How to Get Paid as a Family Caregiver in Indiana

In Indiana, a family member who lives with a Medicaid waiver recipient, including the recipient's spouse, can be paid to provide daily care at home through Structured Family Caregiving (SFC). On the PathWays and Health and Wellness waivers, a spouse is paid only for care beyond what a spouse would ordinarily provide.1,2

SFC is available under PathWays for Aging and the Health and Wellness waiver, and the caregiver must reside in the home with the person they support.3 Attendant Care (ATTC) is a second route for other relatives, such as an adult child; a spouse has been barred from providing it since July 2024, and the only exception is "extraordinary care" for intensive nursing needs.4

This guide covers every legitimate way to be paid as a family caregiver in Indiana for 2026, and how to choose.

The Short Version

If you are a spouse caring for your husband or wife, Indiana's Structured Family Caregiving is usually the route. You must live in the home with them, and you are paid through a contracted SFC provider agency (on the PathWays and Health and Wellness waivers, only for care beyond what a spouse would ordinarily provide).1,2

If you are an adult child or other relative, Attendant Care (ATTC) can pay you for approved hours of care.4

If your loved one is a veteran, check the VA programs first. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a tax-free stipend, and Veteran-Directed Care allows paid spouses. Both can combine with Indiana Medicaid.

What Makes Indiana Different: SFC and the PathWays Launch

Indiana has two main Medicaid pathways for paid family caregiving, and the right one depends on whether you live with the person you care for.

Structured Family Caregiving (SFC) is the model for live-in caregivers. The caregiver must reside in the home with the care recipient, and the state pays a contracted SFC provider agency a daily rate.5 A spouse may provide SFC, within the limits in the section below.1

Attendant Care (ATTC) is the hourly model. Beginning in July 2024, spouses and parents of minor children (legally responsible individuals, or LRIs) may NOT provide attendant care, though each may provide SFC instead. The exception is the "extraordinary care" allowance (Health and Wellness, TBI and, from August 1, 2026, PathWays waivers): an LRI may be paid only for intensive nursing needs, such as tracheostomy care, continuous ventilator management or total parenteral nutrition (TPN), approved by the Individualized Support Team (IST) and FSSA, with payment going only to an FSSA-approved provider agency and capped at 40 hours a week. Under Indiana Code 12-10-17.1-10(b), an LRI cannot be paid for self-directed attendant care.4 On PathWays, only a spouse counts as an LRI.2

Both are available under PathWays for Aging, Indiana's managed care program, launched July 1, 2024, for Hoosiers 60 and older on Medicaid in a full-coverage aged, blind or disabled category.2 The PathWays waiver that pays for SFC and Attendant Care is narrower: CMS's description says it serves people 65 or older, and people 60 to 64 with physical or other disabilities, who meet a nursing facility level of care.3

The Indiana Paid Family Caregiver Pathways

1. Structured Family Caregiving (SFC): Live-In Caregiver Stipend

Who pays: Indiana Medicaid, through the assigned Managed Care Entity (Anthem, Humana, or UnitedHealthcare) and a contracted SFC provider agency.

Who can be paid: A caregiver who lives in the home with the care recipient. FSSA says this may be a nonfamily member or a family member, including the recipient's spouse, and a Power of Attorney or Attorney in Fact who lives with the recipient can also provide paid SFC. Under the approved Health and Wellness, TBI and (from August 1, 2026) PathWays waivers, a spouse is paid only for care that exceeds what a spouse would ordinarily provide for a person of the same age without a disability or chronic illness, and payment goes only to the provider agency (on PathWays, an OMPP-approved one), never directly to the spouse.1,2 The provider agency trains the caregiver based on the recipient's needs and ensures the caregiver meets its qualifications to provide care.1

What it is: On FSSA's February 2024 comparison, the state paid the SFC provider agency a daily rate by assessed level of need: $77.54 (Level 1), $99.71 (Level 2) and $133.44 (Level 3). Since July 1, 2025, the agency must use at least 60 percent of that daily rate for caregiver stipends and the person providing the care, but FSSA also counts caregiver coach and nurse supervision costs and any respite costs inside that 60 percent, so it is not 60 percent reaching you. Ask the agency what share you will actually be paid, and confirm current rates with the Family and Social Services Administration (FSSA) or the agency.3,5

