Can I Get Paid to Care for My Spouse in Indiana?

For years, the answer Indiana spouses got was a flat no. You could be paid to care for your aging mother, your brother, even a neighbor — but not the person you'd promised to care for in sickness and in health. The state treated a husband or wife as someone who was simply supposed to do it for free. That changed, and a lot of married couples in Indiana still have no idea.

Today, most spouses in Indiana can be paid to care for a husband or wife at home through a Medicaid program called Structured Family Caregiving. It comes with real rules you have to meet, and it isn't automatic. But if you're already doing the work, there's a decent chance the state will pay you for it.

This guide walks through exactly who qualifies — both the spouse doing the caregiving and the spouse receiving care — how the spousal rule actually works after Indiana's 2024 overhaul, and what to do if it sounds like you.

The Short Answer for Spouses

Yes — in most cases, a spouse in Indiana can now be a paid caregiver for their husband or wife through Structured Family Caregiving (SFC). The caregiver has to live in the home (which spouses generally do), the person receiving care has to be on the right Medicaid waiver and need a nursing-facility level of care, and the arrangement runs through a licensed provider agency.^[1]

This wasn't always allowed, and the path matters. In a 2024 reorganization tied to a Medicaid budget shortfall, Indiana announced that "legally responsible individuals" — a category that includes spouses and parents of minor children — could no longer be paid through the hourly Attendant Care program as of July 1, 2024.^[2] To keep those caregivers from losing everything, the state pointed them to Structured Family Caregiving, which does allow spouses to be paid.^[2]

So the program that pays spouses today is specifically SFC. If someone told you years ago that a spouse "can't get paid in Indiana," they weren't wrong at the time — they're just out of date now.

Who Is Eligible for SFC: The Two-Sided Test

Here's the part most articles get wrong by only telling half the story. SFC eligibility is a two-sided test. Both the person receiving care and the caregiver have to qualify. Miss either side and the answer is no.

Think of it as two doors that both have to open.

Door One: The Spouse Receiving Care

The person being cared for carries most of the eligibility weight. To qualify, your husband or wife generally must:

• Be an Indiana resident and be enrolled in (or eligible for) Indiana Medicaid, meeting the income and asset rules for the relevant waiver.^[3]
• Be on the right waiver. Since the 2024 changes, SFC is offered through the PathWays for Aging Waiver (for those 60 and older) and the Health and Wellness Waiver (for those 59 and younger with a disability), among others.^[4]
• Meet a "nursing-facility level of care." This is a Medicaid term for someone who can no longer safely manage their basic daily needs alone — typically needing hands-on help with several activities of daily living like bathing, dressing, eating, mobility, or managing medications. A nurse assessment makes this determination.^[3]
• Live full-time in the same home as the caregiving spouse.^[1]

That income-and-asset piece is where many couples assume they're disqualified and stop. Don't. A community spouse's income usually isn't counted the way people fear, and Indiana has spend-down pathways and exemptions that bring many families into range. We cover that in detail in our guide to Indiana Medicaid income and asset limits. Assuming you're over the limit without checking is one of the most common — and most expensive — mistakes families make.

Door Two: The Spouse Providing Care

The caregiving spouse has a lighter list, but it's not nothing. To be a paid SFC caregiver, you generally must:

• Be at least 18 years old and physically and mentally capable of providing the care.^[5]
• Live full-time in the home with the person you care for — which, for spouses, is usually a given.^[1]
• Pass a criminal background check. Not every record is automatically disqualifying, but the check is required.^[5]
• Complete training and ongoing check-ins through your licensed provider agency, which is also responsible for two quarterly home visits by a caregiver coach or registered nurse.^[1]

You do not need to be a nurse, hold a certification, or have any prior caregiving credentials. The whole premise of SFC is that the best person to care for someone is often the person who already loves them and lives with them.

SFC allows a caregiver living with an individual to be paid for providing daily care and support. This may be a nonfamily member or a family member.

