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.
Who qualifies — the care recipient
- Must be 65 or older, or 21-64 with a qualifying disability
- 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)
Who qualifies — the 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
How to apply
- 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
An important distinction: SFCW vs. CDS
Missouri also runs a separate program, Consumer Directed Services (CDS), which is self-directed but generally excludes spouses. 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.