If you live with a parent who needs daily help, structured family caregiving is a Medicaid waiver service that can pay you for that care through an agency, in states that offer it.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income In Georgia, for example, Medicaid pays the agency a daily rate, and the agency pays the live-in family caregiver a stipend of at least 60% of it along with coaching and support.Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA
Hearing that Medicaid might pay you for the bathing, the medications and the nights can feel like the first good news in months, and it can be real. But structured family caregiving only exists in some states, it sits inside a waiver your parent has to qualify for first, and the rules on spouses, pay and taxes change from one state to the next.
In This Guide
- What Is Structured Family Caregiving?
- Which States Offer Structured Family Caregiving?
- Does Your Parent Qualify?
- Who Can Be the Paid Caregiver?
- What Does Structured Family Caregiving Pay?
- Is the Payment Taxable?
- Structured Family Caregiving vs. Consumer Direction
- How to Get Started
- Frequently Asked Questions
What Is Structured Family Caregiving?
Most families who find this service have been doing the work for a while already. Structured family caregiving is a way to have some of that work paid for, without your family turning into an employer.
Indiana's description is the clearest. Indiana Structured Family Caregiving is a Medicaid home and community-based waiver service that pays for a caregiver who lives in the same home as the waiver participant to provide daily care and support, and the caregiver may be a family member or someone outside the family.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Three features define the service in the states that describe it in detail:
- A live-in caregiver. The caregiver and the person getting care share a home.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
- An agency in the middle. In Georgia, the daily payment goes to a structured family caregiving agency, not to the family, and the agency provides coaching and support and pays the caregiver a daily stipend.Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA South Dakota describes the same arrangement: a stipend paid through a provider agency rather than an hourly Medicaid wage.Centers for Medicare & Medicaid Services. (n.d.). South Dakota Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SD
- A waiver behind it. The service is authorized inside a state's 1915(c) home and community-based services waiver or a similar program, so it isn't something you apply for on its own.Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA
Which States Offer Structured Family Caregiving?
Not every state offers structured family caregiving, and several states that offer a live-in caregiver service call it something else. The table below lists the states where we confirmed the service, or a close live-in equivalent, from the state agency or from the federal Centers for Medicare & Medicaid Services (CMS). It is not a complete national count. If your state isn't here, ask your state Medicaid agency whether any waiver pays a live-in caregiver.
| State | What it's called | Where it lives | Can a spouse be paid? |
|---|---|---|---|
| Georgia | Structured Family Caregiving | Elderly and Disabled Waiver (CCSP and SOURCE) | No |
| Indiana | Structured Family Caregiving | PathWays for Aging and Health and Wellness waivers | Yes, as extraordinary care, paid through the agency |
| Ohio | Structured Family Caregiving | PASSPORT, Ohio Home Care and MyCare Ohio waivers | Only under separate state criteria |
| North Carolina | Coordinated Caregiving | CAP/DA waiver | Not stated in our sources |
| South Dakota | Structured Family Caregiving | HOPE waiver | Manual is silent |
| Missouri | Structured Family Caregiving Waiver | Its own waiver, for Alzheimer's and related dementias | Not stated in our sources |
| Nevada | Structured Family Caregiving (SFCG) | Its own waiver, for dementia and related conditions | State's draft waiver document says yes |
| Connecticut | Adult Family Living | Connecticut Home Care Program for Elders | Not published |
| Louisiana | Monitored In-Home Caregiving | Community Choices Waiver | Not published |
| Massachusetts | Adult Foster Care | MassHealth | No |
The details behind each row, with the source for each, are below. Rhode Island and North Dakota appear after the table because their live-in options work differently.
Georgia
Structured family caregiving is a service of Georgia's Elderly and Disabled Waiver, which Georgia runs through the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE) for people 65 or older, and people with physical disabilities, who meet a nursing facility level of care.Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA The Georgia Department of Community Health manual sets the daily rate paid to the agency (see the pay table below).mmis.georgia.gov. (2026). Part II Policies and Procedures for EDWP-CCSP and SOURCE General Services (Version Date July 1, 2026), Appendix R 'Reimbursement Rates for CCSP and SOURCE'. Retrieved Sep 23, 2026, from https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/EDWP-CCSP%20and%20SOURCE%20General%20Services-Q3%20July%202026%2020260917175144.pdf Brevy's Georgia structured family caregiving guide covers the application path in detail.
