Missouri's Structured Family Caregiving Waiver can pay a live-in family member caring for a parent, spouse or other relative with Alzheimer's disease or a related dementia. If you're already giving this care at home, you can be paid through an enrolled in-home services provider agency when the person is 21 or older, on Medicaid and meets nursing facility level of care. The first step is a call to the state's in-home services referral line at 866-835-3505.

Who Can Be Paid Through Missouri's Structured Family Caregiving Waiver?

If you live with and care for a relative with dementia, the Structured Family Caregiving Waiver (SFCW) may be able to pay you for that care. It is a 1915(c) waiver of Missouri Medicaid, called MO HealthNet, run by the Missouri Department of Health and Senior Services (DHSS) through its Division of Senior and Disability Services (DSDS).,,

If you've been told Missouri Medicaid won't pay a spouse, that rule belongs to Consumer Directed Services, whose attendant can't be the participant's spouse or legal guardian. SFCW can pay a spouse or guardian, who must be employed by a MO HealthNet enrolled provider agency, work under its licensed nursing oversight and document the care at least daily.

Your relationship Can you be paid?
Adult child or other relative who lives with them Yes, if already the live-in caregiver and employed by the agency
Spouse Yes, if already the live-in caregiver and employed by the agency
Legal guardian Yes, if already the live-in caregiver and employed by the agency
Relative who lives elsewhere Not as the primary caregiver, who must live in the same household full time
A second family member Only as the substitute caregiver
Power of attorney Not stated in our sources; ask the program

Only one primary caregiver can be hired, and that person must already be the live-in caregiver before SFCW is authorized. DSDS staff confirm who that is; the agency's licensed practical nurse decides whether the caregivers are qualified for the person's needs.

Does the Person You Care For Qualify?

Under DHSS rules, including its Home and Community-Based Services (HCBS) Manual 3.60, a person entering SFCW must:

The person can't live in a facility, group home or boarding home, and can't be enrolled in any other HCBS state plan or waiver service, such as Consumer Directed Services or the Aged and Disabled Waiver; those services must be end-dated before SFCW is authorized.,

The approved waiver and its December 2025 renewal draft each cap SFCW at 300 participants per waiver year (July 1 to June 30); if slots fill, "the date of referral will be used."

What the Paid Caregiver Does and Must Meet

SFCW pays for care you're probably already giving: cleaning and laundry, help with bathing, dressing and other personal care, medication oversight to the extent state law allows, and, whenever possible, escorting the person to necessary appointments.

Under the approved waiver, the agency must make at least monthly home visits, you complete daily notes electronically, and caregivers get at least 8 hours of training a year. SFCW caregivers must be at least 18 and able to read, write and follow directions, with at least one of these:

  • At least six months of paid work as an agency homemaker, nurse aide, maid or household worker.
  • At least one year of experience, paid or unpaid, caring for children or for sick or aged individuals.
  • Formal training in nursing arts or as a nurse aide or home health aide.

If you're already stretched thin, the visits and notes can feel like one more job, so ask each agency how it handles them before you choose.

How Much the Missouri Structured Family Caregiving Waiver Pays

The figure Missouri publishes is what the agency gets, not what you get. DHSS's HCBS Manual and rate table state no caregiver wage, only the agency's Medicaid rate: $110.33 per day in the July 2026 rate table, which DHSS's FY 27 memo calls the SFCW "daily stipend rate." The Missouri SFCW unit is one 24-hour day, so it pays by the day, not the hour, and the SFCW rate is based on 60% of the nursing facility daily rate.

The $110.33 daily SFCW rate (July 2026) is not your take-home pay. HCBS Manual 3.60 says "The SFCW provider can take no more than 35% of the SFCW unit rate" and requires the provider to pay the primary and substitute caregivers, so get each agency's payment schedule in writing before you choose.

Estimate based on home care aide wages: for a sense of what this kind of work pays in Missouri, the median hourly wage for home health and personal care aides in the state was $15.90 in May 2025, according to the Bureau of Labor Statistics. That's an occupation figure, not a rate SFCW pays you as a family caregiver.

How to Start Getting Paid

1
Step 1

Call DSDS

Make a Home and Community-Based Services referral at 866-835-3505, or use the online referral form for someone not yet receiving services. Ask for the Structured Family Caregiving Waiver by name.

2
Step 2

Complete the assessment

DSDS assesses level of care and confirms the dementia diagnosis with the person's physician.,

3
Step 3

Choose an agency and a substitute

The provider is the person's choice, subject to availability, and a list of qualified providers is available on request.

4
Step 4

Wait for approval and a slot

DHSS's Bureau of Federal Programs checks whether a slot is open. A denial comes with a Notice of Adverse Action, which you can appeal.

5
Step 5

Start the work and the daily notes

The agency must pay you for the care.,

SFCW authorization doesn't by itself make someone eligible for Missouri's Home and Community Based (HCB) Medicaid. For HCB Medicaid itself, Missouri's 2026 eligibility standards list a monthly income limit of $1,737 for the person, not including a spouse, and a resource maximum of $6,220.50 after Division of Assets. If the person isn't on Medicaid yet, see how to apply for Missouri Medicaid.

Is SFCW Pay Taxable?

Missouri SFCW pay may be excludable from federal gross income under IRS Notice 2014-7, which covers 1915(c) Medicaid waiver payments for care in the caregiver's own home, where the person also lives. SFCW is a live-in 1915(c) waiver, so ask a tax professional whether your pay qualifies, and see whether Medicaid caregiver payments are taxable.

Frequently Asked Questions

My parent has a Medicaid transfer-of-property penalty. Can they still get SFCW?

Yes, if they meet the other SFCW requirements. Missouri's HCBS Manual 3.60 says participants in a transfer of property penalty are eligible for Medicaid-funded SFCW. People who get Medicaid through Missouri's Blind Pension are not eligible for SFCW.

My parent is on a Medicaid spenddown. Can they still get SFCW?

Yes, but only during periods when the spenddown is met. Under DHSS's HCBS Manual 3.60, Missouri SFCW can be authorized during periods when spenddown liability is met.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in MissouriGet paid as a family caregiver in Missouri in 2026: Consumer Directed Services, the dementia caregiving waiver that can pay a spouse, pay rates, and VA options. CaregiverHow to Get Paid to Care for Your Spouse in MissouriIn Missouri a spouse cannot be paid through Medicaid CDS, but the Structured Family Caregiving Waiver (dementia) and the VA's PCAFC stipend can pay a spouse. CaregiverMissouri Caregiver ProgramsEvery caregiver program in Missouri: Consumer Directed Services paid pathways, the Aged and Disabled Waiver, respite, NFCSP grants, VA benefits, and taxes. CaregiverDementia Care in MissouriA 2026 guide to dementia caregiving in Missouri: the Alzheimer's Association helpline, Medicaid respite, Area Agencies on Aging, getting paid, and VA benefits. MedicaidMissouri Medicaid HCBS WaiversMissouri Medicaid HCBS waivers pay for home and community care through MO HealthNet's Aged and Disabled Waiver for adults who need nursing-facility care. CaregiverStructured Family Caregiving Across the StatesStructured family caregiving lets Medicaid pay a relative who lives with a parent for daily care, through an agency. See which states offer it and what it pays.

Find personalized help getting paid as a live-in caregiver through Missouri's Structured Family Caregiving Waiver 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.

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