3.60 Structured Family Caregiving Waiver
Home and Community Based Services Manual
3.60 Structured Family Caregiving Waiver
Revised - March 2025
Introduction
The Structured Family Caregiving Waiver (SFCW) is a Home and Community Based Services (HCBS) waiver service offered through the Division of Senior and Disability Services (DSDS) available to participants with a diagnosis of Alzheimer’s disease or related dementia disorders. The goal of the SFCW is to provide necessary care to participants in a home environment by fostering the participant’s independence while preserving dignity, self-respect, and privacy in a non-institutional setting.
Purpose
SFCW is designed to provide long-term care to those whose needs can be met within the SFCW. Participant needs shall be addressed in a manner that support and enable the individual to maximize their ability to function at the highest level of independence possible. The participant’s needs are met by a cooperative relationship between the participant and/or legal guardian, the primary and substitute caregivers, and the SFCW provider.
The participant’s right of self-determination shall be sought and respected throughout the Person-Centered Care Planning (PCCP) process and delivery of the SFCW. The participant shall participate and approve of the services being delivered or when appropriate, the legal guardian may communicate this approval.
- The SFCW service shall be administered and received in the participants' or primary caregivers' home and community. The primary caregiver must be the live-in caregiver already providing care to the participant prior to authorization of SFCW.
- The primary and substitute caregivers may be a non-family member, family member, or legal guardian.
Eligibility
All SFCW participants must meet the following eligibility criteria:
- Be 21 years of age and over at initial entry
- Diagnosed with Alzheimer's or related dementia disorders as defined by state statute 172.800 RSMo by a physician licensed in the State of Missouri
- Reside full time in the same household as the primary caregiver
- Have an established backup plan
- A qualified substitute caregiver familiar with the participant’s needs, chosen by the participant or legal guardian and employed by the provider, must be identified and available to provide services at times when the primary caregiver is not available.
- Meet Nursing Facility Level of Care (LOC)
- Have an appropriate Medicaid Eligibility (ME) code
- Be in active Medicaid status
- Participants eligible for Medicaid on a spenddown basis may be authorized to receive SFCW during periods when spenddown liability is met.
- When the participant has not met their monthly spenddown liability amount, the participant and provider may make a private arrangement for the continued delivery of services. In these instances, the participant is responsible for the cost of services received.
- Authorization of the SFCW does not meet the requirements for an individual to be eligible for Home and Community Based (HCB) Medicaid.
- Participants in a ‘Transfer of Property penalty’ are eligible for Medicaid funded SFCW
- Participants who receive Medicaid due to eligibility for Blind Pension (BP) are not eligible for the SFCW.
Restrictions
The SFCW has the following restrictions:
- The participant must not be enrolled in any other HCBS state plan or waiver service, regardless of which state agency administers the waiver
- Individuals who reside in a facility of any kind, group home, or boarding home are not eligible for the SFCW.
- The hiring of more than one primary caregiver is not allowed.
Service Descriptions
The SFCW provider is required to develop, implement, and provide a Person-Centered Care Plan (PCCP) that addresses the participant’s needs and ensures the primary and substitute caregivers are properly qualified to meet the participant’s needs.
Allowable Services and Supports
These are supportive and health-related attendant and homemaker services that substitute for the absence, loss, reduction, or impairment of a physical or cognitive function. The following are services related to needed Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs) .
- Homemaker which includes general household tasks like cleaning and laundry.
- Attendant care to provide assistance with ADLs such as bathing, dressing, and other personal care tasks.
- Medication oversight to manage medications and doses (to the extent permitted under State law).
- Escorting for necessary appointments, whenever possible, such as transporting individuals to doctor appointments and community activities that are therapeutic in nature or assists with maintaining natural supports.
Provider Choice
The HCBS provider must be enrolled as a SFCW provider with the Department of Social Services (DSS), MO HealthNet Division, and Missouri Medicaid Audit and Compliance (MMAC) Unit. The SFCW provider is selected through the participant's choice and provider availability. A list of all qualified providers is available to the participant or legal guardian upon request, at reassessment, or anytime a provider change request is made.
Cost Maximum
Unit Rate: The SFCW unit of service is one-day, which equals a 24-hour period. The per diem unit rate is based upon 60% of the nursing facility daily rate. The SFCW unit shall never be authorized with any other HCBS.
The SFCW provider can take no more than 35% of the SFCW unit rate. The provider must pay the primary caregiver and substitute caregiver for services rendered.
Process
The SFCW is limited to a specific number of unduplicated participants during any waiver year.
- The SFCW year runs from July 1 of each year through June 30 of the following year.
- Once a slot has been filled during the current waiver year, it cannot be used again in the same waiver year if the original participant leaves the SFCW for any reason.
When requested, services available through the SFCW shall be discussed with the participant and/or legal guardian, and anyone requested by the participant. DSDS staff shall confirm that the live-in caregiver already providing care to the participant will be the primary caregiver delivering SFCW. DSDS staff shall then document the identity of the primary and substitute caregivers.
DSDS staff shall confirm the diagnosis that meets the criteria outlined by state statute 172.800 RSMo by contacting the physician identified by the participant or legal guardian. If unable to reach by phone, DSDS staff shall utilize the SFCW Diagnosis Verification form. DSDS staff shall upload the completed form upon receipt.
Following confirmation of the appropriate diagnosis, DSDS staff shall provide the participant and/or legal guardian with information on SFCW providers for selection.
DSDS staff shall submit the request for SFCW to their supervisor for review. The supervisor shall review all requests for SFCW to ensure all steps are complete and the participant’s unmet needs require the SFCW. If documentation supports the request, the supervisor shall forward the request to the Bureau of Federal Programs (BFP) for review prior to authorization of SFCW. Pending approval from BFP to authorize SFCW, the SFCW unit and provider selection may be entered in pending status in the participants electronic case record.
BFP will review the SFCW request, and if necessary, request additional clarification or details.
- The supervisor will be notified if the request is not approved for any reason.
- Denial of a request for SFCW enrollment requires an Adverse Action. DSDS staff shall send a Notice of Adverse Action to the participant and/or legal guardian which is subject to appeal rights.
- Upon approval of a request, BFP will determine if a SFCW slot is available and notify the supervisor to enroll the participant.
NOTE: Participants receiving other HCBS or waiver services that want to enroll in SFCW, must have the other HCBS state plan or waiver services’ end-dated prior to the authorization of SFCW.