By Indy Senior Advisor Care Team · September 4, 2026
Indiana pays some live-in family caregivers a daily rate through Structured Family Caregiving on the PathWays and Health and Wellness waivers. Here is who qualifies, what the living-together rule really means, and what the service quietly turns off.
The service most Indianapolis families have never heard of
Somewhere in the second or third month of caring for a parent full time, a specific thought arrives: I am doing a job, and nobody is paying me for it. You cut your hours at work. You moved your mother into the back bedroom in Beech Grove, or you moved into hers in Speedway. You are handling meals, bathing, laundry, rides to the IU Health cardiology appointment, and the 3 a.m. wandering. Meanwhile the agency quote you got for the same work came back at a number you cannot afford.
Indiana has a Medicaid service built for exactly that household. It is called Structured Family Caregiving, or SFC, and it pays a live-in caregiver for daily care and support through a contracted provider agency. The state's own service description is blunt about who can be that caregiver: "This may be a nonfamily member or a family member." A daughter counts. A son-in-law counts. In Indiana, a spouse counts too, which is not true in every state.
SFC is available on two Indiana waivers: the PathWays Waiver for Hoosiers 60 and older, and the Health and Wellness Waiver for people under 60 with disabilities. If you are reading this about a parent, PathWays is almost certainly the one that applies. We have written separately about how PathWays and RCAP fit together, and SFC is one of the services that lives inside PathWays.
This post is about the details families get wrong: the living-together requirement, who is allowed to be paid and who is quietly disqualified, why the payment is a daily rate rather than an hourly wage, and the list of other services that SFC shuts off the moment you enroll.
The living-together rule is real, and it is more flexible than it sounds
The single hardest requirement is also the simplest: the caregiver must reside in the home with the individual. Not nearby. Not "three days a week." Not "I have a key and I'm there every morning by seven." The state's service description says the caregiver lives with the person receiving care, and provider agencies enforce it, because the daily rate is built on the assumption that someone is present around the clock.
For a lot of central Indiana families this is the fork in the road. If your mother is in her own house in Eagledale and you are in Fishers, SFC is not the program for your situation as it stands today. Attendant care, adult day services, or in-home aide hours through the waiver may be. That is a conversation for the care manager, not a reason to stop reading — but be clear-eyed that SFC assumes a shared household.
There is one accommodation worth knowing, because it has rescued arrangements that looked disqualified. FSSA's own provider FAQ was asked whether the "common wall" setup would continue to be acceptable for the living-together requirement — a duplex or a townhome, in other words — and the state's answer was that this continues to be permitted. A converted double on the near east side, a mother-in-law unit sharing a wall, a duplex in Irvington where your father has the front half: those have a real argument.
What that means practically is that the housing conversation should happen before the application, not after. Families in the Indianapolis metro who are already weighing a move — consolidating two households, or someone giving up a rental — should factor SFC eligibility into that decision while it is still a decision. Once your parent has signed a lease across town, you have narrowed your own options.
Who Indiana allows to be the paid caregiver
This is where Indiana's rules stopped matching most families' assumptions, and the change is recent enough that people still repeat the old version. Effective July 1, 2024, FSSA rewrote which relationships can be paid for which service under the PathWays and Health and Wellness waivers. The short version: the rules for Structured Family Caregiving are broader than the rules for attendant care.
For an adult receiving waiver services, Indiana's relationship guidance lists these people as permitted to provide structured family care: the spouse of the waiver recipient, the guardian of an adult, a biological or adoptive parent, a stepparent, a power of attorney or attorney-in-fact, an authorized Medicaid representative or Social Security representative, a health care representative who is not a legally responsible individual, and other relatives. That is a wide door.
Now the contrast that catches people. Beginning in July 2024, a spouse may not provide attendant care. A husband who had been paid to provide attendant care hours for his wife lost that path — but SFC remained open to him. If someone told you that Indiana stopped paying spouses, they were describing attendant care and generalizing it incorrectly. Ask your care manager specifically about SFC.
