Twelve states pay a family member or friend to live with a Medicaid member and care for them full time, with a professional team behind the caregiver. Georgia, Indiana, Ohio, Missouri, South Dakota and Nevada call it structured family caregiving. The other six call it something else, and the aggregator lists that circulate are either written for the family, out of date, or both. NASHP’s 2022 survey had seven states. This is the list as the states’ own rules, waivers and provider manuals have it, read in October 2026, for the organization the rules are addressed to: the provider agency.
One state does not fit. North Dakota’s Family Personal Care has the live-in caregiver and the daily rate but no agency: the relative enrolls with Medicaid directly as a Qualified Service Provider, and the county case manager does the assessment, the plan and the monitoring. It is on the list because it is the same model from the family’s side, and off the rest of this page because there is no agency to write for. Two states that appear on aggregator lists, Oklahoma and Pennsylvania, were checked against their own waiver service lists and have no such service; family members there are paid hourly through self-direction, which is a different thing.
The twelve, side by side
| State | Program and authority | What the state calls the agency | Staff the agency must have | Visit cadence |
|---|---|---|---|---|
| Georgia | Structured Family Caregiving, Elderly and Disabled Waiver Program (CCSP and SOURCE) | “SFC Provider Agency”: a Medicaid personal support services provider with three years’ experience | Health coaches as W-2 employees; a Georgia RN employed or under contract | Monthly contact; health coach home visit every six months; RN or LPN supervisory visits on the PSS schedule |
| Indiana | Structured Family Caregiving, PathWays for Aging, Health and Wellness, TBI and CIH waivers | “Provider agency”: provider type 32, specialty 350, secondary specialty A21 | A caregiver coach or RN; the RN in an as-needed oversight role | “A minimum of two quarterly home visits” (the same module also says two per quarter) |
| Ohio | Structured Family Caregiving, PASSPORT, Ohio Home Care and MyCare Ohio; OAC 5160-44-33 | “Agency provider”: a Medicare-certified or accredited home health agency, or an ODA-certified provider | One of: an RN, an LPN under an RN, an LSW or an LISW | Initial in-person visit; monthly contact; no more than sixty days between in-person visits |
| Missouri | Structured Family Caregiving Waiver, its own 1915(c), renewed to June 2031; dementia diagnosis required | In-home services provider, “provider type 26”, with the SF specialty | A case manager or RN for the care plan; home visits by staff at LPN level or above; an RN employed or consulting | Monthly home visits |
| South Dakota | Structured Family Caregiving, HOPE Waiver | “Medicaid-Enrolled Structured Family Caregiving Provider Agency” | Staff experienced with elders or adults with disabilities, or trained by the agency; no RN required; case management is the state’s | Monthly care conference, on-site or virtual; at least one on-site a year; the October 2026 renewal adds a pre-service and a six-month home visit |
| Nevada | HCBS Waiver for Structured Family Caregiving, its own 1915(c) since January 2025 | “Provider Type 95”: a licensed personal care agency with an intermediary service organization endorsement | None specified for the direct service; a separate case management service with credentialed case managers | Case manager monthly contact and quarterly face-to-face; no agency cadence set |
| Louisiana | Monitored In-Home Caregiving, Community Choices Waiver (also the Residential Options Waiver) | Licensed HCBS provider with the MIHC module | An RN and a care manager, each with two years’ experience | Monthly on-site visit by the RN or the care manager, each at least every other month |
| North Carolina | Coordinated Caregiving, CAP/DA (also CAP/C) | “Atypical NC Medicaid Provider” with three years delivering HCBS | No RN or care manager mandated | Home visits on assessed need; training and coaching at least monthly |
| Connecticut | Adult Family Living, CHCPE and PCA waivers | “Provider Agency”; the access agency does assessment and care management | Nursing oversight; no agency care manager | Nursing oversight at least “bi-monthly”; the access agency’s care manager monthly, with a home visit every six months |
| Massachusetts | Adult Foster Care, MassHealth, 130 CMR 408.000 | “Provider” under contract with MassHealth, accredited by NCQA, COA or CARF | A multidisciplinary team: program director, RN or LPN, care manager | Level I: nurse and care manager alternate so the member sees one of them every month; Level II: both every month, and weekly nurse visits in the first month |
| Rhode Island | RIte @ Home, shared living, under the state’s Section 1115 waiver | “RIte @ Home Provider Agency”, certified by EOHHS | An RN with three years’ experience, a program director, a case manager (a 2024 draft moves case management outside the agency) | Weekly for the first two months, then monthly; RN visit within five days of a hospitalization |
| North Dakota | Family Personal Care, HCBS Medicaid Waiver | None. The relative enrolls as a Qualified Service Provider | None. The county HCBS case manager oversees | Case manager contact within thirty days, quarterly after, in person at six and twelve months |
What the rules have in common
Read together, eleven agency models share more than the lists suggest.
