How to Get Paid to Care for a Family Member in Indiana

Indiana Structured Family Caregiving

What Is Structured Family Caregiving?

Structured Family Caregiving (SFC) is an Indiana Medicaid HCBS service designed to support eligible individuals who need substantial assistance while living in a community setting. Instead of requiring the person to move into a nursing facility or other institutional setting, SFC can support caregiving in the person's home or another qualifying residential arrangement.

Indiana's SFC framework provides a daily rate/per diem to the SFC provider when authorized services are delivered according to the person's approved service plan. The amount of care and service level is determined through an assessment and the individual's person-centered service plan.

This means Indiana does not simply pay every family caregiver an hourly wage for every hour of care provided. The payment structure is tied to the authorized Medicaid service.

Indiana Paid Family Caregiver Programs

The correct program depends on the person receiving care.

Which Indiana Medicaid Programs Include Structured Family Caregiving?

Structured Family Caregiving is a service within particular Medicaid programs, not a stand-alone Indiana benefit you can apply for on its own. The first question is always which program the person receiving care is eligible for or already enrolled in.

Indiana’s terminology has changed in recent years. If you find older material referring only to the “A&D Waiver”, check how the current Health and Wellness Waiver and Indiana PathWays for Aging apply to your situation.

Indiana Programs and Pathways Compared

Indiana does not run one universal caregiver-payment program. The table below is an orientation aid, not an eligibility determination — not every program pays a family caregiver, and the rules differ by waiver and by service.

Being eligible for a program does not mean a particular family member can be paid. Those are two separate questions, and both have to be answered through the service planning process.

Which Indiana Program Might Apply to Me?

Age is a useful starting point for narrowing the pathway, but it is not the only eligibility factor. Medicaid eligibility, functional needs and the applicable level-of-care determination all matter, and none of these are age-based cash programs.

Health and Wellness Waiver

• Generally serves qualifying individuals age 59 and younger with a disability
• Requires applicable Medicaid eligibility and functional / level-of-care criteria

Indiana PathWays for Aging

• Generally serves qualifying individuals age 60 and over
• Medicaid eligibility and the applicable functional and level-of-care requirements also apply

Traumatic Brain Injury Waiver

• A specialized pathway for qualifying individuals with a traumatic brain injury
• Has its own eligibility and level-of-care requirements

If you are not sure which applies, the care manager, PathWays care coordinator or your Area Agency on Aging can tell you which route fits the person you care for.

Indiana’s 2024 Change: Attendant Care vs Structured Family Caregiving

This is one of the most misunderstood points in Indiana, and it matters for families who were previously paid — or hoped to be paid — through Attendant Care.

Indiana FSSA guidance states that beginning July 1, 2024, legally responsible individuals could no longer provide Attendant Care under the applicable Aged and Disabled / Health and Wellness waiver arrangement, while legally responsible individuals could provide care through Structured Family Caregiving.

Attendant Care did not become Structured Family Caregiving. Indiana FSSA is explicit that they are separate services with separate rules:

• Attendant Care and Structured Family Caregiving are different Medicaid services.
• Legally responsible individuals were restricted from providing Attendant Care under the applicable waiver beginning July 1, 2024.
• Structured Family Caregiving became an available pathway for eligible family caregiving situations, where the service is appropriate and authorized.
• Which service fits your circumstances is a conversation to have with the care manager, not an assumption to make.

Confirm the current position with Indiana FSSA Division of Aging, because guidance issued around a policy change is updated over time.

Who Can Qualify for Structured Family Caregiving in Indiana?

Two sets of requirements apply at the same time: those for the person receiving care, and those for the caregiver.

The care recipient

The person receiving care generally needs:

• Applicable Indiana Medicaid eligibility
• Enrollment in, or eligibility for, an applicable waiver or program
• Functional care needs identified through assessment
• An applicable level-of-care determination
• An approved plan of care or person-centered service plan
• A need for services that can appropriately be met through Structured Family Caregiving

No single diagnosis automatically qualifies someone. Eligibility rests on Medicaid status, program enrollment, assessed need and authorization.

