When Maria’s father was diagnosed with Parkinson’s, she knew she would take care of him. But as time passed, the reality of full-time caregiving set in. The late-night falls, the endless paperwork, the impossible choice: leave her job and risk financial ruin or pay for outside help they couldn’t afford.

Maria’s story isn’t unique. Across the country, families are making similar sacrifices to care for their loved ones. They aren’t just caregivers; they’re daughters, sons, spouses, and grandchildren stepping in where the system falls short. The Medicaid Structured Family Caregiving (SFC) program is one of the few initiatives that recognizes the value of these family caregivers — offering them financial support, training, and resources so they can provide care at home rather than being forced into costly institutional settings.

The Economic Impact of Family Caregiving

Family caregivers provide an estimated $600 billion in unpaid care each year¹. This unpaid labor reduces strain on Medicaid and other public healthcare programs. However, caregivers often face significant financial hardship, with more than 60% reporting they had to cut back on work hours or leave jobs entirely to provide care². The Structured Family Caregiving program is designed to help offset these burdens while reducing overall healthcare costs.

How SFC Helps Families

For families like Maria’s, SFC isn’t just a benefit — it’s a lifeline. Here’s how it makes a difference:

• Financial Assistance: With the stipend from SFC, Maria no longer has to choose between putting food on the table and keeping her father safe at home. Caregivers typically receive between $1,200 and $3,500 per month, depending on the state and level of care required³.
• Training & Support: Care coaches provide guidance, regular check-ins, and expert advice, helping families navigate the challenges of caregiving.
• Integration with Home and Community-Based Services: SFC ensures families can access essential medical and personal care services at home rather than relying solely on hospital visits.
• Cost-Effective Alternative: Home-based care under SFC is significantly more affordable than institutional care. The average cost of a nursing home is $108,000 per year⁴, whereas structured family caregiving costs Medicaid a fraction of that, leading to substantial savings while improving patient quality of life.

Each state structures its program differently, defining eligibility requirements, payment models, and administration. From New York to Colorado, families are making SFC work for them in different ways. Let’s explore how four states have implemented the program.

How SFC Works Across the Country

New York: Direct Payments for Family Caregivers

Maria’s family benefits from New York’s Consumer Directed Personal Assistance Program (CDPAP), which allows Medicaid recipients to hire their own caregivers, including family members. These caregivers are compensated directly, with fiscal intermediaries managing payments and compliance. It should be noted that recent administrative changes have raised concerns about accessibility and program efficiency⁵.

Pennsylvania: Reimbursement-Based Support

Sarah’s mother requires daily assistance, but direct payments aren’t an option. Instead, Pennsylvania’s Family Caregiver Support Program (FCSP) reimburses Sarah for eligible caregiving expenses. The program also provides respite care, training, and peer support networks — helping caregivers like Sarah balance their responsibilities⁶.

Colorado: Person-Centered Care in Action

Lucas lives in Colorado, where SFC is woven into Home and Community-Based Services (HCBS) waivers. This ensures that caregivers like him receive compensation while his aging father gets home-based medical and personal care. The program prioritizes tailored care planning and ongoing caregiver training, making it easier for Lucas to provide quality support⁷.

Mississippi: A Hybrid Model with Telehealth Support

Mississippi’s approach is to help families in rural areas, such as Lisa and her grandmother. The state integrates SFC into its Elderly and Disabled (E&D) Waiver Program, offering financial assistance to caregivers. However, reimbursement rates are lower than in some other states. Mississippi has expanded telehealth services to bridge gaps in remote regions, helping caregivers connect with professionals when in-person guidance isn’t readily available⁸.

Why Structured Family Caregiving Matters

• Preserve Quality of Life: Receiving care from a loved one fosters emotional well-being and a sense of security, just as Maria’s father experiences daily.
• Cost-Effective for Medicaid: Families like Lucas’ help reduce Medicaid’s financial burden by choosing home care over institutional settings. States implementing SFC have reported 10–30% cost savings compared to nursing home placements⁹.
• Provides Structured Training: Caregivers like Sarah receive professional guidance, reducing stress and uncertainty in their caregiving journey.
• Ensures Continuity & Stability: Family caregivers provide the consistency that institutional care often lacks, giving people like Lisa’s grandmother the comfort of familiarity.

Challenges Families Face in SFC Programs

But while these programs are a lifeline, they’re not without challenges.

• Complexity & Variability: Each state structures its program differently, often making navigating eligibility and requirements difficult.
• Caregiver Burnout: Even with financial aid, caregiving can be exhausting. Without adequate respite care and mental health support, caregivers risk burnout.
• Financial Limitations: Stipends often do not fully replace lost income, making full-time caregiving financially difficult for many.
• Lack of Awareness: Many families, including Lisa’s, before they found SFC, were unaware of the program or struggled with the Medicaid application process.

Technology’s Role in Supporting Caregivers

Digital platforms can ease the burden of caregiving, helping families manage care coordination, track medications, and access resources. Platforms like HealthHive offer tools that simplify caregiving logistics and reduce administrative stress for Maria, Sarah, Lucas, and Lisa.

Funding Digital Caregiving Solutions

State Medicaid programs, grants, and healthcare providers can help fund digital caregiving tools, integrating them into Medicaid’s care coordination efforts. These solutions enhance compliance, reduce hospitalizations, and alleviate caregiver strain, benefiting families and the healthcare system.

Looking Ahead: Strengthening Support for Family Caregivers

Medicaid’s Structured Family Caregiving program is a meaningful step toward recognizing and compensating family caregivers. But financial assistance alone isn’t enough. Making caregiving sustainable takes all of us — lawmakers, healthcare providers, technology companies, and communities. The future of caregiving isn’t just about financial aid; it’s about ensuring families have the support, resources, and recognition they deserve.

¹AARP, “Valuing the Invaluable: 2023 Update on Family Caregiving.”

²National Alliance for Caregiving and AARP, “Caregiving in the U.S. 2020.”

³Medicaid.gov, “Home and Community-Based Services Waivers.”

⁴Genworth, “Cost of Care Survey 2023.”

⁵New York State Department of Health, “Consumer Directed Personal Assistance Program.”

⁶Pennsylvania Department of Aging, “Family Caregiver Support Program.”

⁷Colorado Department of Health Care Policy and Financing, “HCBS Waivers Overview.”

⁸Mississippi Division of Medicaid, “Elderly & Disabled Waiver.”

⁹U.S. Department of Health & Human Services, “Home-Based Care Cost Savings Study.”

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