Structured Family Caregiving Ohio: How Live-In Family Members Get Paid

Most Ohio families providing daily care to an aging parent do it for free. They take time off work, skip their own medical appointments, and spend their own money covering gaps that Medicaid does not fill. The state has a program that pays family caregivers — but relatively few families know it exists.

Structured Family Caregiving (SFC) is a service available under Ohio's PASSPORT waiver that allows a live-in family caregiver — including, notably, a spouse — to receive a daily stipend for providing personal care and supportive services to the waiver participant. It was added to the PASSPORT program in October 2024 and fills a real gap: before this change, spouses were historically excluded from being paid for care under Ohio's waiver system.

What Structured Family Caregiving Covers

Under the SFC model, the live-in caregiver provides the same types of personal care services that would otherwise be delivered by a home care agency employee:

• Assistance with bathing, dressing, grooming, and toileting
• Mobility assistance, including help with transferring and repositioning
• Meal preparation and feeding assistance
• Medication reminders
• Light housekeeping and laundry
• Health monitoring and accompanying to medical appointments

The difference from standard agency care is the relationship and the setting: the caregiver lives in the same home as the PASSPORT participant, knows the person's routines and preferences, and provides care in a familiar environment rather than through a rotation of agency staff.

Who Can Be the Caregiver

The caregiver must live in the same home as the PASSPORT participant. They must meet training and qualification requirements set by the participating agency. Eligible caregivers include:

• Adult children living with the parent
• Spouses — a significant change from historical Ohio policy
• Other relatives or household members meeting the residency and training requirements

The caregiver cannot simultaneously be a paid PASSPORT provider in another capacity and receive the SFC stipend for the same participant. The SFC arrangement is specific to the live-in model.

How the Stipend Is Structured

The live-in caregiver does not receive the stipend directly from Ohio Medicaid. The program operates through a participating agency provider who contracts with or employs the family caregiver. The agency:

• Verifies the caregiver's eligibility and completes required training
• Incorporates the care tasks into the formally approved individual care plan
• Monitors care delivery and coordinates with the PASSPORT case manager
• Processes the stipend payment to the caregiver

The daily stipend amount varies by agency and care level but is set based on the intensity of care provided. It is not a full replacement for professional home care agency rates — it is a supplemental payment that recognizes the caregiver's contribution while the participant remains in the community.

Because the payment flows through an agency, the caregiver is treated as a contracted caregiver or employee, which has tax implications. The family should understand upfront that the stipend is reportable income.

How It Fits Into the PASSPORT System

Structured Family Caregiving is one of several consumer-directed and caregiver-support options available under PASSPORT. The broader menu includes:

• Structured Family Caregiving (live-in family member paid through an agency)
• Choices Home Care Attendant Service (C-HCAS): Allows the participant to hire, direct, and manage their own personal care attendant — including family members who do not live in the home
• Consumer-Directed Personal Care Service (CD-PCS): A consumer-directed model where the participant manages their own care budget and direct-hires workers

These programs address a real workforce shortage problem. There is currently a provider enrollment moratorium for home health and hospice services in Ohio, running from May 14, 2026 through November 14, 2026. New home care agencies and independent aides cannot enroll as Ohio Medicaid providers during this period. That makes programs like SFC — which work with existing, enrolled agencies — more important as an immediate option for families.

The Application and Care Plan Process

To access Structured Family Caregiving, your parent must already be approved for the PASSPORT waiver — or be in the process of applying. SFC is not a standalone program; it is a service type within an approved PASSPORT waiver enrollment.

The process:

1. Apply for PASSPORT: Contact the Ohio Benefits Long-Term Services and Supports (OBLTSS) line at 1-844-644-6582 or your regional Area Agency on Aging at 1-866-243-5678 to initiate the intake process.
2. Complete the ACAT assessment: A nurse evaluator from the AAA visits the home and documents the participant's level of care needs. The participant must meet the Nursing Facility Level of Care threshold.
3. Identify an SFC-participating agency: Not every PASSPORT agency offers Structured Family Caregiving. Ask the AAA case manager specifically which local agencies are enrolled to provide SFC services.
4. Complete caregiver training and agency enrollment: The live-in caregiver completes the required training through the agency. The specific training content and hours are set by each agency within state guidelines.
5. Develop the physician-signed care plan: The individual care plan must document all SFC tasks and be signed by the participant's primary care physician, certifying the medical necessity of in-home care.
6. Begin care and payment: The agency processes the monthly stipend based on the care plan and documented care provided.

For Dual-Eligible Seniors in MyCare Ohio Counties

If your parent is dual eligible (both Medicare and Medicaid) and lives in an active MyCare Ohio county, Structured Family Caregiving is also available — but it is coordinated through the managed care plan rather than directly through the AAA. The plan assigns a care coordinator who can connect families with SFC-participating providers in the plan's network.

Contact the selected MyCare Ohio plan (Anthem, CareSource, or Molina) to ask about Structured Family Caregiving availability for your parent's specific care situation.

What It Does Not Cover

Structured Family Caregiving does not eliminate the need for other services. The PASSPORT cost cap means the program cannot fund 24-hour professional care — it is designed to supplement, not replace, the family caregiver. For complex medical needs (wound care, skilled nursing monitoring, injection management), the participant may also receive separate Medicare-covered home health visits.

If the total cost of all PASSPORT services — including the SFC stipend — exceeds 60% of what equivalent nursing facility care would cost, the state cannot authorize additional hours. Families with a parent who has very high-acuity needs may reach this cap.

For families with a parent currently in or approaching a PASSPORT application, the Ohio Aging in Place Guide includes a step-by-step checklist for the SFC enrollment process, a comparison of the consumer-directed care options (SFC vs. C-HCAS vs. CD-PCS), and guidance on how to identify SFC-participating agencies in your region.

See more Ohio guides →