Key takeaway
Indiana now serves older adults through PathWays for Aging managed long-term services and supports, and serves adults with disabilities through the Aged & Disabled (A&D) Waiver. Both have self-direction options, and Structured Family Caregiving can pay live-in family caregivers a daily stipend.
- PathWays for Aging: Indiana's MLTSS program for adults 60+ on Medicaid; allows family caregivers under self-direction.
- A&D Waiver: Pays family caregivers for adults with disabilities; spouses and legal guardians are excluded.
- Structured Family Caregiving (SFC): Pays a live-in family caregiver a daily stipend plus support from a home care agency.
- Veterans: Aid & Attendance and Veteran Directed Care can pay family, including spouses under VDC.
Overview
Indiana, through the Family and Social Services Administration (FSSA), funds paid family caregiving primarily through Medicaid. For adults 60 and older, services are now coordinated under PathWays for Aging, a managed long-term services and supports (MLTSS) program launched in 2024. For adults under 60 with disabilities, the Aged & Disabled (A&D) Waiver continues to provide home and community-based services.
A unique Indiana option is Structured Family Caregiving (SFC), which pays a live-in family caregiver a tax-free daily stipend in exchange for providing 24-hour care, with oversight from a contracted home care agency. Veterans and surviving spouses have additional VA pathways. Spouses and legal guardians are generally excluded from Medicaid pay, but VA Veteran Directed Care can pay a spouse.
Programs that pay family caregivers in Indiana
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| PathWays for Aging (Indiana Medicaid MLTSS) | Indiana Medicaid members age 60+ who need long-term services and supports; enrollment is mandatory for this population. | Includes attendant care, homemaker, respite, and Structured Family Caregiving. Self-direction allows hiring family caregivers (not spouses). |
| Aged & Disabled (A&D) Waiver (Medicaid 1915(c) waiver) | Adults under 60 with a disability or older Hoosiers transitioning into PathWays; must meet nursing-facility level of care. | Pays family caregivers under self-direction for attendant care; spouses and legal guardians are excluded. |
| Structured Family Caregiving (SFC) (Medicaid waiver service) | Care recipient must live with the caregiver and need significant support; available through PathWays and A&D Waiver. | Daily tax-free stipend (commonly around $80 to $120 per day) paid through a contracted home care agency. |
| Health & Wellness Waiver and PathWays Waiver (Medicaid 1915(c) waivers) | Hoosiers meeting nursing-facility level of care under the FSSA Office of Medicaid Policy and Planning rules. | Fund the services delivered under PathWays MLTSS and A&D programs, including attendant care by family members. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with daily activities; income/asset limits apply. | Increases pension to offset care costs; can pay adult children and relatives. Spouses are not paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veterans in VA health care needing nursing-home level care, living in a participating VAMC service area. | Flexible monthly care budget the veteran manages to hire caregivers, including spouses. |
Indiana Medicaid programs
Indiana Medicaid is the dominant source of paid family caregiving in the state. PathWays for Aging now coordinates services for Hoosiers 60 and older, while the A&D Waiver continues to serve adults under 60. Structured Family Caregiving (SFC) is a unique Indiana option that compensates a live-in family caregiver with a daily stipend.
PathWays for Aging
PathWays is Indiana's managed long-term services and supports (MLTSS) program for older adults. Three managed care entities (MCEs) coordinate care, including in-home services delivered by family caregivers under self-direction.
- Available to Indiana Medicaid members 60+ who meet nursing-facility level of care.
- Includes attendant care, homemaker, respite, adult day, and Structured Family Caregiving.
- Self-direction allows hiring family members; spouses and legal guardians are excluded.
- Members are assigned a care manager through their chosen MCE (such as Anthem, Humana, or UnitedHealthcare).
Aged & Disabled (A&D) Waiver
The A&D Waiver covers Hoosiers under 60 with disabilities who need a nursing-facility level of care. It funds attendant care, respite, and supports for home and community living.
- Open to adults with qualifying physical or cognitive disabilities.
- Self-direction allows hiring family caregivers (not spouses or legal guardians).
- Income/asset limits follow Medicaid long-term care rules.
- Structured Family Caregiving is also available under A&D for live-in family caregivers.
Structured Family Caregiving (SFC)
SFC is a Medicaid waiver service that pays a live-in family caregiver a tax-free daily stipend (under IRS guidance) to provide 24-hour support. A contracted home care agency provides oversight, training, and respite.
