SFC vs. Attendant Care in Indiana: Which Is Right for Your Family?

When an Indiana family first discovers that Medicaid will pay them to care for a loved one, the relief usually lasts about five minutes — right up until they realize there isn't one program, there are two, and nobody has explained the difference. Structured Family Caregiving. Attendant Care. Both pay family members. Both run through Medicaid. They are not the same thing, and choosing the wrong one can cost a family thousands of dollars a year or disqualify them entirely.

The difference comes down to three things: where the caregiver lives, how they get paid, and whether that pay is taxed. Get those three straight and the right choice usually becomes obvious.

This guide lays out both programs side by side, in plain language, so you can tell which one fits your family before you spend weeks pursuing the wrong one.

The Short Version

Structured Family Caregiving (SFC) pays a live-in family caregiver a flat daily stipend. The caregiver must live with the person they care for. The pay is usually tax-free. There's no hourly timesheet.^[1]

Attendant Care (sometimes called CDAC or ATTC) pays a caregiver an hourly wage for a set number of approved hours. The caregiver does not have to live with the person. The pay is taxable, and you get a W-2.^[2]

That's the whole distinction in two sentences. Everything else is detail — but the detail matters, because it determines how much you take home and whether you qualify at all.

Where the Caregiver Lives

This is the first fork in the road, and it eliminates one option for most families immediately.

SFC requires the caregiver to live full-time in the same home as the care recipient. The program is built on the assumption that a live-in caregiver is effectively on duty around the clock, which is why it pays a daily rate rather than counting hours.^[3]

Attendant Care has no such requirement. A caregiver can drive across town, provide a few hours of hands-on help, and go home to their own house. If you're a daughter who checks on your mother every morning and evening but you each keep your own home, Attendant Care fits your life and SFC does not.^[4]

So the first question to ask is simple: do you live with the person you care for, or could you? If yes, SFC is on the table. If no, and moving in isn't realistic, Attendant Care is likely your path.

How the Pay Works

The payment models are genuinely different, and they suit different care situations.

Under SFC, the care recipient is assessed and assigned one of three care levels. Each level carries a fixed daily rate the state pays the agency: $77.54, $99.71, or $133.44 per day as of 2025.^[5] Indiana requires providers to pass at least 60% of that daily rate through to the caregiver.^[5] You're paid the same daily amount whether a given day was quiet or exhausting. Over a month, that adds up to a predictable, steady stipend. We explain how those tiers are assigned, and how to move up one, in the 3 SFC payment levels in Indiana.

Under Attendant Care, a case manager authorizes a certain number of care hours based on assessed need, and the caregiver is paid for those hours. The state reimbursement rate is $34.36 per hour, of which providers must pass at least 70% through to the caregiver.^[5] If more hours are approved, you can earn more; if few hours are approved, you earn less.

Here's the counterintuitive part that families miss: for someone who needs a lot of daily care, the SFC daily stipend often pays more than the limited hours Attendant Care would authorize. For someone who needs only a few hours of help a day, Attendant Care's hourly model may come out ahead. The "better-paying" program depends entirely on how much care your loved one actually needs.

The Tax Difference Is Bigger Than It Looks

This is where the two programs really diverge, and it's the factor families underestimate most.

SFC stipends paid to a live-in caregiver are usually treated as "difficulty of care" payments under IRS Notice 2014-7, which means they're excluded from federal income tax.^[6]

This treatment applies, regardless of the individual care provider's relationship to the person receiving the care, as long as the individual care provider has the same home as the eligible person receiving care.

Attendant Care wages are ordinary taxable income. You receive a W-2, and federal and state taxes are withheld like any other job.^[7]

Consider two caregivers who each receive $48,000 in a year. The Attendant Care caregiver pays federal and state income tax on all of it. The live-in SFC caregiver, if their stipend qualifies for the exclusion, may owe no income tax on it at all.^[6] Same headline number, very different take-home. We always recommend confirming your own situation with a tax professional, since the exclusion depends on living arrangements and individual facts — but for a live-in family caregiver, the tax treatment alone can tilt the decision toward SFC.