Indiana
In Indiana, structured family caregiving is available under PathWays for Aging for people 60 and older and the Health and Wellness waiver for people 59 and under, and the participant must meet waiver eligibility, including nursing facility level of care.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income See the Indiana paid caregiver guide.
Ohio
Ohio's structured family caregiving rule lets an agency provider employ or contract a caregiver who lives with the person to provide daily care. Ohio's structured family caregiving is open to someone at least 18 who is enrolled on the MyCare Ohio, Ohio Home Care or PASSPORT waiver, needs help with daily personal care and household support, and chooses it.Administration for Community Living. (n.d.). National Family Caregiver Support Program. acl.gov. Retrieved Sep 4, 2026, from https://acl.gov/programs/support-caregivers/national-family-caregiver-support-program See the Ohio paid caregiver guide.
North Carolina
North Carolina calls its version Coordinated Caregiving. NC Medicaid defines Coordinated Caregiving as supportive services to a live-in caregiver, approved under the Community Alternatives Program for Disabled Adults (CAP/DA) waiver, and treats it as a separate service from CAP consumer direction.Centers for Medicare & Medicaid Services. (n.d.). North Carolina waiver factsheet - Medicaid.gov. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NC In North Carolina's Coordinated Caregiving, the caregiver can live in the participant's home, or the participant can live in the caregiver's home.North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment= See the North Carolina paid caregiver guide.
South Dakota
South Dakota's HOPE waiver includes structured family caregiving for people 65 or older and adults 18 to 64 with disabilities who meet a nursing facility level of care. In South Dakota's HOPE waiver, a family member, or a non-relative the state calls fictive kin, may be the paid principal caregiver.Centers for Medicare & Medicaid Services. (n.d.). South Dakota Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SD See the South Dakota paid caregiver guide.
Missouri
Missouri runs a separate Structured Family Caregiving Waiver, which the Missouri Department of Health and Senior Services says supports participants with Alzheimer's disease or a related dementia to receive care in their home.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO See the Missouri paid caregiver guide.
Nevada
Nevada also runs structured family caregiving as its own waiver. CMS lists the Nevada Waiver for Structured Family Caregiving, and Nevada Medicaid says the SFCG waiver is for people with a diagnosis of dementia or a related condition who meet a nursing facility level of care and financial criteria. To ask for services, you contact the Aging and Disability Services Division (ADSD).Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV See the Nevada paid caregiver guide.
Connecticut
Connecticut's live-in model is Adult Family Living, a service under the Connecticut Home Care Program for Elders. The caregiver lives in the home, which belongs either to the older adult or to the caregiver, and an intermediary agency authorized by the state provides training and support. Connecticut's Adult Family Living has four levels of care, and the caregiver's stipend depends on the level, but the program pages we rely on don't publish the amount.State of Connecticut. (n.d.). Connecticut Home Care Program for Elders Connecticut Home Care Program for Elders CHCPE. portal.ct.gov. Retrieved Jun 3, 2026, from https://portal.ct.gov/dss/health-and-home-care/connecticut-home-care-program-for-elders/connecticut-home-care-program-for-elders-chcpe See the Connecticut paid caregiver guide.
Louisiana
Louisiana's Community Choices Waiver covers Monitored In-Home Caregiving. The state's whole description of the service is one sentence: "A principal caregiver lives with you and helps you with basic self-care, such as dressing, bathing, etc." The state publishes no payment amount and no rule on who the caregiver may be, so ask before you plan around it.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA See the Louisiana paid caregiver guide.
Massachusetts
MassHealth Adult Foster Care pays a live-in caregiver to give daily personal care to a MassHealth member, with nursing oversight and care management from an Adult Foster Care provider agency. The member and the caregiver live together in either person's home. A MassHealth Adult Foster Care member must be 16 or older and need daily hands-on help, or cueing and supervision, with at least one activity of daily living.Commonwealth of Massachusetts. (n.d.). MassHealth Adult Foster Care program fact sheet. mass.gov. Retrieved Sep 3, 2026, from https://www.mass.gov/info-details/masshealth-adult-foster-care-program-fact-sheet See the Massachusetts paid caregiver guide.