A second wrinkle affects adult children who took on guardianship. A legal guardian of an adult may provide attendant care, but capped at up to 40 hours per person per week, with any additional authorized hours covered by other attendant staff. That same guardian may provide structured family care. And holding power of attorney does not, by itself, disqualify you from either — FSSA's FAQ says plainly that a POA or attorney-in-fact can be a paid caregiver under both services when the recipient and the POA live together.
One prohibition to respect: under Indiana Code 12-10-17.1-10(b), legally responsible individuals are barred from being compensated for self-directed attendant care. Self-direction and SFC are different arrangements, and mixing up the two is a common way families end up with an answer that does not match their actual plan.
It is a daily rate, not an hourly wage — and we cannot tell you the number
Families reasonably want to know what SFC pays before deciding whether to reorganize their lives around it. Here is an honest answer: we are not going to publish a dollar figure, because we could not trace one to an Indiana primary source. Plenty of home care companies and caregiver-marketing sites post specific daily rates for Indiana SFC. Those numbers disagree with each other, and none of them is a state rate table. Rearranging your household around a figure you read on a vendor's blog is a bad trade.
What the state does confirm is the structure. FSSA describes SFC compensation as a per diem: the state pays a daily rate to the Structured Family Caregiving provider when services are delivered that day, based on an approved service plan. The provider agency is paid, and the agency in turn pays the caregiver stipend. You are not billing hours the way an agency aide does.
The rate is not flat across every household. There are three SFC levels, and Indiana's provider FAQ explains that for members 18 and older, the care manager determines the level using a needs-based assessment. During the July 2024 transition, levels were mapped from previously authorized attendant care hours — level one at 1 to 20 hours a week, level two at 21 to 40, level three at 41 and above — which is a useful sense of the gradient even though a fresh assessment, not an hour count, drives the level now.
Two questions to ask the provider agency directly, in this order: what daily rate applies at the level my parent has been assessed at, and what portion of that rate reaches the caregiver. Those are different numbers, and the difference between agencies is the part nobody advertises.
On taxes: you will see confident claims that SFC stipends are tax-free for live-in caregivers. There is a real federal doctrine behind that idea, but whether it applies to a specific household is not something a senior care website should be telling you. Ask a tax preparer who has handled difficulty-of-care payments before you assume any of it is untaxed.
What SFC turns off
This is the section families skip and then regret. Enrolling in Structured Family Caregiving is not purely additive — it displaces certain other services, because Indiana treats them as duplicative of the per diem.
FSSA's FAQ states that when a waiver recipient has SFC, separate payment may not be made for home and community assistance, assisted living, attendant care, or adult family care. Read that list twice. If your mother is currently receiving paid attendant care hours from an outside aide and you switch to SFC, those separately billed hours are not simply layered on top. If the household plan involves an eventual move to a licensed assisted living community, SFC and the assisted living service are not paid together.
Home health is a partial exception with a hard edge. Prior-authorized home health and SFC can both be authorized, and can be delivered on the same day — but not at the same moment, and not by the same person. FSSA addressed this directly because families were being told otherwise: if a home health provider tells you that you can be paid as the home health aide and as the structured family caregiver for the same person, that is incorrect information. Another household member who is qualified can serve as the aide; you cannot wear both badges.
Medication administration sits in an odd spot worth understanding. The state's position is that an immediate family member administering medication is part of the ordinary family relationship, not a billed SFC activity — so it happens, but it is not documented as SFC service delivery. Do not let an agency tell you it is a billable add-on.
The practical takeaway: before you switch, write down every paid service currently in your parent's plan and walk the list item by item with the care manager. If the math only works when SFC is stacked on top of hours that SFC will actually cancel, you need to know that in week one, not month four.
The 15 respite days that are already yours
Buried in the SFC service is a benefit most caregivers never claim. The provider agency must give the principal caregiver up to 15 days of unskilled respite per calendar year, and the funding for it is already inside the daily rate paid to the agency. It is not an extra you have to fight for. It is part of what the agency was paid to deliver.
