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Missouri Structured Family Caregiving

Missouri's Structured Family Caregiving program pays family caregivers a daily stipend through a Medicaid waiver to provide in-home care to individuals aged 21+ with Alzheimer's disease or a related dementia as an alternative to nursing facility placement. The caregiver must live with the care recipient. Spouses may serve as caregivers. A provider agency coordinates services, provides caregiver training, and conducts regular oversight visits.

Pays family caregivers a daily stipend for providing in-home care to Medicaid-eligible individuals aged 21+ with Alzheimer's disease or a related dementia who require a nursing facility level of care. Missouri's July 2026 HCBS Services Units and Rates appendix lists Structured Family Caregiver as S5126HB, one day, one unit/day, at $110.33. The SFCW policy says the unit is one day/24 hours, the provider may not receive more than 35% of the unit rate, and the provider must pay the primary and substitute caregivers for services rendered. The caregiver must live with the care recipient. Spouses, legal guardians, immediate family, other family, and non-family caregivers may serve when they meet program requirements. An enrolled SFCW provider develops and manages the person-centered care plan and must be selected through participant choice and provider availability. Income and resource eligibility are determined through Medicaid, not SFCW directly.

Eligibility

  • Asset limit of $6,068
  • U.S. citizenship or qualified immigrant status required
  • Care recipient must have a qualifying disability
  • Applicant must have a qualifying disability
  • Applicant age: at least 63
  • Care recipient age: at least 63
  • Must live with care recipient

Questions to ask the program

These are questions to ask the program, not a verdict on your eligibility. Confirm the current rules directly with the program.

  • Does the person receiving care live in Missouri? — Residency is usually the first thing a program checks.
  • What are the current income and asset limits, and whose income counts? — Our record lists an asset limit around $6,068 — limits change, so confirm the current figures.
  • Is the person receiving care in the covered age range (63 or older)?
  • What counts as a qualifying disability or level of care need, and what documentation shows it?
  • Which citizenship or immigration statuses does the program accept, and which documents show it?
  • Do you need to live with the person receiving care, and how is that verified?
  • Is there a caregiver-specific department, coordinator, or support line? Ask for it by name. — Many agencies have one that isn’t advertised on the website.
  • What documents do you need from us to start an application?
  • Is there a waitlist right now, and how long is it?

Services

Pays family caregivers a daily stipend for providing in-home care to Medicaid-eligible individuals aged 21+ with Alzheimer's disease or a related dementia who require a nursing facility level of care. Missouri's July 2026 HCBS Services Units and Rates appendix lists Structured Family Caregiver as S5126HB, one day, one unit/day, at $110.33. The SFCW policy says the unit is one day/24 hours, the provider may not receive more than 35% of the unit rate, and the provider must pay the primary and substitute caregivers for services rendered. The caregiver must live with the care recipient. Spouses, legal guardians, immediate family, other family, and non-family caregivers may serve when they meet program requirements. An enrolled SFCW provider develops and manages the person-centered care plan and must be selected through participant choice and provider availability. Income and resource eligibility are determined through Medicaid, not SFCW directly.

How to apply

    1. Have active Medicaid (eligibility determined by DSS Family Support Division); if income is over the limit, FSD may process HCB Medicaid via the IM-54A referral. 2. Submit a referral to the DSDS HCBS Call Center at 866-835-3505 (8:30am-3:00pm Mon-Fri), through the Online HCBS Referral Form, or by emailing a Referral Form to HCBSCallCenterReferrals@health.mo.gov; participants, family, friends, or informal supports can refer. 3. Complete a face-to-face assessment for Nursing Facility Level of Care and a person-centered care plan.

Use the official program page for application details: official program page.

  • medicaid (depends_on): Care recipient must be Medicaid-eligible
  • hcbs-waivers (companion): SFC is available through the Missouri Structured Family Caregiving Waiver (SFCW)