The caregiver

• Acting as the principal caregiver for the participant
• A live-in arrangement, as SFC is built around shared residence
• A caregiver relationship permitted under the applicable waiver rules
• Completion of any required training
• Any required screening, provider or enrollment steps
• Ongoing documentation of the care provided
• Meeting the ongoing service and reporting requirements of the SFC provider agency

Exact caregiver qualifications differ by waiver and can change. Confirm the current requirements with the care manager or the SFC provider agency before making plans that depend on being paid.

Who Can Receive Structured Family Caregiving in Indiana?

SFC is connected to Indiana Medicaid HCBS waiver eligibility. The current Indiana system includes programs such as:

• Health & Wellness Waiver
• Indiana PathWays for Aging
• Traumatic Brain Injury Waiver
• Other applicable HCBS waiver programs

Indiana's former Aged & Disabled Waiver structure changed in 2024. The Health & Wellness Waiver serves eligible individuals age 59 and younger with a disability, while PathWays for Aging serves eligible older adults. Eligibility also depends on Medicaid status, functional needs, level-of-care requirements and the specific program.

Generally, an individual seeking HCBS waiver services must meet both Medicaid eligibility requirements and HCBS waiver requirements. These can include:

• A qualifying age, disability, or other eligibility category
• Medicaid eligibility
• Functional limitations
• Nursing-facility level of care or another applicable level-of-care requirement
• Living in, or transitioning to, an appropriate community setting
• An approved service plan

Does a Diagnosis Automatically Qualify Someone for Indiana Structured Family Caregiving?

No.

Dementia, Alzheimer’s, Parkinson’s, stroke, autism, multiple sclerosis or any other diagnosis does not by itself create eligibility. What matters is what the person’s condition causes them to need day to day, such as:

• Bathing assistance
• Dressing
• Toileting
• Eating
• Mobility
• Transfers
• Medication reminders and support
• Supervision
• Meal preparation
• Household support
• Safety monitoring
• Transportation to appropriate appointments and activities, where covered

Diagnosis explains the condition. Functional need helps demonstrate the care required. That is why a clear, contemporaneous record of the assistance you provide is so useful at assessment time.

Does the Caregiver Have to Live With the Person?

Indiana FSSA describes Structured Family Caregiving as a service arrangement in which the waiver participant lives together with a principal caregiver who provides daily care and support. Shared residence is a defining feature of the service.

This is one of the clearest differences between SFC and some other Indiana home-care or self-directed options, where a worker may come to the home rather than live in it. The live-in expectation applies to Structured Family Caregiving — it should not be assumed for every Indiana Medicaid caregiver service.

If a shared living arrangement is not possible, ask the care manager which other services on the applicable waiver may fit instead.

Can a Family Member Be a Paid Caregiver in Indiana?

Yes — family members can potentially be paid through Structured Family Caregiving when the applicable program and caregiver requirements are satisfied. Indiana’s official PathWays provider information states that family members can be paid providers in the Structured Family Caregiving program.

Which relationships are permitted depends on the waiver, the service and the current rules. Some relationships that are allowed for Structured Family Caregiving are not allowed for self-directed employment, and the reverse can also be true.

Do not assume every relative qualifies, and do not assume a relative is excluded. Ask the care manager specifically: “Under this waiver, can this relative be the paid principal caregiver for Structured Family Caregiving?”

Can a Spouse Be Paid as a Caregiver in Indiana?

Potentially — through Structured Family Caregiving, subject to the applicable waiver and SFC requirements.

This is one of the most important distinctions for Indiana families. Current Indiana FSSA guidance confirms that a waiver recipient whose spouse will provide Structured Family Caregiving can work with their care manager to consider SFC in the service plan under the Health & Wellness, PathWays and Traumatic Brain Injury waivers.