How Spouses Get Paid: The Three Tiers

SFC doesn't pay by the hour. After a nurse assesses your spouse's needs, they're placed into one of three care levels, and each level carries a fixed daily rate the state pays the provider agency.^[6] As of the 2025 rate guidance, those daily rates were $77.54, $99.71, and $133.44 depending on the assessed level, and Indiana now requires agencies to pass at least 60% of that daily rate through to the caregiver.^[6]

The stipend is paid the same whether a given day was calm or grueling, which suits the round-the-clock reality of caring for a spouse. And for a live-in caregiver, the payment is generally treated as a tax-free "difficulty-of-care" payment under IRS rules.^[7]

If your spouse's needs grow over time, you can request a reassessment — a higher assessed level means a higher daily rate. We walk through exactly how the tiers work and how to move between them in our companion guide on SFC payment levels.

Where the Spousal Rule Has Real Limits

This is the honest part, and it matters. SFC is not a fit for every married couple, and a few limits are worth knowing before you get your hopes up.

The live-in requirement is firm. SFC is built around a caregiver who lives in the home. For most spouses that's not an obstacle, but if you're separated, maintain separate residences, or your spouse lives in a facility, SFC won't fit as written.

Self-directed Attendant Care is generally off the table for spouses. Indiana's rules continue to bar a spouse from being paid as a self-directed Attendant Care worker.^[8] SFC is the spousal route; the self-directed hourly route is not.

Your spouse has to actually meet the level-of-care bar. If their needs are real but light, they may not yet meet the nursing-facility level of care SFC requires. That can change as needs increase, and a reassessment is always worth requesting.

There's a waitlist for the aging waiver. As of early 2026, the PathWays Waiver waiting list stood in the thousands, with the state admitting people over time.^[9] The benefit is real, but the timeline isn't instant.

None of these are reasons not to look into it. They're reasons to get a clear-eyed answer for your specific situation rather than assuming either a yes or a no.

What This Means for You

If you're a husband or wife in Indiana already doing the daily work of caring for your spouse — the bathing, the medications, the meals, the constant attention — there's a real chance the state will pay you a tax-free stipend to keep doing it at home. The spousal door that used to be closed is open now, through Structured Family Caregiving, and a lot of couples simply haven't heard.

At Tender Home Care, this is all we do: Structured Family Caregiving in Indiana. We'll look at your specific situation and tell you honestly whether you and your spouse qualify — and if a different program fits better, we'll point you there instead. For couples who do enroll with us, we'll match any competitor's caregiver pay rate and add a $250 sign-up bonus for new caregivers. The conversation costs nothing, and it might change your family's whole financial picture.

If you want the full overview of how the program works start to finish, start with our guide on how to get paid to care for a family member in Indiana.

Sources

1. [1] Indiana FSSA. "Structured Family Caregiving (SFC)." Office of Medicaid Policy and Planning program description, updated August 25, 2025. Link.

2. [2] Indiana Public Radio. "Advocates raise concerns on FSSA's proposed 'extraordinary care' definition for attendant care" — legally responsible individuals moved out of attendant care as of July 1, 2024, with FSSA pointing spouses and parents to Structured Family Caregiving. July 14, 2025. Link.

3. [3] American Council on Aging (Medicaid Planning Assistance). "Medicaid Structured Family Caregiving (SFC): Benefits & Eligibility." 2026. Link.

4. [4] Indiana FSSA. "Medicaid Strategies" — SFC available under PathWays for Aging and the Health and Wellness Waiver; legally responsible individuals and attendant care guidance. 2024–2026. Link.

5. [5] Indiana FSSA. "Attendant Care and Structured Family Care Relationship Guidance," per Indiana Code 12-10-17.1-10. Link.

6. [6] Indiana Health Coverage Programs. "Bulletin BT2025105: rates and minimum passthrough percentages for Attendant Care and Structured Family Caregiving," per House Enrolled Act 1120. July 10, 2025. Link.

7. [7] Internal Revenue Service. "Certain Medicaid Waiver Payments May Be Excludable From Income" (Notice 2014-7). Link.

8. [8] National Law Review (Krieg DeVault LLP). "HCBS Update: Indiana Implements Home-Grown 70/30 Direct Caregiver Compensation" — restrictions on legally responsible individuals and self-direction under HEA 1120. July 15, 2025. Link.

9. [9] Indiana Capital Chronicle. "PathWays for Aging launches for 123,000 eligible senior Hoosiers" — waiver structure and waitlist context. July 2, 2024. Link.