Ohio Home Care Waiver: Get Paid To Care For A Family Member

Yes — and this is one of the biggest differences between Ohio and states like New York. Under Structured Family Caregiving, a spouse who lives with you can be the paid caregiver and receive the daily stipend, the same as any other live-in family member. A spouse can also be paid for hourly self-directed personal care on the Ohio Home Care Waiver, PASSPORT, or MyCare Ohio, but only when specific conditions are met: there is no other willing and able provider available, the state agrees your health and safety needs can be met, and the care rises to Ohio's "extraordinary care" standard (documented on form ODM 10372). Spouses paid for hourly care are limited to 40 hours per week and cannot be paid for respite. So if the goal is simply "can my husband or wife get paid," Structured Family Caregiving is usually the cleanest path in Ohio, because the live-in stipend model was built with spouses and close relatives in mind.

It depends on which service you use. Structured Family Caregiving pays a daily stipend rather than an hourly wage. Ohio Medicaid pays the SFC agency $102.68 per day (and $51.34 per half day) under the rate rule effective April 17, 2026; the agency keeps a share for required nurse and social-work coaching and passes the rest to the caregiver, so families commonly report taking home somewhere around $1,500 to $1,800 a month. Because the caregiver lives with the person, that stipend is frequently tax-free under IRS Notice 2014-7. If instead you provide hourly self-directed personal care, a family or friend (non-agency) aide is reimbursed at $22.32 per hour, with overtime at $33.48 per hour. Actual take-home varies by the agency's pass-through, your MyCare Ohio managed-care plan, and how many hours or days are authorized in your care plan, so ask your case manager or SFC agency for your exact numbers.

Structured Family Caregiving (SFC) is a Medicaid service Ohio added to its main waivers — the Ohio Home Care Waiver, PASSPORT, and MyCare Ohio — in late 2024. Instead of paying you by the hour, it pays a daily stipend to a family member or friend who lives full-time with the person receiving care and serves as their primary caregiver. You do not clock in and out; the stipend recognizes that you are continuously present and responsible. To qualify, the caregiver and the person must live together (in either home), the caregiver must be at least 18, and the person cannot be medically unstable or so complex that SFC is standing in for skilled nursing. A certified SFC agency supports you: a nurse or licensed social worker acts as your "coach," provides training, and checks in monthly (with an in-person visit at least every 60 days). Many families prefer SFC because it fits the reality of moving in with — or moving a parent into — the home.

No professional license, CNA, or Home Health Aide certification is required to be a paid family caregiver in Ohio, whether through Structured Family Caregiving or self-directed personal care. The whole point of these programs is to let the people who already know and love the person provide the care. There is some required onboarding. For self-directed hourly care you enroll and are screened through Ohio Medicaid and the financial management agency (PPL). For Structured Family Caregiving, the certifying agency provides training — generally at least eight hours of initial training, more if the agency is Medicare-certified — plus ongoing coaching and monthly check-ins from a nurse or social worker. You may also complete a background check and basic health screening. But there is no clinical exam or skills test to pass. If you have been informally caring for a family member for years, you already have the experience these programs are designed to pay for.

Plan for roughly 45 to 90 days from first contact to your first payment, though it varies. The main steps are: applying for (or confirming) long-term-care Medicaid, completing the level-of-care assessment, getting enrolled on a waiver with a case manager, and then enrolling the caregiver through PPL (for hourly care) or a Structured Family Caregiving agency. If the person is not yet on Medicaid at all, add time for that application — sometimes another 30 to 90 days. You can speed things up by gathering documents early: proof of Ohio residency and identity, Social Security numbers, proof of income and assets (bank statements, benefit letters), and any medical records that show the need for hands-on care. Calling a Single-Entry Point Support Navigator (1-833-496-1288) or OBLTSS (1-844-644-6582) at the start helps route you to the right assessment quickly instead of waiting on a mailed form.

For most live-in caregivers, no. Because Structured Family Caregiving requires the caregiver to live in the same home as the person receiving care, the stipend generally qualifies as a "difficulty of care" payment that is excluded from federal gross income under IRS Notice 2014-7. That means the stipend is often not subject to federal income tax. This is a genuine advantage of the daily-stipend, live-in model — the same income earned as hourly wages while living elsewhere would typically be taxable. That said, tax situations vary, the exclusion has specific requirements, and it does not automatically cover every state or local tax, so you should confirm your own situation with your SFC agency and, ideally, a tax professional. By contrast, hourly self-directed personal care paid through the financial management agency (PPL) is normally treated as taxable wages with federal, state, and local taxes withheld — unless you also live with the person and the difficulty-of-care exclusion applies.

They are two different ways Ohio pays a family caregiver, and the right one depends on your living situation. Self-directed personal care pays an hourly wage (about $22 an hour for a family or friend aide) for a set number of authorized care hours each week — good when you provide defined help like bathing, dressing, meals, and toileting but are not necessarily living with the person around the clock. Structured Family Caregiving pays a flat daily stipend and requires you to live full-time with the person; it is built for whole-life, continuous caregiving rather than counted hours. Hourly care runs through the state financial management agency (PPL) with taxes withheld; Structured Family Caregiving runs through a certified SFC agency that also coaches and monitors you, and the stipend is often tax-free. Some families start with one and switch as the situation changes — for example, moving from hourly help to SFC after a parent moves in. Your case manager can tell you which your care plan supports.

Enrolling in these caregiver programs does not take away the person's other Medicaid benefits — they keep doctor visits, hospital coverage, prescriptions, medical equipment, and other covered services. Structured Family Caregiving and self-directed personal care are additional waiver services that sit alongside the rest of the Medicaid package, not replacements for it. If the person is dually eligible for Medicare and Medicaid (common for older adults and often served through MyCare Ohio), Medicare keeps paying for acute care like hospital stays and doctor visits while Medicaid covers the long-term personal care. The caregiver's income is a separate question: earning the stipend or wages can affect the caregiver's own taxes and, in some cases, their own benefits, but the tax-free treatment of a live-in SFC stipend often softens that. It generally does not change the care recipient's eligibility, as long as the plan of care and the person's income and assets still meet the waiver rules at each reassessment.