Do I Need a Structured Family Caregiving (SFC) Provider, or Can I Set It Up Myself?

You've done the research. You understand that Indiana's Structured Family Caregiving program will pay you to care for your loved one. You've read that the program pays a licensed agency, and the agency keeps a percentage before passing the rest to you. And now you're thinking the obvious thought: Why is there a middleman taking a cut? Can't I just do this myself and keep the whole amount?

It's a fair question, and the honest answer matters more than a comfortable one. So here it is plainly: No, you cannot set up Structured Family Caregiving on your own in Indiana. The program legally requires a licensed provider agency. You can't bill the state directly, and there's no DIY version.

That sounds like bad news if you were hoping to skip the cut. But there's more to it, and by the end of this you'll understand both why the rule exists and what you're actually getting for that percentage. Whether that trade is worth it is a reasonable thing to weigh, and we'll be straight about it.

The Short Answer, and Why

Indiana Medicaid does not pay family caregivers directly under SFC. The state pays licensed provider agencies, and the agency handles the caregiver's payment, tax paperwork, required home visits, and compliance with program rules.^[1] Without an approved agency, you cannot participate in SFC at all.^[2]

This isn't a quirk of one company trying to insert itself into the process. It's how the program is structured at the state level, and every SFC caregiver in Indiana works through some agency. The only real choice you have is which agency — not whether to use one.

The agency requirement is the single most common surprise families hit, and it's the reason "just do it yourself" isn't on the menu.

Why the State Built It This Way

The agency structure exists so the state can trust that the program is being run honestly. Think about what Medicaid is doing here: sending public money to private homes to pay family members for care that, by definition, happens behind closed doors with no time clock. That arrangement only works if someone is verifying that the care is real, the caregiver is qualified, and the rules are being followed.^[3]

The agency is that someone. It confirms the caregiver passed a background check. It makes sure a care plan exists and gets updated. It sends a caregiver coach or registered nurse to visit regularly and check on how things are going. And it keeps the documentation the state requires to keep funding the program.^[4]

The provider will complete two quarterly home visits by a Caregiver Coach (or RN) and will have consistent contact with the caregiver.

Strip the agency out and the whole model collapses — there'd be no way for the state to know whether it was paying for genuine care or writing blank checks. The "middleman" is really the accountability layer that lets the program exist in the first place.

What the Agency Actually Does for You

It's easy to picture the agency as a toll booth that takes a percentage and waves you through. In practice, a good agency does a meaningful amount of work that you would otherwise be doing alone, badly, at 11pm, while also being a full-time caregiver.

Here's what falls to the agency rather than to you:

• Medicaid and waiver paperwork. The enrollment process involves multiple state agencies, eligibility verification, and documentation that has to be exactly right or it gets delayed. The agency manages this.
• The nurse assessment and care plan. Coordinating the assessment that determines your loved one's care level, and building the care plan the program requires.
• Payment and tax handling. Processing your stipend on a regular schedule and producing the right tax documentation, so you're not trying to figure out difficulty-of-care tax rules by yourself.
• Required home visits. A caregiver coach or registered nurse conducts the regular visits the state requires, which also means someone is checking in on you and your loved one.
• Ongoing compliance. Reassessments when needs change, progress reports, and keeping everything current so your payments don't get interrupted.^[5]

The percentage the agency keeps pays for the part of this program that isn't the caregiving — the part most families have no idea how to do and no time to learn.

So What Are You Actually Choosing Between?

Since you can't go solo, the real decision is which agency to work with — and that decision genuinely matters, because agencies are not identical.

The things worth comparing:

• How much of the daily rate passes through to you. Indiana sets a floor here: as of July 2025, SFC providers must pass at least 60% of the daily rate through to the caregiver.^[5] But that's a minimum, not a ceiling. Some agencies pass through more, and that difference is the most direct dollars-and-cents reason to compare.
• How responsive they are. When you call with a problem, does someone answer, or do you wait three days? For a stressed caregiver, responsiveness is worth a lot.
• How well they handle the enrollment slog. A good agency keeps your application moving and keeps you informed through what can be a months-long process.
• Whether they're local. An Indiana-based agency that knows the state's programs and can actually come to your home is a different experience than a national call center.
• What support they offer beyond the check. Training, a real care coach, help during hard stretches.

We cover how to weigh these in detail in our honest comparison of the major SFC providers in Indiana — including where larger competitors have advantages we don't. The right agency is genuinely useful; the wrong one is closer to a toll booth. Choosing well is the part you actually control.

One more dollars-and-cents point the agency handles for you: for a live-in family caregiver, the SFC stipend is generally treated as a tax-free "difficulty-of-care" payment under IRS rules, and the agency produces the paperwork that reflects that.^[6] It's a meaningful part of the program's value that's easy to miss when you're only looking at the headline percentage.

The Honest Caveat

Let's not oversell it. The agency does take a percentage, and that percentage is money that doesn't reach your household. If you're a highly organized person who could theoretically manage paperwork and compliance, it's reasonable to feel some friction about paying for a service you suspect you could partly do yourself.

But you can't actually do it yourself — not legally, not under this program. So the friction isn't really "agency vs. no agency." It's "a good agency that earns its percentage vs. a mediocre one that doesn't." That's the frame that matters. The families who feel cheated are usually the ones who ended up with an unresponsive agency that took its cut and disappeared. The families who feel well-served picked carefully.

And if SFC's structure genuinely doesn't work for you, it's worth remembering that it's not the only program. Attendant Care operates differently, and our guide on SFC vs. Attendant Care lays out the alternatives.

What This Means for Your Family

You can't set up Structured Family Caregiving yourself, and now you know why: the agency is the accountability layer that lets the state fund care happening inside private homes. The percentage an agency keeps pays for the paperwork, the assessments, the compliance, and the support that you'd otherwise face alone. Your real choice is picking an agency that earns it.

At Tender Home Care, we're one of the licensed Indiana agencies you could choose. We focus only on Structured Family Caregiving, we're local, and we try to be the kind of agency that earns its percentage rather than just collecting it. On the one number families compare most — caregiver pay — we'll match any competitor's rate, and new caregivers get a $250 sign-up bonus. We'll also tell you honestly if another program or provider fits your family better. The conversation costs nothing.

If you're still getting oriented, our main guide on how to get paid to care for a family member in Indiana covers the whole program start to finish.

Sources

1. [1] Indiana FSSA. "Structured Family Caregiving and Home Health Services FAQ" — Medicaid pays provider agencies, not caregivers directly. 2024. Link.

2. [2] Indiana FSSA. "Structured Family Caregiving Frequently Asked Questions for Waiver Individuals and Families." 2024. Link.

3. [3] Indiana FSSA. "Providing Structured Family Caregiving — Provider Training" — agency oversight, documentation, and audit requirements. 2024. Link.

4. [4] Indiana FSSA. "Structured Family Caregiving (SFC)." Office of Medicaid Policy and Planning fact sheet, 2025. Link.

5. [5] Indiana Health Coverage Programs. "Bulletin BT2025105: minimum passthrough percentages for SFC and Attendant Care," per House Enrolled Act 1120. July 10, 2025. Link.

6. [6] Internal Revenue Service. "Certain Medicaid Waiver Payments May Be Excludable From Income" (Notice 2014-7) — difficulty-of-care payments to a qualifying live-in caregiver may be excluded from gross income. Link.