Structured Family Caregiving in Georgia: how it works and how to apply.

What Structured Family Caregiving is

Structured Family Caregiving, usually shortened to SFC, is a service inside Georgia’s Elderly and Disabled Waiver Program. It pays a daily stipend to a family member who lives with the person receiving care and provides that care day to day.

It is not a job with the state, it is not a wage with a timesheet, and it is not a program you can apply to on its own. It is one line in a waiver care plan. Everything difficult about getting it comes from that fact.

If you have arrived here from the wider question of how a family member gets paid for caregiving, the broader answer, including the routes that are not SFC, is at how to get paid as a family caregiver.

Who can be the paid caregiver

This is where most families find out whether the idea is going to work, so it is worth being blunt about it.

The caregiver must live with the member. Not nearby. Not in the same building. The same home. A daughter who drives over every morning and every evening, does the shopping, manages the medications and sleeps at her own house does not meet the requirement, however much care she is providing.

These relatives can qualify: adult children, grandchildren, siblings, and in-laws.

These are excluded, without exception: spouses, legal guardians, and conservators. A husband caring for his wife cannot be paid through SFC. A daughter who has been appointed her mother’s legal guardian cannot be paid through SFC while she holds that appointment.

And the caregiver must also:

• be 18 or older
• be related to the member by blood or marriage
• pass a background check

The exclusions catch people out constantly, particularly the spousal one and the guardianship one. Families who have already been through a guardianship process for a parent with dementia sometimes discover the two things do not sit together. If that is your situation, raise it early, with a case manager and, where a guardianship is involved, with the attorney who handled it.

What it pays

The stipend is roughly $80 a day. It is set within the waiver, not negotiated between the family and an agency, and like everything in the waiver it can change.

Payments to a caregiver who lives with the person they care for are generally treated as excludable from gross income under IRS Notice 2014-7, the same provision that covers other Medicaid home care payments to co-resident caregivers. Generally is doing real work in that sentence. Whether it applies to a particular household depends on that household’s facts, and this is general information rather than tax advice. Anyone planning around it should ask a tax preparer.

What the stipend is not is a promise. Whether SFC ends up in a plan of care depends on the assessment, on the waiver rules, and on the approval of the plan. No agency can tell a family in advance that the stipend will be approved, and any that does is telling you something it is not allowed to tell you.

The two things that have to be true first

Families often ask how to apply for SFC, and the honest answer is that you do not apply for SFC. You apply for the waiver, and SFC comes after.

One: the person receiving care must be enrolled in EDWP. That means meeting a nursing-home level of care, assessed with the DON-R, and meeting Medicaid’s financial rules. Age and diagnosis on their own do not do it.

Two: a case manager has to write SFC into the plan of care. The plan is approved by the member’s physician or by the case management agency’s medical director under General Services §602.11. If SFC is not in the approved plan, there is nothing to pay against.

There is a third piece that catches people. The SFC agency is a separate contracted provider from the case management agency. The case management agency assesses, plans and coordinates. A different, separately contracted SFC provider handles the caregiver side: the onboarding, the background check, the training and support, and the payments. So a family will normally be dealing with two organizations, and it is worth knowing that from the start rather than discovering it halfway through.

How to apply, step by step

1. Call the Area Agency on Aging. For older adults and adults with disabilities this is the front door. It runs the Aging and Disability Resource Connection, and it handles the intake and the initial screening. In the metro Atlanta region the Area Agency on Aging is the Atlanta Regional Commission, and its service is called Empowerline.

2. Go through the level-of-care assessment. Someone will assess what the person can and cannot do safely, using the DON-R. Say what is actually happening at home, including the bad days. Families routinely present their parent at their best, out of pride or habit, and then wonder why the assessment does not reflect reality.

3. Sort out the Medicaid financial side. This runs in parallel and it is frequently the slow part, especially where there are assets, a house, or a spouse still at home.

4. Choose a case management agency. The member has the right to choose their EDWP provider, and the case manager is obliged to tell them what providers are available in their area. This is a real choice and it is worth using.

5. Raise Structured Family Caregiving in the assessment. Say plainly who lives in the home, who is providing the care now, and that you want SFC considered. Do not assume it will be offered.

6. If SFC goes into the plan, choose an SFC provider. Georgia contracts with more than one SFC provider agency, and which one a family uses is the family’s choice. Ask what each one requires of caregivers, how it trains and supports them, how often it visits, and how and when it pays. A case manager should give you options, not a single name.

7. Complete the caregiver requirements. Background check, whatever onboarding and training the SFC provider requires, and the documentation showing the caregiver and the member share a home.

8. Expect it to take a while. Two to six months from first call to services starting is realistic, and there is often a waiting list. Nobody should be quitting a job on the assumption of a start date.

What SFC does not do

It does not replace the rest of the care plan. A caregiver being paid a stipend is still allowed respite, and still needs it. Other services - personal support hours, home-delivered meals, adult day health, an emergency response system - can sit in the same plan, and the point of the plan is to keep the arrangement survivable rather than to shift the whole load onto one relative.

It also does not turn the caregiver into an employee of the state or of the case management agency, and it does not carry the benefits a job would. That is worth thinking about carefully before anyone gives up work.

Where to raise it

If you are already on the waiver, raise it with your case manager and ask for it to be considered at the next review. If you are not on the waiver, the sequence above is the sequence, and it starts with the Area Agency on Aging.