Draft:Structured Family Caregiving

Structured Family Caregiving (SFC) is a Medicaid program in the United States where a family member or a close acquaintance is officially recognized and compensated for providing caregiving services to a relative or friend with health-related needs. SFC programs aim to reduce the need for institutional care by supporting home-based care options.

History
As life expectancy continues to rise, so does the proportion of older adults, many of whom will require some form of long-term care. This demographic shift is accompanied by a rise in chronic conditions such as dementia, diabetes, and heart disease, further intensifying the need for continuous caregiving.

State Implementations

 * Connecticut: SFC operates under the CT Home Care Program for Elders Waiver, serving the elderly (65+ years) population.
 * Georgia: SFC operates under the Community Care Supports Program and Services Options Using Resources in Community Environments (SOURCE), both under the GA Elderly and Disabled Waiver, serving elderly or physically disabled individuals.
 * Indiana: SFC operates under the IN Aged and Disabled Medicaid Waiver, serving elderly or disabled persons.
 * Louisiana: SFC operates under the LA Community Choices Waiver, serving seniors and adults with disabilities.
 * Massachusetts: SFC operates under the Adult Foster Care Program, serving people aged 16+ with a medical or mental condition.
 * Missouri: SFC operates under the Structured Family Caregiving Waiver, serving people aged 21+ with Alzheimer's Disease or related dementia.
 * North Carolina: SFC operates under the NC Community Alternatives Program for Disabled Adults and NC Community Alternative Program for Children, serving individuals with developmental disabilities or who are medically fragile (no age limit).
 * Ohio: SFC operates under the OH Individual Options Waiver, serving individuals with developmental disabilities (no age limit).
 * Pennsylvania: SFC operates under the PA Community Health Choices Waiver, serving people aged 21 and older with skilled nursing needs.
 * Rhode Island: SFC operates under the RIte @ Home Program, serving adults 18-64 with disabilities or anyone 65 and older who is eligible for Medicaid long-term services and supports.
 * South Dakota: SFC operates under the SD Home & Community Based Options and Person-Centered Excellence Waiver (HOPE Waiver), serving seniors and adults with disabilities.

Care Recipient
SFC programs operate under Medicaid waivers. To receive care under these programs, the recipient must be eligible for Medicaid. Eligibility for SFC requires a formal assessment to determine if the person's condition warrants the level of care provided by SFC programs, which is usually the same as the criteria for nursing home care or intensive in-home care. Some programs are designed to cater to specific groups, such as older adults, people with disabilities, or those with chronic conditions.

Caregiver
Many SFC programs have established guidelines regarding the qualifications of caregivers. While family members are often given priority, certain states allow non-family members with a significant personal relationship with the care recipient to be eligible. They may need to undergo training or certification to ensure that the caregiver can provide a high standard of care in a home setting. Usually, the caregiver and the care recipient must live together to qualify for the program.

Compensation
The stipend paid in SFC programs is determined on a per-day basis and is directly linked to the care recipient's needs as outlined in their Individual Service Plan (ISP). A managing agency or organization is responsible for processing payments in most SFC programs. Caregivers must comply with specific program requirements to receive payments.

Medicaid pays provider agencies a daily stipend, with a percentage of this amount, usually between 50% and 65%, paid to the caregiver. The exact amount varies depending on the state and the needs of the care recipient.