That is not the same as automatic approval. In practice:

• SFC rules are different from the self-directed INCharge rules.
• A spouse cannot be hired as an INCharge self-directed worker.
• A spouse's SFC eligibility is subject to the applicable waiver requirements and the SFC requirements.
• The service must be authorized in the approved service plan.
• Payment is made through the approved provider and payment structure, rather than as a direct state payment to the spouse.

Do not treat these as the same program.

Can a Daughter or Son Be Paid to Care for a Parent in Indiana?

Potentially, depending on the waiver, service, caregiver qualifications and the approved service arrangement. Not every adult child automatically qualifies.

Indiana's current waiver documents distinguish legally responsible individuals from other relatives, and permit certain relatives to provide specific services when the applicable conditions are satisfied. An adult biological or adoptive child who is not acting as a legal guardian may be able to provide certain services, including Structured Family Caregiving, where the waiver and service rules allow it.

This means an adult child caring for an aging parent should not assume that being a family member automatically disqualifies them. Instead, ask:

1. Is the parent Medicaid eligible?
2. Does the parent meet HCBS waiver requirements?
3. Which waiver is the parent enrolled in?
4. Does the parent qualify for Structured Family Caregiving?
5. Is the adult child an allowable caregiver under that specific service?
6. What services will be included in the approved service plan?

What About a Parent Caring for a Child?

The rules for a parent caring for a minor child are different from the rules for a spouse or an adult child, and they can differ between Structured Family Caregiving and self-directed services.

A parent of a minor child may be able to provide Structured Family Caregiving under applicable Indiana waiver rules when the service is authorized and all requirements are satisfied. This is not a universal rule across every Indiana waiver.

Self-directed worker rules are different and may exclude a parent of a minor child from serving as the participant-directed worker.

The specific waiver, service, caregiver relationship, authorization and current Indiana rules must be confirmed with the participant's care manager.

Can My Family Member Be the Paid Caregiver?

The honest answer depends on two things at once: the program, and the service within it. The spouse, adult child and parent-of-a-minor-child answers are covered above. Here are the remaining relationships families ask about most.

Sibling

A sibling may potentially qualify to provide Structured Family Caregiving, depending on the applicable waiver, the approved provider arrangement and whether the caregiver meets the live-in and provider requirements. It is not automatic, and it is not universally excluded.

Other relatives

Indiana waiver rules may permit certain other relatives — for example a grandchild, niece or nephew — to provide Structured Family Caregiving. The exact rules depend on the waiver and the service, so ask the care manager about the specific relationship rather than assuming a general answer applies.

Legal guardian

Guardian rules are program-specific and should not be generalized across Indiana waivers. A legal guardian may be permitted to provide Structured Family Caregiving in some circumstances, while under current INCharge self-direction rules a legal guardian cannot be the paid self-directed worker. Confirm the current rule for the applicable waiver and service before making plans.

Friend or neighbour

Self-directed programs may allow certain non-relative workers where the service permits it. Worker qualifications still apply, including minimum age, required background checks and required training, and relationship restrictions apply to some services.

There is no reliable universal yes/no chart for Indiana. Ask the care manager the question in this exact form: “Under this waiver, for this service, can this relative be the paid caregiver?” and ask for the answer in writing.

Indiana Family Caregiver Relationship Rules

The relationship between the caregiver and care recipient matters — but so does the program. Indiana allows certain relatives and, in some circumstances, legally responsible individuals to provide specific Medicaid HCBS services. The exact rules depend on the waiver, service and caregiver relationship, so no single relationship rule applies across every Indiana Medicaid program.

This table is a starting point, not an eligibility determination. Indiana's official relationship rules should be reviewed for the specific waiver and service before assuming that a particular family member can be paid.

How Much Can a Family Caregiver Make in Indiana?

There is no single Indiana family caregiver wage, and any site quoting one figure for the whole state is oversimplifying. Indiana establishes the applicable Medicaid rate structure, and the amount available can depend on the participant’s approved service and program.

