The 3 SFC Payment Levels in Indiana — and How to Move Up a Tier

Two families in Indiana can do nearly identical caregiving — same hours, same devotion, same exhaustion — and be paid very different amounts. The reason usually isn't the agency or some negotiation. It's a single number assigned after a nurse's visit: the care level. Structured Family Caregiving pays by tier, and most families never learn what tier they're on, how it was decided, or that it can change.

Indiana's Structured Family Caregiving program pays one of three daily rates, and the tier is set by an assessment of how much help the person needs — not by how hard you work. Understanding that distinction is worth real money over a year, because if your loved one's needs have grown since the last assessment, your pay may be stuck below where it should be.

This guide explains the three SFC payment levels, how the assessment assigns one, and exactly how to request a reassessment if your situation has changed.

How SFC Pay Actually Works

Start with the model, because it's different from a job. Structured Family Caregiving doesn't pay by the hour and there's no timesheet. Instead, the state pays a flat daily rate on the premise that a live-in caregiver is effectively on duty around the clock.^[1]

That daily rate isn't one fixed number. After the person receiving care is assessed, they're placed into one of three care levels, and each level carries its own daily rate.^[2] The state pays that rate to your licensed provider agency, and Indiana now requires the agency to pass at least 60% of it through to you, the caregiver.^[3]

So your weekly stipend is really the product of two things: the tier your loved one is assigned, and the percentage your agency passes through. You can influence both — the tier through accurate assessment, and the pass-through by choosing a good agency.

The Three Payment Levels

Here are the three tiers and their daily rates as of Indiana's 2025 rate guidance. Higher levels reflect greater assessed care needs and pay more.^[3]

The gap between the tiers is significant. Over a full year, the difference between Level 1 and Level 3 — at the same pass-through percentage — comes to more than $20,000 in total daily reimbursement.^[3] That's why the assessment isn't a formality. It sets the financial floor for everything that follows.

How Your Tier Gets Decided

The level is assigned by the state's assessment process, not set by your agency, and it's based on the care recipient's medical needs and how much daily support they require.^[4] It's worth knowing one more thing about the money before we get to the assessment itself: whatever tier you land in, the SFC stipend is generally treated as a tax-free "difficulty-of-care" payment for a live-in caregiver under IRS rules.^[5] The tier sets the amount; the tax treatment lets you keep more of it.

In practice, a case manager or nurse evaluates your loved one — typically looking at how much help they need with activities of daily living (bathing, dressing, eating, toileting, transferring, mobility) and instrumental activities (managing medications, meals, safety supervision).^[4] The more hands-on assistance and supervision the person genuinely needs, the higher the assigned level.

A few things follow from this that are worth holding onto:

• The assessment is about the care recipient, not the caregiver. Your effort doesn't raise the tier; their assessed need does.
• It's a snapshot in time. The level reflects how things looked on the day of the assessment. Conditions like dementia, Parkinson's, or recovery after a stroke change — sometimes a lot — between assessments.
• An accurate picture matters enormously. Underreporting how much help your loved one needs, or having a "good day" during the visit, can land a household in a lower tier than it should be.

Structured Family Caregiving pays caregivers per day using a three-tiered system based on an evaluation of the Medicaid member. The daily rate for level one is about $77, level two is about $100 and level three is about $133.

How to Move Up a Tier

This is the part most families don't know they're allowed to do. Care needs rarely stay flat. Someone who needed moderate help last year may need extensive help now — and if the assessment hasn't caught up, the pay hasn't either. Indiana reassesses as needs change, and you can request a reassessment.^[6]

Here's how to go about it.

1. Document the change

Before you call anyone, write down what's different since the last assessment. Be specific and concrete: "Six months ago Mom could shower with standby help; now she needs full assistance and a transfer." "Dad now needs help managing all medications and can't be left alone." Note new diagnoses, new mobility aids, new incontinence needs, new wandering or safety risks. A reassessment is only as good as the picture you paint of a normal, hard day.

2. Contact your case manager (or care coordinator)

Reach out to your case manager — or, on the PathWays for Aging Waiver, the care coordinator at your managed care entity (Anthem, Humana, or UnitedHealthcare). Tell them your loved one's needs have increased and you'd like a reassessment of the care level. Your provider agency can help you initiate this too.

3. Be honest and complete at the assessment

When the nurse or case manager comes, describe a typical difficult day, not a rare good one. People instinctively downplay their loved one's decline — it's painful to say out loud — but understating need is exactly what keeps families in too low a tier. If a higher level is warranted by the findings, the nurse can assign it and the daily pay rises accordingly.^[6]

Where the Tier System Has Real Limits

An honest word, because chasing a tier for its own sake is the wrong goal. A few things are worth keeping straight.

You can't manufacture a level. Reassessment helps when needs have genuinely grown. It is not a way to game the system, and overstating need on a Medicaid assessment isn't something any reputable agency will help you do.

A higher tier means harder caregiving. Moving from Level 1 to Level 3 isn't really "good news" — it usually means your loved one has declined. The point of getting the tier right is to make sure that when the work gets heavier, the support keeps pace with it.

The pass-through percentage still matters. Even at the right tier, a low pass-through quietly shrinks your stipend. If your agency pays only the 60% floor, the same Level 2 assessment pays you less than it would at an agency that pays more. Our honest comparison of Indiana SFC providers covers how to weigh that, and if you're already enrolled, you have the right to switch — see our guide on how to switch your caregiver agency.

The tier doesn't change the rules of eligibility. All three levels still require a nursing-facility level of care and the rest of the program's requirements. A reassessment moves you between tiers; it doesn't get someone in who doesn't otherwise qualify.

What This Means for Your Family

If you're in Structured Family Caregiving and you've never thought about your care level, it's worth a look — especially if your loved one's needs have grown since the last nurse's visit. The tier sets your daily rate, it's based on assessed need rather than your effort, and it can be revisited when that need changes. A reassessment is a phone call away, and for many families it's the difference between a stipend that fits the work and one that lags behind it.

At Tender Home Care, we help families make sure their loved one is assessed at the right level and that the timing of reassessments keeps up with real changes in care. We focus only on Structured Family Caregiving in Indiana, we'll match any competitor's caregiver pay rate, and we add a $250 sign-up bonus for new caregivers. If you think your tier no longer fits your reality, the conversation costs nothing.

New to all of this? Start with our overview of 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 — flat daily stipend for a live-in caregiver. Updated August 25, 2025. Link.

2. [2] WFYI / Indiana Public Broadcasting. "FSSA lays out providers, tier-system transition from attendant care to Structured Family Caregiving" — three-tiered daily system at roughly $77, $100, and $133 per day. May 2, 2024. Link.

3. [3] Indiana Health Coverage Programs. "Bulletin BT2025105: rates and minimum passthrough percentages for Structured Family Caregiving and Attendant Care," per House Enrolled Act 1120. July 10, 2025. Link.

4. [4] American Council on Aging (Medicaid Planning Assistance). "Medicaid Structured Family Caregiving (SFC): Benefits & Eligibility" — care level assigned through state assessment of the recipient's needs. 2026. Link.

5. [5] 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.

6. [6] Indiana FSSA. "Medicaid Strategies" and SFC guidance — periodic reassessment of care needs as the individual's condition changes. 2024–2026. Link.