dakota offers a similar benefit that allows family and spouses to be paid caregivers.
SFC is usually offered through a Home and Community-Based Services (HCBS) 1915(c) Medicaid Waiver, which means there are a limited number of enrollment slots. When those slots are full, applicants are placed on a waiting list.
What Are the Benefits of Structured Family Caregiving?
SFC benefits both caregivers and care recipients. Caregivers receive financial support so they can focus on care without the added strain of lost income. They also gain training and resources to improve care quality. Recipients benefit from remaining in their home and receiving consistent care from someone they know and trust.
Typical support includes 24-hour supervision, help with Activities of Daily Living (ADLs) like bathing, dressing, toileting, and mobility, as well as Instrumental Activities of Daily Living (IADLs) like cooking, cleaning, managing bills, and transportation. Caregivers may also assist with medication management and behavioral challenges, such as wandering in dementia.
How Does the Program Work and How Are Caregivers Paid?
Caregivers typically become contractors or employees of a home health agency or provider organization. They are overseen by care coordinators, nurses, or social workers who ensure training needs are met, review daily care notes, and conduct monthly home visits.
Medicaid pays the provider agency a daily rate, and the agency passes a percentage—often between 50% and 65%—to the caregiver. Rates and percentages vary by state and sometimes by the recipient’s level of care. For example, South Dakota (effective July 1, 2025) pays:
- Base: $80.87/day
- Tier 1: $101.09/day
- Tier 2: $113.22/day
At least half of that daily rate must go to the caregiver. In Missouri, the single rate is $103.80/day, with a required minimum of 65% paid directly to the caregiver.
Who Qualifies for Structured Family Caregiving?
Eligibility varies by state and program, but general requirements include:
Caregiver Requirements
- Must be at least 18 years old
- Must live with the care recipient
- Must be the primary provider of care
- Must pass a background check
- Some states prohibit spouses from serving as paid caregivers
Care Recipient Requirements
- Must qualify for Medicaid under the program offering SFC
- Must meet income and asset limits (often around $2,901/month income and $2,000 in countable assets for the applicant)
- Must have a functional need, typically requiring a Nursing Home Level of Care (NHLOC)
How Do State Rules for SFC Differ?
State rules vary widely. For example, Missouri requires the recipient to have Alzheimer’s or related dementia, while Georgia requires the caregiver to be unable to work outside the home due to caregiving duties. Some states allow spouses to be paid (Indiana, Louisiana, Missouri, Nevada, North Carolina, South Dakota), while others prohibit it (Connecticut, Georgia, Massachusetts, Rhode Island).
Medicaid Structured Family Caregiver Programs by State (Updated Feb. 2025)
| State | Benefit Name | Medicaid Program | Population Served | Spouse Eligible? |
|---|---|---|---|---|
| Connecticut | Adult Family Living | Home Care Program for Elders (CHCPE) Waiver | Elderly (65+) | No |
| Georgia | Structured Family Caregiving | Community Care Supports Program (CCSP) & SOURCE (under Elderly & Disabled Waiver Program) | Aged or physically disabled | No |
| Indiana | Structured Family Caregiving | Pathways for Aging Waiver | Aged, blind, or disabled | Yes |
| Louisiana | Monitored In-Home Caregiving | Community Choices Waiver | Seniors and physically disabled adults | Yes |
| Massachusetts | Adult Foster Care | Adult Foster Care Program | Aged 16+ with medical or mental condition | No |
| Missouri | Structured Family Caregiving | Structured Family Caregiving Waiver | Aged 21+ with Alzheimer’s or related dementia | Yes |
| Nevada | Structured Family Caregiving | Nevada SFC Waiver | Persons with Alzheimer’s or related dementias | Yes |
| North Carolina | Coordinated Caregiving | Community Alternatives Program for Disabled Adults Waiver (CAP/DA) | Seniors and disabled adults | Yes |
| North Dakota | Family Personal Care | Medicaid Waiver for Home & Community-Based Services | Seniors and disabled adults | Yes |
| Ohio | Structured Family Caregiving | PASSPORT Waiver | Seniors 65+ and physically disabled 60–64 | Yes |
| Rhode Island | Rlte @ Home | Medicaid LTSS under Comprehensive Demonstration Waiver | Seniors and disabled adults | No |
| South Dakota | Structured Family Caregiving | HOPE Waiver | Seniors and adults with disabilities | Yes |