Eligibility, recipient: Enrolled in Indiana Medicaid and meets a nursing facility level of care. The PathWays waiver serves people 65 or older, or 60 to 64 with a physical or other disability; the Health and Wellness waiver serves individuals 59 and under. Per the federal approvals, both waivers have a designated number of slots. There is no waitlist for the overall PathWays program, but people eligible for PathWays waiver services may be placed on a waitlist.3,2

Income and assets: Monthly income of up to $2,982 (300% of the maximum SSI amount, effective March 1, 2026), counting the individual's income only, not a spouse's. The asset limit is $2,000 (single) or $3,000 (married).2

Best for: A spouse or other live-in family member caring for a Medicaid-eligible Hoosier who needs nursing-level support at home.

2. Attendant Care (ATTC): Hourly Care

Who pays: Indiana Medicaid, through the MCE.

Who can be paid: Other relatives of an adult care recipient, such as an adult child, can provide approved hours of attendant care, and a Power of Attorney or Attorney in Fact can provide paid attendant care when living with the recipient. A spouse or the parent of a minor child is limited to the extraordinary care described above. On the Health and Wellness and TBI waivers, from January 1, 2026, a paid relative who is not an LRI can be reimbursed for no more than 40 hours of attendant care per week.4

What it is: ATTC is paid by the hour. FSSA's February 2024 comparison put the rate paid to the provider agency at $34.36 per hour, and since July 1, 2025 the agency must devote at least 70 percent of that reimbursement to direct-service compensation. FSSA counts wages, employee-related expenses and the agency's administration and overhead inside that 70 percent, so ask the agency what share you will actually be paid.5 PathWays plans also list Self-Directed Attendant Care services; if your family member self-directs, ask the MCE how you are paid.2

Best for: An adult child or other relative who wants to be paid hourly for helping a PathWays-eligible parent or family member.

3. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran, including a spouse, adult child, parent, or other family member.6

2026 stipend: The PCAFC stipend starts from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12. That monthly base is then multiplied by a factor set in 38 CFR 71.40(c)(4)(i), and which factor applies depends on whether the veteran is in the current program or is a legacy participant or legacy applicant.6

• Current program (38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is unable to self-sustain in the community.6
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor comes instead from the sum of the veteran's 2019 clinical ratings, with no self-sustain determination required. A sum of 21 or higher pays 1.00, a sum of 13 to 20 pays 0.625, and a sum of 1 to 12 pays 0.25. This legacy schedule lapses October 1, 2028.6

A veteran who meets both sets of criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, for as long as the veteran remains at the address VA has on record. Confirm the exact amount with the VA Caregiver Support Coordinator.6

Veteran eligibility: Service-connected disability rating of 70 percent or higher, needs personal care for at least six continuous months, enrolled in VA health care.

Why it stands out: Tax-free stipend, allows paid spouses, can stack with SFC or ATTC.

Best for: Families of eligible veterans where one person provides substantial daily care.

4. VA Veteran-Directed Care (VDC)

Who can be paid: Almost any caregiver the veteran chooses, including a spouse.

How it works: The veteran receives a flexible monthly budget from their VA care team and hires caregivers at a self-set rate within that budget. Ask your VA social worker whether VDC is available at your Indiana VA medical center.

Best for: Indiana veterans who want to pay a spouse or choose their caregiver directly.

5. VA Aid and Attendance Pension

2026 maximums: VA publishes Maximum Annual Pension Rates (MAPR) as annual amounts, effective December 1, 2025 to November 30, 2026. A MAPR is the maximum amount of pension payable, not a flat payment: VA bases the payment on the difference between your income for VA purposes and the MAPR. Aid and Attendance MAPR for a veteran with no dependents: $29,093/year; with one dependent: $34,488/year; for a surviving spouse with no dependents: $18,697/year. Unreimbursed medical expenses above 5% of the MAPR may reduce income for VA purposes. Confirm current figures at the VA pension rate page before applying.7

Net worth limit: $163,699. Net worth is not VA's only test. VA's net worth calculation includes the claimant's and dependents' assets and income for VA purposes.7

How caregivers get paid: The pension goes to the veteran; caregivers are paid out of it, ideally under a written agreement. The Indiana Department of Veterans Affairs lists County Veterans Service Offices that assist veterans and their family members with benefits they may be eligible for. Separately, VA says an accredited Veterans Service Organization (VSO) representative's help on VA benefit claims is always free, while an accredited attorney or claims agent can charge fees.8

Best for: Veterans or surviving spouses whose income and net worth fall within VA's limits.