Who Can Be the Caregiver

The programs also differ on a rule that became important after a 2024 policy change.

As of July 2024, Indiana no longer allows legally responsible individuals — most commonly spouses and parents of minor children — to provide Attendant Care. Those caregivers are now directed toward SFC instead.^[8] So if you're caring for your husband or wife, SFC is generally your route; the hourly Attendant Care path is largely closed to spouses. We cover this in depth in can I get paid to care for my spouse in Indiana?.

For an adult child caring for a parent, both programs remain open, and the choice comes back to the live-in question and the care-hours math.

A side-by-side look

A table can only take you so far, though. The right choice depends on the specific person, the specific home, and the specific care needs — which is exactly the kind of thing worth talking through with someone who knows the programs rather than guessing from a chart.

Where Each Program Falls Short

Neither program is perfect, and pretending otherwise would do you a disservice.

SFC's limits: It requires you to live with the person, which isn't possible for every family. It pays the same daily rate regardless of how heavy a particular day was, which can feel unfair on the hardest days. And because it's tied to a nursing-facility level of care, lighter-need situations may not qualify.

Attendant Care's limits: The pay is taxable, which quietly shrinks it. Hours are capped by what the case manager authorizes, so you can't simply work more to earn more. And since the 2024 change, it's no longer an option for most spouses.

There's also a rule both programs share that surprises people: you generally can't stack them or double up with other hands-on care services for the same hours. Medicaid won't pay twice for the same care.^[9]

How to Decide

Walk through these questions in order:

1. Do you live with the person you care for (or could you)? If no, Attendant Care is likely your path. If yes, keep going.
2. Are you the person's spouse? If yes, SFC is generally your route.
3. How much daily care does your loved one need? Heavy, around-the-clock supervision tends to favor the SFC daily stipend. A few hours of help a day may favor Attendant Care's hourly model.
4. How much does the tax difference matter to your budget? For many live-in caregivers, the tax-free SFC stipend wins on take-home pay alone.

For most live-in family caregivers in Indiana — especially those caring for someone with substantial daily needs — SFC tends to be the stronger fit, mostly because of the tax treatment and the steady daily rate. But "most" is not "all," and the only way to know for certain is to look at your specific situation.

What This Means for Your Family

If you've read this far and you're still not sure which program fits, that's normal. The distinction is genuinely confusing, and the stakes — thousands of dollars a year, plus whether you qualify at all — are high enough that guessing isn't worth it.

At Tender Home Care, we focus specifically on Structured Family Caregiving in Indiana, and we'll tell you honestly if Attendant Care is the better fit for your situation, even though it's not what we do. We'd rather point you to the right program than enroll you in the wrong one. For families who do choose SFC 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.

If you want the full picture of how SFC works start to finish, our guide on how to get paid to care for a family member in Indiana walks through the whole process.

Sources

1. [1] Indiana FSSA. "Structured Family Caregiving and Home Health Services FAQ." 2024. Link.

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

3. [3] Indiana FSSA. "Structured Family Caregiving (SFC)." Office of Medicaid Policy and Planning fact sheet, 2025. Link.

4. [4] Indiana FSSA. "Attendant Care and Structured Family Care Relationship Guidance." Per Indiana Code 12-10-17.1-10(b). Link.

5. [5] Indiana Health Coverage Programs. "Bulletin BT2025105: rates and minimum passthrough percentages for Attendant Care and Structured Family Caregiving." July 10, 2025. Link.

6. [6] Internal Revenue Service, Taxpayer Advocate Service. "Certain Medicaid Waiver Payments May Be Excludable From Income (Notice 2014-7).". Link.

7. [7] Internal Revenue Service. "Certain Medicaid Waiver Payments May Be Excludable From Income — FAQ.". Link.

8. [8] Indiana Capital Chronicle. "PathWays for Aging launches for 123,000 eligible senior Hoosiers." July 2, 2024. Link.

9. [9] Indiana FSSA. "Structured Family Caregiving Frequently Asked Questions" — duplication of services. 2024. Link.