Rhode Island and North Dakota
Rhode Island lists RIte@Home (LTSS Shared Living) among its main home and community-based options, for people who need considerable help with daily activities but want care in a home-like setting. The state's description we rely on doesn't explain how the caregiver is paid, so ask the state before counting on it.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf See the Rhode Island paid caregiver guide.
North Dakota's Medicaid HCBS waiver includes family personal care, which pays a spouse or certain relatives who live in the same home for help with activities of daily living such as bathing and dressing. Under North Dakota's family personal care, the family member enrolls as a Qualified Service Provider, and the service doesn't pay for housework, laundry or meal preparation.Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND See the North Dakota paid caregiver guide.
Does Your Parent Qualify?
This is the part that surprises families most, and it's worth knowing before you get your hopes up or turn down other help. Your parent doesn't apply for structured family caregiving directly. Your parent applies for the waiver that contains it.
Federal rules allow home and community-based waiver services only for people the state determines would otherwise need the level of care given in a hospital, a nursing facility or an intermediate care facility for people with intellectual disabilities. Each state also caps how many people a waiver serves, and a state with a cap can keep a waiting list.Centers for Medicare & Medicaid Services. (1915). Medicaid.gov — Home & Community Based Services 1915(c) Authority. medicaid.gov. Retrieved Aug 5, 2026, from https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c
In practice, that means three questions, in this order:
- Is your parent eligible for Medicaid long-term care in your state? Each waiver has its own financial rules. In South Dakota's HOPE waiver, for instance, the 2026 monthly income limit is $2,982 and the resource limit is $2,000.Centers for Medicare & Medicaid Services. (n.d.). SD Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver (0189.R07.00) - Medicaid.gov. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83171
- Does your parent need a nursing-facility level of care? Indiana, Georgia, South Dakota and Nevada all state this test for their programs.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income,Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA,Centers for Medicare & Medicaid Services. (n.d.). South Dakota Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SD,Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV
- Is there an opening? Louisiana's Community Choices Waiver, for example, offers slots to six priority groups first, and everyone else gets an offer first-come, first-served based on the date they asked for services.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA If your state keeps a list, asking early is one of the most useful things you can do.
Some programs add their own conditions. Nevada's and Missouri's structured family caregiving waivers are built around dementia.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV,Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
Who Can Be the Paid Caregiver?
In every state here that spells out its caregiver rules, the caregiver shares a home with the person getting care.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income,Commonwealth of Massachusetts. (n.d.). MassHealth Adult Foster Care program fact sheet. mass.gov. Retrieved Sep 3, 2026, from https://www.mass.gov/info-details/masshealth-adult-foster-care-program-fact-sheet,Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA,North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment=,Centers for Medicare & Medicaid Services. (n.d.). SD Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver (0189.R07.00) - Medicaid.gov. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83171,Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV,State of Connecticut. (n.d.). Connecticut Home Care Program for Elders Connecticut Home Care Program for Elders CHCPE. portal.ct.gov. Retrieved Jun 3, 2026, from https://portal.ct.gov/dss/health-and-home-care/connecticut-home-care-program-for-elders/connecticut-home-care-program-for-elders-chcpe,Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA,Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND Beyond that, the rules differ more than most families expect, and the differences land hardest on spouses.
