The Complete Guide to Family Managed Home Care (FMHC) in Ontario
A clear, practical breakdown of Ontario's Family-Managed Home Care program - written for families, SDMs, and caregivers.
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FMHC Overview
Family-Managed Home Care (FMHC), also known as Self-Directed Care (SDC), is a program administered by Ontario Health atHome. Rather than receiving personal support services through a contracted agency, approved families receive direct funding to hire and manage their own care workers.
That shift in control is meaningful - it means care can be arranged around the client's actual schedule, preferences, and needs. But it also means the family takes on real administrative and employer-level responsibilities that don't exist in the traditional home care model. Managing payroll, tracking expenses against a funding budget, submitting monthly reports, and maintaining records for seven years are all part of the job.
Eligibility
FMHC is not open to everyone, and enrollment is not a direct application - it begins with a conversation with your Ontario Health atHome Care Coordinator. Eligibility is assessed in two distinct parts.
Clinical Eligibility
The person receiving care must already have an assessed need for home and community care services and an active care plan. The program is currently available to:
- Children with complex medical needs
- Adults with acquired brain injuries
- Children receiving education at home who meet program criteria
- Individuals in extraordinary circumstances as determined by Ontario Health atHome
Administrative Eligibility
Someone capable of managing the program's financial and employer-level responsibilities must be in place. This person is called the contract holder, and they can be the client themselves if capable, or a Substitute Decision Maker (SDM) acting on their behalf.
Ontario Health atHome assesses both clinical and administrative eligibility carefully. If either is not met, enrollment will not proceed. The Care Coordinator is your starting point for any conversation about whether FMHC is the right fit.
Substitute Decision-Maker (SDM)
A Substitute Decision-Maker is a person authorized to make decisions on behalf of someone who is unable to make them independently. In the context of FMHC, the SDM takes on the financial and administrative responsibilities of the program - managing funds, submitting reports, and fulfilling all obligations under the SDC agreement.
Who Can Be a Substitute Decision-Maker?
An SDM can be a spouse, partner, family member, or trusted person who is capable of managing these responsibilities on the client's behalf. For minors, a parent or legal guardian who lives with the child can serve in this role.
How to Become an SDM
For minors, a parent or legal guardian who lives with the child can serve as SDM. For adults, the SDM must hold one of the following:
- Guardian of Property status under Part 1 of the Substitute Decisions Act, 1992
- A Continuing Power of Attorney for Property under the Powers of Attorney Act or Part 1 of the Substitute Decisions Act, 1992
- A role managing Ontario government funding from the Passport Program, Ontario Works, or Ontario Disability Support Program (ODSP) on behalf of the client
For information on establishing Power of Attorney or Guardian of Property status:
attorneygeneral.jus.gov.on.ca/english/family/pgt/
What the Program Requires of You
Ontario Health atHome assesses whether the prospective contract holder has the capacity to manage all of the following before approving enrollment. You should be capable of:
The Application Process
Unlike most programs, FMHC doesn't have a standalone application form you fill out and submit. Access runs through Ontario Health atHome, and the process moves in stages - beginning with a conversation with your Care Coordinator.
Expressing Interest
Start by telling your Care Coordinator you're interested in self-directing care. They will walk through the basics of the program and make an initial assessment of whether you might be eligible. If things look promising, your file is referred to the FMHC team for a more formal review.
If you don't already have a Care Coordinator through Ontario Health atHome, your first step is to contact them directly to request a home care assessment. Once assigned, your Care Coordinator becomes your starting point for everything FMHC-related.
Meeting 1 - Getting Oriented
The FMHC team will book your first formal meeting, where you'll learn how to submit your application, review the client's care needs, and discuss your options for structuring care - whether through a registered agency, an independent contractor, or by hiring directly as an employer. This decision has meaningful administrative and financial implications, and it's worth understanding your options before moving forward. After this meeting, you have 60 days to complete the onboarding checklist before your file can advance to Meeting 2.
Meeting 2 - The Contract
After your application is submitted, you'll meet with the FMHC team a second time to review the full program agreement and all associated documentation, including your care plan and approved budget. This is a substantive meeting - the agreement outlines your legal obligations, the funding structure, reporting requirements, and the circumstances under which the contract can be amended or terminated. Ask questions here. Once signed, it is binding. At the end of this meeting, a start date is agreed upon. If Ontario Health atHome receives your signed agreement by the 20th of the month, your first deposit will arrive on the 1st of the following month. If received after the 20th, your start date shifts to the month after.
Meeting 3 - Financial Orientation
Ontario Health atHome offers a third meeting for the contract holder and their bookkeeper, focused specifically on the financial and reporting side of the program. This meeting is described as optional in official documentation, but every system needs to be in place before the first month of expenses is reported. Your bookkeeper must be available to attend when requested. Tabber is available to attend this meeting alongside you to answer financial and reporting questions directly with your Care Coordinator.
Before Funding Begins
Ontario Health atHome will not deposit initial funds until you have provided:
- Proof that you have opened your dedicated FMHC bank account
- Proof of the insurance required under your agreement
- The name and contact information for your bookkeeper, along with your consent for Ontario Health atHome to communicate directly with them about your funds
- Confirmation that you have hired or retained a service provider, including a description of the services they will provide
Once everything is in place, your first deposit will arrive. After that, funding is deposited monthly - within 14 calendar days of Ontario Health atHome receiving your complete monthly report.