Structured Family Caregiving is not a universal hourly wage. Indiana FSSA materials describe SFC compensation using needs-based levels and a daily or per-diem structure, depending on the applicable program and rules. We do not republish older payment rates here, because figures found in 2024-era material may no longer reflect the current structure.

Keep one distinction clear: FSSA establishes the Medicaid reimbursement rates and service structures. The provider agency receives the authorized Medicaid payment, and the caregiver's compensation is then handled through the applicable provider or employment arrangement. A Medicaid reimbursement rate is not the caregiver's take-home pay, and there is no universal Indiana hourly caregiver wage to quote.

These are different things, and it helps to keep them separate:

• Medicaid reimbursement — what the program pays for an authorized service
• Service rate — the rate attached to the authorized service and level
• Daily or per-diem structure — SFC is generally paid per day, not per hour worked
• Caregiver compensation — what the caregiver actually receives from the provider
• Authorized service level — set through assessment and the service plan
• Provider payment — the SFC provider agency administers the payment arrangement
• Taxes and payroll — treatment depends on the arrangement; get this confirmed in writing

SFC levels

Indiana FSSA guidance describes Structured Family Caregiving as having needs-based levels, with the level determined by the participant’s assessed needs rather than chosen by the family. We do not publish level thresholds or dollar amounts here, because those figures change and older FAQ material can be out of date.

Ask the care manager or SFC provider for the current level criteria and the current rate for the applicable waiver, in writing, and ask explicitly what portion of that rate reaches the caregiver. A Medicaid provider reimbursement rate is not the same as take-home pay.

What Training Does an Indiana Structured Family Caregiver Need?

Structured Family Caregiving involves training and ongoing support from the SFC provider agency. The purpose is to prepare the caregiver to safely meet the participant’s assessed needs and to keep the required documentation.

Training content and any required hours vary by provider and by waiver, and they can change, so ask the provider agency for their current requirements rather than relying on figures found in older material. Typically the provider will explain what must be completed before services begin and what is required on an ongoing basis.

How Does a Structured Family Caregiver Get Enrolled?

Structured Family Caregiving runs through an approved provider agency rather than the family billing Medicaid directly. The usual shape of the process is:

1. The participant is connected with an approved Structured Family Caregiving provider agency
2. The principal caregiver is identified in the service plan
3. Any required screening or background checks are completed
4. Required training is completed
5. Required caregiver and provider paperwork is submitted
6. The service is authorized before caregiving is paid
7. Documentation and reporting continue for as long as the service runs

FeatherKeep does not handle provider enrollment, screening or authorization. Those steps sit with the provider agency, the care manager and the applicable Indiana program.

What Does the Indiana Care Manager Do?

The care manager (or care coordinator under PathWays) is the practical gatekeeper for Structured Family Caregiving. Their role generally includes helping to:

• Assess the participant’s needs
• Develop and coordinate the person-centered service plan
• Identify which services are appropriate
• Discuss whether Structured Family Caregiving fits the situation
• Coordinate provider and service arrangements
• Monitor ongoing needs and how the plan is working
• Handle reassessments and changes in the plan

Practical tip: put your questions in writing, keep a note of every call, and record the name and date of anyone who tells you something about eligibility or rates. That record is what makes follow-up easier months later.

How to Apply for Structured Family Caregiving in Indiana

1. Determine the care recipient’s Medicaid eligibility.
2. Determine which Indiana waiver or program applies.
3. Request and complete the applicable level-of-care and needs assessment.
4. Work with the assigned care manager or care coordinator.
5. Ask specifically whether Structured Family Caregiving is appropriate.
6. Identify an approved Structured Family Caregiving provider.
7. Identify the principal caregiver.
8. Complete required caregiver and provider enrollment steps.
9. Complete required training.
10. Have Structured Family Caregiving included in the approved service plan.
11. Begin services only after authorization and enrollment steps are complete.
12. Maintain the required ongoing documentation.