Federal Medicaid rules don't answer the spouse question one way for the whole country. A state may define "family member" differently for a 1915(c) waiver than for its regular personal care benefit, and whether a spouse counts as a legally responsible relative is itself a matter of state law.U.S. Government Publishing Office. (n.d.). 42 CFR 440.167 — Personal care services (Medicaid state plan benefit). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-440/subpart-A/section-440.167 Here's how the states in this guide handle it:
- Georgia: The state's manual says Medicaid won't reimburse waiver services from legally responsible relatives (spouses, legal guardians or parents of minor children) when the care is something they're already obligated to provide. Other relatives can be paid once they meet the provider qualifications and training.Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA
- Indiana: Indiana's Family and Social Services Administration (FSSA) lists the spouse among the people who may provide structured family care. Under the Health and Wellness waiver, a spouse is paid only when the care counts as "extraordinary care," and the payment goes to an approved agency, never directly to the spouse.State of Indiana. (n.d.). SFC FAQ Families FINAL. in.gov. Retrieved Jul 13, 2026, from https://www.in.gov/fssa/files/SFC-FAQ-Families-FINAL.pdf
- Nevada: The state's posted waiver document, marked as a draft, says the caregiver may be a non-family member, a family member or a legally responsible individual, and it names spouses among legally responsible individuals. Confirm the current rule with ADSD.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV
- Ohio: Spouses and other relatives with legal decision-making authority can provide the service only under a separate set of state criteria.Administration for Community Living. (n.d.). National Family Caregiver Support Program. acl.gov. Retrieved Sep 4, 2026, from https://acl.gov/programs/support-caregivers/national-family-caregiver-support-program
- Massachusetts: The Adult Foster Care caregiver can't be the member's spouse, the parent of a minor member or another legally responsible relative, and MassHealth's fact sheet also excludes legal guardians.Commonwealth of Massachusetts. (n.d.). MassHealth Adult Foster Care program fact sheet. mass.gov. Retrieved Sep 3, 2026, from https://www.mass.gov/info-details/masshealth-adult-foster-care-program-fact-sheet
- South Dakota, Connecticut and Louisiana: The state sources we rely on don't say whether a spouse can be paid, so ask the agency directly.Centers for Medicare & Medicaid Services. (n.d.). South Dakota Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SD,State of Connecticut. (n.d.). Connecticut Home Care Program for Elders Connecticut Home Care Program for Elders CHCPE. portal.ct.gov. Retrieved Jun 3, 2026, from https://portal.ct.gov/dss/health-and-home-care/connecticut-home-care-program-for-elders/connecticut-home-care-program-for-elders-chcpe,Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
If you're caring for a husband or wife, Brevy's guide to getting paid to care for your spouse covers the other routes.
Expect a screening either way. In Indiana's structured family caregiving, the agency makes sure the caregiver meets its qualifications, and background check results are among the documents it gathers.State of Indiana. (n.d.). SFC FAQ Families FINAL. in.gov. Retrieved Jul 13, 2026, from https://www.in.gov/fssa/files/SFC-FAQ-Families-FINAL.pdf
What Does Structured Family Caregiving Pay?
This is usually the first question, and it deserves a straight answer: the published numbers are what Medicaid pays the agency, not what lands in your account.mmis.georgia.gov. (2026). Part II Policies and Procedures for EDWP-CCSP and SOURCE General Services (Version Date July 1, 2026), Appendix R 'Reimbursement Rates for CCSP and SOURCE'. Retrieved Sep 23, 2026, from https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/EDWP-CCSP%20and%20SOURCE%20General%20Services-Q3%20July%202026%2020260917175144.pdf Several states set a minimum share the agency must pass on, but what that share covers differs. South Dakota requires the caregiver's stipend itself to equal at least 50% of the tier rate.Centers for Medicare & Medicaid Services. (n.d.). South Dakota Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SD Indiana's 60% minimum passthrough also counts the agency's caregiver coach, nurse supervision and respite costs, so it isn't 60% of the rate going to the caregiver.State of Indiana. (n.d.). IHCP Bulletin BT2025105 — minimum passthrough percentages for Attendant Care and Structured Family Caregiving (Indiana Medicaid / FSSA OMPP). in.gov. Retrieved Aug 1, 2026, from https://www.in.gov/medicaid/providers/files/bulletins/BT2025105.pdf
| State | Daily rate Medicaid pays the agency | Minimum share the state sets | Sourcemmis.georgia.gov. (2026). Part II Policies and Procedures for EDWP-CCSP and SOURCE General Services (Version Date July 1, 2026), Appendix R 'Reimbursement Rates for CCSP and SOURCE'. Retrieved Sep 23, 2026, from https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/EDWP-CCSP%20and%20SOURCE%20General%20Services-Q3%20July%202026%2020260917175144.pdf,State of Indiana. (n.d.). IHCP Bulletin BT2025105 — minimum passthrough percentages for Attendant Care and Structured Family Caregiving (Indiana Medicaid / FSSA OMPP). in.gov. Retrieved Aug 1, 2026, from https://www.in.gov/medicaid/providers/files/bulletins/BT2025105.pdf,North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment=,Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV,Centers for Medicare & Medicaid Services. (n.d.). South Dakota Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SD |
