What the Structured Family Caregiving Waiver is
Unlike self-directed programs, Missouri's Structured Family Caregiving Waiver (SFCW) works differently: your existing informal caregiver becomes the paid caregiver. Caregivers are employed and paid through a Structured Family Caregiving Provider Agency enrolled with the Missouri Department of Social Services.
Does Missouri's SFCW require a specific diagnosis?
Yes — and this is where Missouri differs from states like Ohio. To qualify for the Structured Family Caregiving Waiver, the person receiving care must be diagnosed with Alzheimer's disease or a related disorder and be aged 21 or older. A general aging-related or disability-related need is not enough on its own for this particular waiver.
Could your family member qualify?
- Must be diagnosed with Alzheimer's disease or a related disorder
- Must be aged 21 or older
- Must meet a nursing facility level of care requirement
- Must be enrolled in MO HealthNet and meet income/asset limits (asset limit $6,220.50 for a single applicant as of 2026)
Not sure about any of these? Don't guess.
A short, free check can tell you what may be worth applying for — no obligation.
Check my eligibilityCan you be the paid caregiver?
- Spouses and legal guardians can be paid — a genuine flexibility not available in most other states
- Must already be serving as the informal, live-in caregiver
- Program participant and caregiver must live in the same home full-time
Are you the spouse of the person receiving care?
Spousal rules vary a lot by state and by program — don't assume you're disqualified or automatically eligible.
See the spouse answer for this stateHow much does SFCW pay?
The SFCW daily rate is $110.33 per day effective 1 July 2026. Provider agencies are required to pay the caregiver a minimum of 65% of that daily rate; the remainder covers the agency's coaching, oversight and administration. Ask your provider agency to confirm in writing what share of the daily rate you will receive.
Ready to apply? Here's where to start
- Confirm the care recipient's Medicaid (MO HealthNet) eligibility
- Contact DHSS Senior and Disability Services to request a Home and Community Based Services functional assessment
- Confirm eligibility for the Structured Family Caregiving Waiver specifically (distinct from Missouri's separate Consumer Directed Services program)
- Choose an enrolled SFCW provider agency
- Complete required enrollment and begin receiving the stipend
Getting approved is only part of it. Family caregivers often need to keep track of care hours, documents, reassessment dates and other benefits — FeatherKeep helps keep that organized in one place.
See how FeatherKeep helpsAn important distinction: SFCW vs. CDS
Missouri also runs a separate program, Consumer Directed Services (CDS). CDS is self-directed and excludes spouses entirely — it is a different program with different rules, so don't treat the two as interchangeable. If you're a spouse, SFCW is your relevant pathway; if you're another relative or friend wanting more flexibility, CDS may be worth asking about instead.
What you'll need to keep track of once approved
- Documentation of your existing caregiving relationship and living arrangement
- Ongoing level-of-care and eligibility documentation
- Payment records from your provider agency
Keeping this organized
Once approved, keeping your documentation current for renewals is an ongoing task. FeatherKeep organizes this automatically as you go.
Related guides: US pillar page, Indiana, Georgia, North Carolina, Ohio
Disclaimer
General information only, not legal or financial advice. Missouri's program details, income/asset limits, and eligibility rules change over time — confirm current details with the Missouri Department of Health and Senior Services before applying.