Indiana does not use a single statewide entry point for every program. For the Health and Wellness and Traumatic Brain Injury waivers, Indiana currently directs applicants to their local Area Agency on Aging. For Indiana PathWays for Aging, enrollment and service planning run through the PathWays managed care entity and its care coordination team.

Start with INconnect Alliance / your Area Agency on Aging if you are not sure which route applies.

What Happens After I Apply?

The exact steps and timescales vary by program, but the general shape of the process looks like this:

1. Application and intake are completed.
2. Eligibility is reviewed, including Medicaid financial eligibility.
3. A functional and level-of-care assessment is carried out.
4. Care planning begins with the assigned care manager or care coordinator.
5. The applicable program or waiver determination is made.
6. Services, including Structured Family Caregiving where appropriate, are authorized in the person-centered service plan.
7. Caregiver and provider requirements are completed — screening, training and paperwork.
8. Services begin once the authorization and provider arrangements are in place.

Authorization matters. Do not start providing care on the assumption that payment will be made retroactively. Payment generally follows an authorized service and an approved provider arrangement, so confirm the start date in writing before you rely on it.

Keeping a dated record of every call, assessment and letter while you wait makes the next conversation far easier — especially if a reassessment or a change in condition happens part way through.

Is There a Waiting List for Indiana Medicaid Waiver Services?

There can be. Indiana FSSA has operated a waiting list for the Health and Wellness waiver, and waiver access can be limited by available capacity rather than eligibility alone.

Waiting-list status varies by program and changes over time, so confirm the current position for the specific waiver with FSSA or your Area Agency on Aging. Meeting the financial and functional criteria does not always mean services start immediately.

If a wait applies, ask what interim supports exist, how the list is prioritized, and how you will be contacted.

Indiana Medicaid Self-Directed Caregiving

What Is INCharge Self-Directed Services?

Indiana's INCharge Self-Directed Services gives eligible HCBS waiver participants more control over who provides their support and how those services are delivered.

Participants who self-direct can generally:

• Recruit workers
• Interview workers
• Hire workers
• Set schedules
• Train workers
• Supervise workers
• Monitor services
• Determine wages within the applicable budget and rules
• Terminate workers when necessary

Indiana provides Financial Management Services to assist with employment administration, payroll, taxes, and related requirements.

INCharge is available on several Indiana HCBS waivers, including:

• Health & Wellness
• PathWays for Aging
• Traumatic Brain Injury
• Family Support Waiver
• Community Integration & Habilitation

Not every service on every waiver is self-directed. The Family Supports and Community Integration & Habilitation waivers serve people with intellectual and developmental disabilities and operate under their own service menus and rules — they should not be assumed to work the same way as the Health & Wellness, PathWays and TBI structured family caregiving pathway.

Who Can Be Hired Through INCharge?

Indiana states that self-directed participants can hire:

• Family members
• Friends
• Neighbors
• Other qualified individuals they recruit

But there are important exclusions. A:

• Spouse
• Legal guardian
• Parent of a minor child

cannot be hired as the self-directed worker under the current INCharge rules.

Self-directed workers generally must also:

• Be at least 18
• Pass required background checks
• Complete required training

This is why searching only for "Indiana Medicaid self-directed caregiving" can produce a different answer from searching for "Indiana Structured Family Caregiving."

Structured Family Caregiving vs. Self-Direction

These programs solve different problems.

Structured Family Caregiving

SFC may be a better pathway when:

• A family member is providing substantial ongoing care
• The care recipient qualifies for an applicable HCBS waiver
• The family relationship is permitted under SFC
• The service is authorized in the person's service plan
• The individual is living in an appropriate community setting

SFC uses an authorized daily rate/per diem structure.

INCharge Self-Direction

Self-direction may be a better fit when:

• The individual wants direct control over hiring workers
• The service is available for self-direction under the person's waiver
• The selected caregiver meets worker requirements
• The caregiver is not a prohibited relationship such as a spouse or parent of a minor child
• The individual is prepared to manage schedules, hiring, training and supervision

Indiana provides Financial Management Services to help administer payroll and taxes.