|---|---|---|---|
| Georgia | $110.39 (effective July 1, 2024) | Caregiver's stipend at least 60% of the per diem | Georgia Department of Community Health manual |
| Indiana | $77.54 (Level 1), $99.71 (Level 2), $133.44 (Level 3), on FSSA's February 2024 comparison | 60% passthrough, which also covers coach, nurse and respite costs | Indiana FSSA |
| North Carolina | $63.55 high acuity, $41.93 low acuity (fee schedule last updated February 2022) | Policy says both "at least 50 percent" and "up to 50 percent" | NC Medicaid |
| Nevada | Not stated in our sources | Caregiver's stipend at least 65% of the per diem, under Assembly Bill 208 | Nevada's draft waiver document |
| South Dakota | Three tiers by level of support; amounts not in our sources | Caregiver's stipend at least 50% of the tier rate | South Dakota HOPE waiver manual |
Connecticut and Louisiana don't publish an amount for their live-in services.State of Connecticut. (n.d.). Connecticut Home Care Program for Elders Connecticut Home Care Program for Elders CHCPE. portal.ct.gov. Retrieved Jun 3, 2026, from https://portal.ct.gov/dss/health-and-home-care/connecticut-home-care-program-for-elders/connecticut-home-care-program-for-elders-chcpe,Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Because North Carolina's policy is inconsistent and every agency decides its own split above the floor, ask each agency the same question in writing before you sign on: what share of the daily rate will I be paid?North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment=
Is the Payment Taxable?
Some provider agencies advertise the stipend as tax-free.North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment= The federal rule is narrower, and it hinges on where you live.
Under IRS Notice 2014-7, the IRS treats qualified Medicaid waiver payments as difficulty-of-care payments that can be excluded from the caregiver's federal gross income. The Notice 2014-7 exclusion applies when a caregiver is paid through a state's 1915(c) waiver and the caregiver and the person getting care share the same home as the caregiver's primary residence. The IRS Notice 2014-7 exclusion doesn't apply if the caregiver keeps a separate home where they regularly live, so a caregiver who keeps their own place and visits can't use it.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 1, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Two more limits matter:
- Federal income tax only. Whether Social Security and Medicare taxes apply depends on whether the caregiver is an employee of the agency, an employee of the person getting care, or an independent contractor.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Jun 3, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
- Not automatic outside 1915(c) waivers. For a Medicaid program that isn't a 1915(c) waiver, the IRS says the answer depends on the nature of the payments and the purpose and design of the program.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Jul 10, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income Rhode Island, for example, runs its home and community-based services under a Section 1115 demonstration rather than standalone 1915(c) waivers.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
For the full picture on caregiver taxes, see tax breaks for family caregivers, and talk to a tax professional about your own return.
Structured Family Caregiving vs. Consumer Direction
Families in some states get a choice between structured family caregiving and consumer direction (also called self-direction). The two can sound alike, since both can pay a relative, but they ask very different things of you.
Under self-direction, the person getting care or their representative takes on employer authority: recruiting, hiring, training, scheduling and supervising workers, and deciding what to pay within the budget. Whether a relative can be hired is a state option.U.S. Government Publishing Office. (1915). 42 CFR 441.450 — Basis, scope, and definitions (Self-Directed PAS, 1915(j)) — eCFR current edition. ecfr.gov. Retrieved Sep 2, 2026, from https://www.ecfr.gov/current/title-42/section-441.450 North Carolina's Medicaid program lists Coordinated Caregiving and CAP consumer direction as separate services, and under consumer direction the beneficiary or a representative acts as the employer of record.Centers for Medicare & Medicaid Services. (n.d.). North Carolina waiver factsheet - Medicaid.gov. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NC
| Structured family caregiving | Consumer direction (self-direction) | |
|---|---|---|
| Who runs it | A provider agency | The person getting care or their representative, as the employer |
| Caregiver lives with the person | Yes, required | Not part of the federal definition |
| How the caregiver is paid | A daily stipend from the agency | Pay set within the person's budget |
| Training and support | Agency coaching and support | The employer arranges training |
| Can a relative be paid | Depends on the state | A state option |
The choice can matter most for spouses. In Indiana, a spouse generally can't be paid for Attendant Care, so structured family caregiving is the main route for most spouses.State of Indiana. (n.d.). SFC FAQ Families FINAL. in.gov. Retrieved Jul 13, 2026, from https://www.in.gov/fssa/files/SFC-FAQ-Families-FINAL.pdf Read more in Brevy's guide to Medicaid self-direction and consumer-directed services.