Unskilled respite means temporary relief that does not require licensed personnel — help with activities of daily living, in place of the usual caregiver, provided by a direct service worker the agency employs or contracts. It can happen at home or in the community. The state also requires that respite be provided by a qualified caregiver familiar with the participant's needs, which is a standard you are allowed to hold the agency to.
Here is the catch you should raise while you are still choosing an agency, not after you have signed: how a "day" gets counted is up to the provider. FSSA was asked whether a day means eight hours or twenty-four, and the answer was that the calculation depends on the SFC provider, with individuals encouraged to ask prospective providers how they support the respite requirement. An agency that lets you draw respite in hourly increments is meaningfully more useful to a caregiver who needs a Tuesday afternoon than one that only releases full days.
If the 15 days run out and you still need relief, the next step is a conversation with the care manager about whether skilled respite — home health aide or skilled nursing — is warranted separately on the waiver. Note that regularly scheduled coverage does not qualify: FSSA says a standing every-Monday-and-Wednesday arrangement does not meet the definition of temporary and periodic respite.
What the agency owes you, and how to judge one
SFC is not a check the state mails you. It runs through a certified provider agency, and the quality of that agency determines whether the arrangement supports you or merely bills for you.
Indiana requires an SFC provider to have a Caregiver Coach, or an RN, on the organizational chart, filled at the time of certification. The agency must complete two quarterly home visits by the caregiver coach or RN, plus consistent communication with the caregiver and the individual. The RN's role is explicitly consultative — oversight and support on the medical aspects of caregiving, not hands-on care. If skilled care is needed, that comes through home health, separate from SFC.
On the front end, Indiana requires the agency owner to demonstrate three years of delivering direct, hands-on care to elders and adults with disabilities and their caregivers in Indiana, or as a Medicaid participating provider in another state, or to hold national accreditation. That is a floor, not a distinction — every certified agency cleared it.
So compare on the things that vary. Ask how the coach actually shows up between the two required quarterly visits. Ask how respite days are counted. Ask what the caregiver's stipend is as a share of the per diem. Ask what happens the week you get the flu and cannot provide care — the backup plan is a real required document, and FSSA says it should be person-centered and revisited as needs change, not a form filed once and forgotten.
You are entitled to interview more than one agency. Families who treat this like choosing a contractor rather than accepting an assignment get noticeably better support out of the same program.
How to start, from the Indianapolis metro
Two things have to be true before SFC is on the table: your parent has to be eligible for Indiana Medicaid, and they have to be enrolled on the applicable waiver. Waiver access is not automatic — there is a level-of-care determination behind it, which we cover in our piece on Indiana's level of care assessment, and PathWays has had a waiting list since its July 2024 launch, when 9,015 people were waiting statewide out of 39,842 total slots. Current counts change; ask where things stand today rather than trusting any published number, including that one.
If your parent is already on PathWays, they have a managed care entity — Anthem, Humana, or UnitedHealthcare — and a care manager through it. That care manager is the person who completes the SFC level assessment and adds the service to the plan. FSSA's guidance says a household whose spouse will provide SFC can work with the care manager at any time to consider including the service. You do not have to wait for an annual review to raise it.
If you are starting from zero, the front door for Marion, Hamilton, Hendricks, Johnson, Boone and Hancock counties is the same one: CICOA Aging & In-Home Solutions, the Area Agency on Aging for all six counties, at 317-803-6131 for the Resource Center or 800-432-2422 toll-free. Unlike some metros, central Indiana is not split across multiple agencies — one call covers the whole service area. CICOA also administers PathWays waiver case management locally, so the same organization can walk you from screening through service planning.
Come to that call with three things written down: who lives in the household today, what care your parent needs on an average day, and what paid services are already in place. Those are the facts that determine whether SFC fits, and having them ready turns a vague call into a real screening.
One last piece of perspective. SFC does not make family caregiving easy, and the per diem will not replace a salary. What it does is put a floor under an arrangement that most families are already running for free — and attach a coach, an RN, and 15 respite days to work that was previously invisible. For a household in central Indiana that has already made the decision to keep a parent at home, that is worth an hour on the phone. If you want help thinking through whether it fits your situation, reach out to our advisors — there is no cost to families.