- The care recipient and caregiver must live in the same home.
- A registered nurse or coach from the agency visits and reviews care notes regularly.
- Daily stipends commonly range from about $80 to $120 depending on care needs.
Community supports outside Medicaid
For Hoosiers who do not qualify for Medicaid, Indiana's Area Agencies on Aging (AAAs) coordinate caregiver supports under the federal Older Americans Act. While these supports do not typically replace a full caregiver wage, they help offset the cost of unpaid family caregiving.
Counseling, training, respite vouchers, and supplemental supports for family caregivers of older adults.
Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE) is an Indiana state-funded program that can provide in-home services for non-Medicaid eligible adults.
Who qualifies
- CHOICE serves adults 60+ or adults with disabilities who need help with daily activities and are not Medicaid-eligible.
- Family Caregiver Support is open to caregivers of adults 60+ or of any age with Alzheimer's/related dementia.
- Availability and amounts vary by AAA region and annual funding.
Veterans' programs
Indiana veterans and surviving spouses can use VA benefits to fund in-home care. The Indianapolis VAMC and several Community Based Outpatient Clinics participate in Veteran Directed Care, which is the only VA path that can pay a spouse.
Aid & Attendance Pension
A&A increases a qualifying veteran's or surviving spouse's VA pension to cover care costs. The veteran can use the boost to compensate a family caregiver.
- Wartime service, ADL need, and income/asset limits required.
- Commonly used to pay adult children for hands-on care.
- Spouses cannot be paid directly via A&A.
Veteran Directed Care (VDC)
VDC provides a monthly care budget the veteran manages with help from a financial management service. It is the only VA option that can pay a spouse.
- For veterans meeting nursing-home level of care in VA health care.
- Family caregivers, including spouses, can be hired.
- Availability depends on participating Indiana VAMCs.
Long-term care insurance
If the care recipient owns a long-term care insurance policy, the benefits may cover in-home care provided by a family member, depending on policy terms.
What to check in the policy
- Policy must cover in-home personal care, not only nursing-facility care.
- Cash/indemnity policies that pay the policyholder offer the most flexibility to hire family.
If the policy only reimburses licensed agencies, families sometimes have the caregiver hired through a licensed Indiana home care agency so the insurer will pay.
How to apply in Indiana (step-by-step)
- Identify the right path: PathWays for Aging (60+), A&D Waiver (under 60), Structured Family Caregiving, CHOICE, VA benefits, or LTC insurance.
- Gather documents: ID, proof of Indiana residency, income/asset records, medical history, and (for veterans) DD-214.
- Contact the right agency:
- PathWays or A&D Waiver: contact the Indiana FSSA Division of Aging or call 1-800-986-3505 to start an assessment.
- Structured Family Caregiving: ask your PathWays MCE or A&D case manager about contracted SFC agencies.
- CHOICE or AAA supports: contact your local Indiana Area Agency on Aging.
- VA paths: speak with a VA social worker or the Indianapolis VAMC Caregiver Support Program.
- Complete a functional assessment (nursing-facility level of care) and a financial review through Indiana Medicaid.
- Choose self-direction or Structured Family Caregiving and enroll your family caregiver with the fiscal employer agent or the contracted SFC agency.
- Begin services; submit timesheets or daily care notes; renew eligibility annually.
Indiana paid caregiver FAQs
Can a spouse be paid as a caregiver in Indiana?
No under PathWays for Aging, the A&D Waiver, or Structured Family Caregiving. A spouse can be paid as a caregiver under VA Veteran Directed Care when the veteran qualifies.
How much do caregivers get paid in Indiana?
Hourly attendant care typically runs about $15 to $20 per hour, depending on the MCE or agency. Structured Family Caregiving pays a daily stipend (commonly $80 to $120 per day) instead of an hourly wage.
Can I be paid to care for my parent in Indiana?
Yes. Adult children can be paid as attendants under PathWays or the A&D Waiver, can be a live-in caregiver under Structured Family Caregiving, or can be paid via VA A&A or VDC.
What is Structured Family Caregiving in Indiana?
SFC is an Indiana Medicaid waiver service that pays a live-in family caregiver a tax-free daily stipend (not an hourly wage) in exchange for providing 24-hour support, with oversight from a contracted home care agency.
How long does PathWays for Aging take to approve?
Once you contact the Indiana Division of Aging and complete the assessment, enrollment in PathWays typically takes several weeks. Financial Medicaid eligibility can add additional time if not already established.