What If You Don’t Qualify for Structured Family Caregiving?

Structured Family Caregiving is not the only option worth asking about. Depending on the program and assessment, other categories may be available:

• Attendant Care, where the service and caregiver rules allow it
• Participant-directed or self-directed services on the applicable waiver
• Home and community assistance services
• Respite
• Adult day services
• Adult Family Care
• Home modifications
• Caregiver support services
• Other home- and community-based services on the applicable waiver
• Veteran programs, where the care recipient or caregiver qualifies
• The Indiana Family Caregiver Program through Area Agencies on Aging

Most of these are support available to the care recipient or family rather than direct caregiver compensation. They can reduce pressure and cost, but they do not necessarily pay the family caregiver. Ask the care manager to state clearly which of the two any given option is.

Indiana Family Caregiver Support

Indiana’s Family Caregiver Support Program, funded through the Older Americans Act and delivered by Area Agencies on Aging, is frequently confused with Medicaid Structured Family Caregiving. They are not the same thing.

In short: Indiana's Family Caregiver Program provides caregiver support through the Area Agencies on Aging. It is different from Medicaid Structured Family Caregiving and should not be presented as a caregiver wage program. Knowing which one you are being offered prevents a lot of disappointment later in the process.

What Should Indiana Family Caregivers Document?

Documentation is part of the Structured Family Caregiving process, not an afterthought. Current Indiana waiver documentation identifies SFC documentation that includes, among other things:

• justification of need
• ADL and IADL support needs
• level of service
• activities to be performed
• frequency of care

Providers generally expect regular entries tied to the participant’s plan and outcomes. Confirm the current requirements with your provider agency.

Keep documentation as care happens rather than reconstructing months of care later. Contemporaneous notes are far easier to keep audit-ready.

Documentation does not guarantee eligibility. What it does is help you communicate the actual care situation accurately at assessment, reassessment and every conversation in between. FeatherKeep helps families keep that information organized as care happens.

Work out what may apply to you

Indiana Structured Family Caregiving Checklist

One working list covering what is worth gathering before, during and after an Indiana application. It is for your own use — nothing here is saved or submitted.

Prefer a printable version? Medicaid structured caregiving checklist.

Organize Your Indiana Caregiving Records With FeatherKeep

Applying for or maintaining Medicaid caregiving services can create a large amount of information to track — assessments, plans, authorizations, training records, daily care notes and follow-up dates. FeatherKeep helps caregivers keep it organized.

FeatherKeep is an organization tool. It does not determine government eligibility, apply on your behalf, or guarantee Medicaid approval, Structured Family Caregiving approval, caregiver payment or any particular payment amount.

How FeatherKeep helps caregivers stay organized.

Official Indiana & federal sources

These are official government sources. Everything else on this page is FeatherKeep organization guidance, not a government determination.

• Indiana FSSA — Medicaid HCBS waivers — Current waiver documents, including Health and Wellness and Traumatic Brain Injury
• Indiana Medicaid — HCBS self-direction (INCharge) — How participant-directed services and worker rules operate
• FSSA Office of Medicaid Policy and Planning — Medicaid policy, rates and program strategy
• Indiana Family and Social Services Administration (FSSA) — The state agency responsible for Medicaid and aging services
• FSSA Division of Aging — Home- and community-based services, waivers and caregiver programs
• Indiana Medicaid — members — Medicaid eligibility, programs and waiver information
• Indiana PathWays for Aging — Managed long-term services and supports for eligible older adults
• INconnect Alliance / Area Agencies on Aging — Local entry point for assessments and waiver applications
• Indiana Administrative Code — Official rule text for Indiana programs
• Medicaid.gov — home and community based services — Federal background on HCBS waivers

Waiver names, service availability, caregiver rules, rates and waiting-list status can change. Verify current information with Indiana FSSA, Indiana Medicaid, the PathWays care coordinator or your Area Agency on Aging before applying.