Experience before enrollment. Georgia requires “3 years of delivering or facilitating delivery of services to older adults and/or adults with disabilities as a Medicaid participating Personal Support Services/Private Home Care provider”. Indiana and North Carolina require three years too. Massachusetts requires national accreditation, and Georgia will from September 2026: new SFC providers must “obtain accreditation with National Committee for Quality Assurance (NCQA)” in case management with the long-term services and supports distinction, and existing ones by September 2027.
Eight hours of training a year. Georgia, Indiana, Ohio, Missouri, North Carolina and Massachusetts each require a minimum of eight hours of caregiver training annually, “that reflects the participant’s assessed needs” in Georgia’s and Indiana’s words. Missouri adds it to the five hours its in-home services rule already requires, with dementia content. Nevada requires twelve hours of dementia-specific training of the agency itself before enrollment, and Louisiana lists the topics without an hour count. Georgia and Louisiana both require the training before the first day of service.
A stipend floor. The caregiver’s share of the daily rate is set in four states: at least 60 percent in Georgia, 65 percent in Nevada, 50 percent in South Dakota and North Carolina. Missouri caps the agency’s share at 35 percent instead.
Electronic daily notes. Georgia, Indiana, Missouri and Louisiana require the caregiver’s daily notes to be captured electronically and reviewed. Georgia’s RN “must review these notes at least every 14 days”, and from September 2026 daily. Louisiana’s agency receives “the daily electronic client progress notes” as a condition of its license module.
The assessment is someone else’s. In every state but Massachusetts and Rhode Island, eligibility and the level of service are set by a case manager outside the agency: the EDWP case manager in Georgia, the waiver care manager in Indiana, the “waiver program case management entity” in Ohio, the Division of Senior and Disability Services in Missouri, the LTSS specialist in South Dakota, the support coordinator in Louisiana, the CAP/DA case manager in North Carolina, the access agency in Connecticut. The agency receives the plan and builds its own care plan under it. Massachusetts and Rhode Island put the clinical assessment inside the agency, which is why those two have the most explicit rules about what the agency must have in hand.
What the agency needs at the start
Massachusetts is the one state that lists it. Under 130 CMR 408.431, “by the first day of AFC, the AFC provider must obtain all the necessary documentation from the member’s PCP”, including the PCP’s summary and order, “the member’s medical history”, the results of a PCP visit within the past three months and a physical within twelve, “a list of current medications, treatments, and other services provided”, and the allergies. If the member was hospitalized in the preceding three months, “a complete discharge summary may be used”. The team then has five working days for an interim plan of care and thirty for the final one.
Rhode Island’s 2018 standards require a clinical nursing assessment by the agency’s RN before service begins, covering “medical history, including past surgeries, chronic health conditions and major health issues”, current medications with prescriber and diagnosis, immunizations and allergies. Georgia’s health coach writes the coaching care plan and the RN signs it within fourteen business days; Missouri’s agency writes a person-centered care plan from a home assessment by LPN-level staff; Louisiana’s RN writes the individual service plan with the care manager. North Carolina’s care plan is due within thirty days of the referral.
Every one of those plans is written from the records the agency has on the day. The rules name what the plan must cover and leave the agency to find the history, which sits with the hospital, the primary care practice and whichever specialists the member has seen. What the SFC nurse needs before the first home visit lists the seven records; structured family caregiving records is the page about having them in hand before the first visit rather than reconstructing them after it. For the agency, the state’s name for the service changes at the border. The record it needs does not.
State by state, with the words the states use
Georgia. The service was added to the Elderly and Disabled Waiver Program on 1 March 2019. The manual’s heading is “Structured Family Caregiver (SFC)”; the agency is the “SFC Provider Agency”, must have a physical place of business in the state, and bills T1020 with the UK modifier. Health coaches need an associate’s degree or two years in community health, long-term care or chronic disease; the RN must be Georgia-licensed. Monthly contacts “either face to face or by telephone”, a six-monthly in-home visit by the coach with the waiver case manager on the phone, and supervisory visits by an LPN or RN on the personal support services schedule, which every SFC agency had to be running by 31 July 2026. Spouses are excluded as paid caregivers.
Indiana. Available on PathWays for Aging, Health and Wellness, Traumatic Brain Injury and Community Integration and Habilitation, and not on Family Supports. “Only agencies may be Structured Family Caregiving providers.” The FSSA fact sheet requires “Caregiver Coach (or RN)” on the organizational chart at certification; the RN “is in place on an as-needed consultative basis”. Three levels of service, set by the case manager’s assessment, paid as a daily rate. The caregiver’s daily notes are electronic and available to the care manager on request. Spouses may be paid, as extraordinary care.