How to Get Started
It can feel like there's no front door here, and that's because structured family caregiving doesn't have one of its own. Start with the waiver, then ask for the service.
Check your state
Use the table above, or ask your state Medicaid agency whether any waiver pays a caregiver who lives with the person.
Apply for the waiver
Your parent applies for the waiver itself. Nevada's SFCG waiver, for example, requires a nursing facility level of care and financial income criteria, and you contact ADSD to request services.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV Indiana requires waiver eligibility, including nursing facility level of care.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 7, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Ask for structured family caregiving in the service plan
In Indiana, the case manager identifies which waiver services meet the member's needs.Centers for Medicare & Medicaid Services. (n.d.). IN PathWays for Aging Waiver (2407.R00.00) — Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/165531
Choose an agency
The agency is who Medicaid pays, and it handles your screening and training.Centers for Medicare & Medicaid Services. (n.d.). Georgia Waiver Factsheet — GA Elderly and Disabled Waiver (0112.R08.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/GA,State of Indiana. (n.d.). SFC FAQ Families FINAL. in.gov. Retrieved Jul 13, 2026, from https://www.in.gov/fssa/files/SFC-FAQ-Families-FINAL.pdf
Get the stipend share in writing
Ask what percentage of the daily rate you'll receive before you sign on.North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment=
If your state doesn't offer structured family caregiving, other paths may still pay you. Brevy's 50-state guide to getting paid as a family caregiver walks through them.
Not sure which waiver in your state offers a live-in caregiver option? Brevy's care navigator can help you find the right office to call.
Frequently Asked Questions
Do I have to move into my parent's home, or can my parent move in with me?
Several states allow either arrangement. North Carolina's Coordinated Caregiving works whether the caregiver lives in the participant's home or the participant lives in the caregiver's home, and Connecticut's Adult Family Living requires the home to be owned by either the older adult or the caregiver.North Carolina Department of Health and Human Services. (2022). NC Medicaid CAP/DA Fee Schedule, last updated Feb 28-2022 (G9003 / G9004 Coordinated Caregiving - High / Low Acuity). medicaid.ncdhhs.gov. Retrieved Sep 30, 2026, from https://medicaid.ncdhhs.gov/cap-dafeescheduleupdated20220228pdf/download?attachment=,State of Connecticut. (n.d.). Connecticut Home Care Program for Elders Connecticut Home Care Program for Elders CHCPE. portal.ct.gov. Retrieved Jun 3, 2026, from https://portal.ct.gov/dss/health-and-home-care/connecticut-home-care-program-for-elders/connecticut-home-care-program-for-elders-chcpe For the federal tax exclusion, though, the shared home has to be the caregiver's primary residence.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 1, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
What if my state doesn't offer structured family caregiving?
Ask whether your state's Medicaid program lets people self-direct their care and hire a relative, since that is a state option rather than a federal rule.U.S. Government Publishing Office. (1915). 42 CFR 441.450 — Basis, scope, and definitions (Self-Directed PAS, 1915(j)) — eCFR current edition. ecfr.gov. Retrieved Sep 2, 2026, from https://www.ecfr.gov/current/title-42/section-441.450 Brevy's 50-state guide to getting paid as a family caregiver, linked below, lists the routes state by state.
Does structured family caregiving cover 24-hour care?
Don't assume it does. Louisiana, for example, states in bold that its Community Choices Waiver "DOES NOT provide help 24 hours per day."Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Ask your state what the service plan will and won't pay for.
Can my brother and I both be paid caregivers for Dad?
Nevada's posted waiver document, marked as a draft, says only one caregiver may provide structured family caregiving to one waiver recipient.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — Nevada Waiver Factsheet. medicaid.gov. Retrieved Oct 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NV Other states' rules may differ, so ask the agency.
Learn More
Find personalized help figuring out whether structured family caregiving can pay you in your state 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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