The Family and Social Services Administration (FSSA) is the primary agency in Indiana that oversees the administration of Medicaid and other programs that benefit vulnerable populations.
Recently, FSSA has initiated a significant policy change, moving from the traditional attendant care program to a new model, Structured Family Caregiving, as part of a broader strategy to address financial sustainability within the state's Medicaid programs.
FSSA's responsibilities include overseeing Indiana's Medicaid program and managing critical caregiving programs for individuals with significant disabilities or chronic health conditions.
In late 2023, FSSA made a serious forecasting error in the growth in Medicaid spending, especially for caregiving programs. The cost of these services, particularly under the Aged and Disabled waiver, had seen unprecedented increases. For example, expenditures quadrupled from about $30 million per month in April 2022 to approximately $120 million by December 2023.
As such, FSSA reevaluated its approach to managing these programs and decided to restructure how caregiving services were funded and delivered. FSSA is shifting away from an hourly wage model to Structured Family Caregiving—a model anticipated to provide a controlled and predictable cost structure while continuing to support the care needs of Medicaid recipients.
Traditionally, family members who provided care for a loved one with severe disabilities or medical complexities could receive an hourly wage from the state by providing attendant care. This payment model was based on the time spent providing care, with caregivers logging hours similar to traditional employees.
The new Structured Family Caregiving model transitions to a fixed daily stipend, simplifying the payment system and reducing administrative burden and overhead. The tax-free stipend is designed to cover a full day's care, regardless of the number of hours worked, providing a predictable and consistent income source for caregivers.
There are eligibility requirements for both the care recipient and the person applying as the caregiver.
The care recipient must be a resident of Indiana and enrolled in the Aged and Disabled Medicaid Waiver, meeting the financial eligibility requirements. Additionally, the care recipient must qualify for a nursing home level of care, as assessed by a case manager, meaning that the care recipient requires assistance with at least three personal care tasks on a daily basis. The care recipient must also reside full-time with their caregiver.
To be eligible for the Structured Family Caregiving program, the primary caregiver must be at least 18 years old and have the physical and mental capabilities to fulfill their caregiving duties. The caregiver must also reside full-time with their care recipient.
Each caregiver in the SFC program receives a service plan created by a case manager and a registered nurse based on their specific needs.
Caregivers are responsible for fulfilling the needs outlined in a care recipient's service plan, which may include:
The program offers additional support through regular home visits from the case manager and registered nurse, in addition to respite care services for up to 15 days per year.
Care recipients can continue to receive other waivers or Medicaid services as long as they are not duplicative. These may include adult day care, transportation, home-delivered meals, personal emergency response, or home modifications.
Structured family care is divided into three levels of care, and the daily caregiver pay rate corresponds to the level of care:
The caregiver is compensated by their SFC provider agency. The provider and caregiver each receive a portion of the rate.
Caregivers can expect to receive 65-70% of the listed daily rate. The remaining portion goes to the provider agency for administrative costs like coach and nurse supervision, office overhead, respite care, et cetera.
Families across Indiana will need to adapt to new systems and procedures. Here are detailed steps and key resources provided by FSSA to ensure families can smoothly transition to the new caregiving model.
Care recipients have the option to continue to receive attendant care services from an individual who is not a Legally Responsible Individual (LRI; a parent of a minor child or a spouse).
If you select attendant care, your case manager will work with you and your attendant care provider to choose an attendant who is not an LRI. Service plans will be reviewed to determine if the requested time of service is consistent with a care recipient's needs.
Alternatively, a care recipient can continue to receive paid support from an LRI through the Structured Family Caregiving program.
You cannot receive both Attendant Care and Structured Family Care.
The first step for someone interested in transitioning to the Structured Family Caregiving program is to establish a relationship with a case management agency or contact their existing case management agency.
Your case manager will have the most current information on your case and will be able to provide specific guidance and support for applying to the SFC program. Your case manager will help you complete the application for the SFC program and ensure that all information is complete and accurate before submission.
Once a recipient is approved for SFC, the next step generally involves the caregiver getting formally hired by a home care agency. This agency acts as the employer, handling essential employment responsibilities such as payroll, taxes, and compliance with state regulations.
The caregiver will need to complete an employment application, undergo background and health checks, and participate in mandatory training that covers the agency's policies, SFC program specifics, and emergency procedures.
Regular assessments will evaluate the care provided and make any necessary adjustments to the care plan, ensuring that the recipient's needs are continuously met and that the caregiving arrangement remains effective and compliant with program standards.
You can ask your case manager for a complete list of SFC providers in your area.
We recognize that this transition to Structured Family Caregiving in Indiana represents a significant change for families.
We invite you to use our interactive matching tool to see if you may be eligible for Structured Family Caregiving or other government programs available in your zip code.
If you qualify for SFC in Indiana, we will help you and your loved one with the administration involved in enrolling. Once your loved one is enrolled, you can choose Givers as your licensed agency to document your work, offer support, and pay you as a caregiver.
For additional information about the Structured Family Caregiving program, call the Indiana Division of Aging toll-free at 888-673-0002.