Ohio. One rule covers all three waivers. The agency must be a Medicare-certified or otherwise accredited home health agency for Ohio Home Care, an ODA-certified provider for PASSPORT, and either for MyCare. Coaching staff is one of four licensed professions. The cadence is the clearest in the country: “an initial in-person home visit”, “monthly contact”, and “no more than sixty calendar days between in-person visits”. Caregivers at Medicare-certified agencies meet the home health aide training in 42 CFR 484.80; at the others, eight hours of initial training set by the member.
Missouri. The only state with a dedicated structured family caregiving waiver, limited to members with Alzheimer’s disease or a related dementia, renewed by CMS from July 2026 to June 2031. The agency is an in-home services provider, type 26, with an SF specialty added by addendum. Every unit must be prior-authorized by the Division of Senior and Disability Services, and “the effective date for the posted PA cannot precede the completion date of the assessment”. The per diem is 60 percent of the nursing facility daily rate.
South Dakota. The HOPE Waiver’s version, with the agency defined as the entity “responsible for the oversight of the Structured Family Caregiving service” that “passes through a portion of the Medicaid reimbursement to the principal caregiver”. The caregiver is a contractor, not an employee. Services begin “within fourteen (14) business days of receipt of the results of the principal caregiver background check”. The waiver renewal effective 1 October 2026 adds a pre-service home visit, a six-month home visit and more monitoring for high-risk participants; the amended provider provisions were not yet published when this was written.
Nevada. The newest program, created by Assembly Bill 208 and approved by CMS in December 2024 for January 2025. Provider type 95 opened for enrollment in March 2025. The agency is a licensed personal care attendant agency with an intermediary service organization endorsement, must show twelve hours of dementia training before enrollment, and pays the caregiver at least 65 percent of the per diem. Case management is a separate waiver service with its own staffing rule; the state’s intake specialist schedules the level-of-care visit “within 45 calendar days of the application date”, and the plan “must be finalized within 60 calendar days from waiver enrollment”.
Louisiana. Monitored In-Home Caregiving under the Community Choices Waiver, with a licensing module of its own. The agency “shall employ a registered nurse (RN) and a care manager who will monitor all clients served”, each with two years’ experience with the elderly or adults with disabilities, and each visits every other month so that someone is on site monthly. A March 2026 notice of intent would let virtual visits replace the RN’s alternate months; its adoption had not been published when this was written. The caregiver completes documented training in the member’s support needs, the daily electronic note, emergencies, abuse reporting and recognizing signs of illness before the first day, and a first aid course within 45 days.
North Carolina. Coordinated Caregiving under the Community Alternatives Program for Disabled Adults, added in March 2020 and also available for children. The agency enrolls as an atypical provider with three years of HCBS experience, or holds a license to provide nursing services. The policy mandates no RN or care manager: the staff who deliver the service are the live-in caregivers, and the application asks how many nurses and allied professionals the agency has “access to”. Training and coaching are monthly at minimum, eight hours a year, and the care plan is due within thirty days of the referral.
Connecticut. Adult Family Living, added to the Home Care Program for Elders and the PCA waiver in July 2013. The provider agency bills Medicaid directly and pays the caregiver; the access agency, which “shall not be a provider of services, other than to provide care management”, does the assessment and the plan. The agency’s obligation is “nursing oversight / supervision … on a minimum of a bi-monthly basis”, with orientation, competency evaluations and continuing education for the caregiver. The caregiver must live in the home and prove residency, and may be a relative “as long as they are not a legally liable relative”.
Massachusetts. Adult Foster Care is a MassHealth service rather than a waiver, ordered by the member’s primary care provider and delivered by “a multidisciplinary team (MDT) and qualified AFC caregiver”. The team is a program director with a bachelor’s degree and five years’ experience, an RN or LPN, and a care manager with a degree and two years’ experience. Prior authorization before the first day and annually. The RN reviews caregiver logs every thirty days and orients each caregiver before personal care begins. Family members, meaning a spouse or a legally responsible relative, may not be the paid caregiver.
Rhode Island. RIte @ Home is the state’s shared living program for elders and adults with disabilities who meet the nursing facility level of care, run by the Executive Office of Health and Human Services. The 2018 standards require an RN with three years’ experience, a program director and a case manager, a service and safety plan approved by the state before service starts, weekly visits for the first two months, and a nurse visit within five days of any hospitalization. A 2024 draft would move case management to a conflict-free case manager outside the agency; its final status is not published.
North Dakota. Family Personal Care pays a spouse, parent, grandparent, adult child, sibling, grandchild, niece or nephew a flat daily rate to provide at least three hours of care a day. The provider is the relative, enrolled individually, with proof of competency. There is no agency role in the rule. The county case manager assesses within ten working days of the request, makes contact within thirty days of the start, and visits in person at six and twelve months.