6. Private Personal Services Contract

Who can be paid: A family member under a caregiver agreement that is notarized at the time it is made and cannot be applied before the date it was notarized.9

Why the format matters: Indiana Medicaid applies a 60-month look-back to asset transfers for long-term care eligibility. Indiana requires a caregiver agreement to be notarized at the time the agreement is made. It cannot be retroactively dated or applied before the date it was notarized, and lump sum payments for past or future services are not valid and may result in a transfer of property penalty.9

One exception families miss: there is no transfer penalty when the home goes to a child who lived in it at least two years before the parent's nursing facility admission and whose care let the parent remain at home. Indiana requires documentation of the parent's condition and the care the child provided.9

Best for: Families with enough assets to private-pay now who want to protect future Medicaid eligibility.

Comparing the Indiana Pathways

How to Choose

1. Is your loved one a veteran? Check the VA programs (sections 3 to 5) first; they can stack with Indiana Medicaid.
2. Are you a spouse or live-in family member? Structured Family Caregiving is your Medicaid route. Contact the MCE or an SFC provider agency to start.
3. Are you an adult child or other relative who does not live with them? Attendant Care (ATTC) can pay you for approved hours. Ask the MCE about setting it up.4
4. Is your loved one 65 or older, or 60 to 64 with a physical or other disability, and on Medicaid in a full-coverage aged, blind or disabled category? The PathWays for Aging waiver pays for SFC and ATTC for people in those age groups who also meet a nursing facility level of care. Start with the MCE assigned to their Indiana Medicaid plan.2,3
5. Do you have substantial private assets? Work with an Indiana elder-law attorney to draft a personal services contract before payments start.

How to Become a Paid Family Caregiver in Indiana: Step by Step

Both SFC and Attendant Care start with the care recipient qualifying for a waiver.

Where to Get Help in Indiana

Tax Considerations

• SFC stipend: ask the provider agency how it reports the payment, and confirm the tax treatment with a tax preparer.
• ATTC is paid by the hour; ask the provider agency (or, for self-directed ATTC, the MCE) how taxes are withheld.
• VA PCAFC is a federal tax-free stipend.
• VA Aid and Attendance is tax-free to the veteran; caregivers pay ordinary income tax on what they receive.

IRS Notice 2014-7: If you live in the same home as the person you care for and are paid through a Medicaid waiver, your wages may be excluded from federal gross income. This applies to many Indiana SFC and ATTC arrangements. Talk to a tax preparer before filing.

Indiana state income tax: Indiana levies a flat income tax of 2.95 percent (2026) plus county income taxes.9

Common Misconceptions

"My spouse can't be paid to care for me in Indiana." Under Structured Family Caregiving, they can, within the limits in the FAQ below.1

"I can be my spouse's paid ATTC attendant." Usually not. Since July 2024 a spouse may not provide attendant care. Only agency-paid extraordinary care for intensive nursing needs qualifies, never self-directed.4

"Medicare will pay me to be my parent's caregiver." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies.

"I can informally get paid out of Dad's savings." Not safely. Indiana Medicaid applies a 60-month look-back to asset transfers, and a caregiver agreement must be notarized at the time it is made and cannot be applied before the date it was notarized.9

Related Terms

• Consumer Directed Services (CDS): The national framework for self-directed programs like Indiana's self-directed Attendant Care option.
• HCBS waiver: The federal authority behind the PathWays for Aging and Health and Wellness waivers that fund SFC and ATTC.
• Activities of Daily Living (ADLs): The functional basis for the nursing-facility level of care that Indiana waivers require.
• Nursing Facility Level of Care: The clinical threshold for Indiana HCBS waiver eligibility.

Learn More

Find personalized help getting paid as a family caregiver in Indiana at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.