A Plain-English Guide to Getting Paid for Caregiving

Structured Family Caregiving, SFC for short, is an Indiana Medicaid program that pays family members and trusted loved ones to provide full-time care at home. If you're already helping a parent, spouse, sibling, or close friend with daily life, bathing, meals, medication, mobility, supervision, SFC compensates you for that work with a tax-free daily stipend.

The program exists because Indiana would rather pay families to keep loved ones at home than pay nursing facilities to house them. It's better care, and it costs the state far less. Funding comes from Indiana Medicaid, administered by the Indiana Family and Social Services Administration (FSSA), and the program runs through licensed provider agencies like Tender Home Care.

Our role is straightforward: we handle the Medicaid waiver application from start to finish, we pay your caregiver every Friday once you're enrolled, and we manage every state requirement after that, home visits, documentation, compliance, care plan updates. You focus on caregiving. We handle the system.

And the most common question we get: yes, it really is free. No cost to the care recipient. No cost to the caregiver. No hidden fees. Medicaid pays Tender Home Care directly for our role, and we pass a generous percentage through to the caregiver as a tax-free stipend. Most families haven't heard of SFC because Indiana doesn't advertise it. That's exactly why we exist.

There are two sides to eligibility: the person receiving care, and the person providing it.

The care recipient must live in Indiana, be enrolled in Indiana Medicaid (or eligible to enroll), and need help with daily activities like bathing, dressing, eating, mobility, toileting, or medication. They also need to meet Indiana's Nursing Facility Level of Care threshold, meaning their care needs would otherwise qualify them for a nursing home. If they aren't on Medicaid yet, that's not a dealbreaker. We help families apply as part of the process, and there are legal tools, spend-down strategies, qualified income trusts, that help people qualify even with modest income or assets.

The caregiver must be at least 18, live with the care recipient, pass a background check, and have a real relationship with them. Spouses, adult children, siblings, grandchildren, nieces, nephews, cousins, and close friends all qualify. Indiana is one of the few states that allows spouses to be paid caregivers, that's a big deal, because most states don't.

If you're not sure whether you and your loved one qualify, that's normal. We do a free eligibility check for every family that reaches out, and we'll tell you honestly within the first conversation.

Enrollment runs in five stages, and we're with you at every one of them.

It starts when you reach out, a phone call, a form, or a 15-minute scheduled call. We ask a few quick questions to confirm basic eligibility, no commitment. From there, we set up a free in-home meeting. We come to you, sit at your kitchen table, walk through the program in detail, answer everything, and start the paperwork together. Most agencies hand you a stack of forms and disappear. We don't.

Next comes the Medicaid waiver application. If your loved one isn't already on a waiver, we coordinate with your local Area Agency on Aging to apply for the right one, Pathways for Aging if they're 60 or older, Health & Wellness if they're younger, or Traumatic Brain Injury if applicable. We handle the paperwork and track the status. Once the waiver is approved, a case manager performs a Nursing Facility Level of Care assessment, which determines your tier and your daily rate. We build the care plan with the case manager.

Then enrollment is complete and you start receiving weekly stipends every Friday. We schedule the first home visit within six weeks and begin ongoing support.

A note on timing: most families are enrolled in about 6 weeks, but some take 2 to 4 months depending on the waiver, the waitlist, and how fast documents come together. Indiana does have waitlists for certain waivers due to state budget constraints. If you end up on a waitlist, we don't disappear. We monitor your position, prepare everything else in the background, and contact you the moment a slot opens. We will give you a realistic timeline at the first meeting and update you every step. If you ever feel like you're in the dark, that's our fault, call us.

You don't need to gather any documents before reaching out. We help families pull together IDs, Medicaid info, medical history, background check authorization, and direct deposit details one piece at a time.

Indiana sets three tiers based on the level of care your loved one needs. Your tier, and the daily rate that comes with it, is determined by a formal care assessment, not by us. If you want a rough estimate of what your situation might look like, our calculator runs you through the typical questions in under two minutes.

Pay arrives every Friday by direct deposit, no exceptions, no delays. We chose weekly pay because caregivers shouldn't have to wait two weeks or a month for income they've earned.

In most cases, the stipend is tax-free. SFC payments fall under IRS “difficulty of care” guidelines for live-in caregivers (Notice 2014-7), which means the money doesn't show up as taxable income on your federal return. We always recommend confirming your specific situation with a tax professional, but the vast majority of our caregivers receive their full stipend tax-free.

If your loved one is hospitalized, the stipend pauses for the duration of the hospital stay and resumes when they return home. We handle the documentation. You focus on being with them.

Once you're in the program, the day-to-day on your end stays simple. The state requires three things, and we make all of them painless.

You'll have a home visit every 6 weeks, a nurse or caregiver coach visits to check on your loved one, review the care plan, and make sure things are going well. We schedule around your availability. You'll keep a basic care log, a short record of the care you're providing, done in minutes a week on your phone with a simple tool we provide. And we'll update the care plan as needs change. If your loved one's health shifts, we adjust the plan together. Sometimes that means a tier change.

That's it. No bureaucracy on your end. Most families stay in the program for years, the only common reasons people leave are when a care recipient is hospitalized long-term, moves into a facility, passes away, or no longer meets medical eligibility. The program isn't designed to kick people out. As long as your loved one remains eligible and you're providing care, you stay enrolled. If your situation changes, we work through it with you.