Your Responsibilities as the Contract Holder
By signing the SDC agreement, you take on the following obligations:
How to Structure Care Arrangements
You have three options for engaging care providers:
Through a Registered Agency
The agency employs the care workers and manages all payroll and employer obligations. Your role is to pay agency invoices and report those payments. This is the simplest arrangement administratively.
As an Independent Contractor
You hire care providers directly, and they invoice you for their services. They are responsible for their own taxes, CPP/EI, and insurance. Your role is to pay invoices, track them against your budget, and report monthly. The working arrangement must genuinely reflect a contractor relationship - the CRA does not rely solely on what a contract says.
As a Direct Employer
You hire care workers as employees, which means you are responsible for payroll, source deductions, CRA remittances, T4s, and all other employer obligations under Ontario and federal law. This arrangement is the most administratively complex and is where having a qualified bookkeeper is most critical.
The approved hourly rate in your budget applies across all three models and is an all-in rate - it is intended to cover wages, applicable payroll costs, insurance, and all other costs associated with delivering the service.
What Your Written Agreement With Each Provider Must Include
Every service provider agreement must contain, at minimum:
- A provision that the provider will deliver services in accordance with the client's care plan
- A provision that the provider will disclose their PVSC results immediately upon receiving them, if not already disclosed before hiring
- A provision that the provider will notify you immediately if charged with or convicted of any criminal offence
- A provision that the provider will notify you immediately if they no longer meet the minimum qualifications set out in Schedule "C"
- A provision that if Ontario Health atHome wishes to obtain information about the client's care or the SDM's participation in the program, the provider will cooperate directly with the Care Coordinator
- The indemnification language set out exactly as it appears in Schedule "D" of the program agreement
- Insurance confirmation: at minimum $2M in Commercial General Liability Insurance and $25,000 in Abuse Liability coverage, unless Ontario Health atHome has provided written permission for an exception
- A relationship clause - either confirming the provider is an employee, or confirming they are an independent contractor - using the exact wording required by Schedule "D"
- A provision acknowledging the provider is a health information custodian subject to the Personal Health Information Protection Act, 2004
Bookkeeper Requirements
Section B5.1 of the SDC agreement requires you to hire or retain a bookkeeper to provide bookkeeping services in respect of the funds, unless Ontario Health atHome has approved an alternate arrangement in writing.
Schedule "O" Requirements
Every individual retained as the bookkeeper must have all of the following:
- A registered business number
- Proof of completion of one of the following: a Payroll Compliance Practitioner (PCP) certificate, a Certified Payroll Manager (CPM) certificate, a Professional Bookkeeper (CPB) certificate, or a Chartered Professional Accountant (CPA) designation
- Proof of insurance coverage
Where the service provider is retained as an independent contractor or employed directly, the bookkeeper must also be a member of the Canadian Payroll Association.
Before your Financial Orientation meeting with Ontario Health atHome, your bookkeeper must provide written confirmation of their Schedule O qualifications. We prepare this documentation as part of our standard onboarding - so your setup is complete and approved without delays.
Your bookkeeper must also be available to attend an orientation meeting with you and Ontario Health atHome when requested.
Monthly Financial Reporting
Monthly financial reports ensure that all transactions through the FMHC bank account are accurately tracked and meet eligibility under your funding agreement with Ontario Health atHome.
When Reports Are Due
Reports are due no later than ten calendar days after the end of each month. Late reports may delay your next funding deposit or trigger a compliance follow-up.
What Must Be Submitted
Each month you must provide:
- The completed Schedule G&H Monthly Financial Report form, signed by you and your service provider
- The agency invoice (if receiving services through a registered agency), the invoice from your service provider (if an independent contractor), or a signed timesheet (if a direct employee)
- Proof of payment for the services described
How to Complete the Report
All updates must be made on the live web version of the Excel file via Sync. Do not complete the file offline and re-upload - this causes version control issues that can affect your submission.
To find the reporting documents, open the Financial Documentation folder in the SYNC Secure Portal and locate the Excel file titled Schedule G&H Monthly Financial Report. Open it using Edit in Office.
How Funding Is Deposited
Funding is deposited monthly into your dedicated FMHC bank account. The amount reflects the maximum authorized under your care plan plus an allowance for eligible expenses. Ontario Health atHome will deposit approved funds no later than 14 calendar days following the day on which they receive your complete, satisfactory submission.
The Surplus Rule
Unused funds accumulate as a surplus. When that surplus exceeds two months' worth of your approved funding, the next month's deposit is skipped. The deposit is withheld until your balance drops below the two-month threshold - it is not permanently forfeited. You will not receive notification of a skipped payment - it is your responsibility to monitor your balance.
What a Typical Month Looks Like
Start of Month
Ontario Health atHome deposits funding into your FMHC bank account based on your approved care plan.
During the Month
Services are delivered. Depending on your setup, you may receive invoices from an agency, receive invoices from independent contractors, or run payroll for employees.
Throughout the Month
As payments are made, each transaction must be tracked and categorized - by service type, provider, and service dates - within your Schedule G&H report.
End of Month
You download the bank statement, ensure every transaction in the account is reflected in the report, and attach supporting documentation (invoices, timesheets, proof of payment).
By the 10th
Everything is uploaded to Sync.
Review & Next Deposit
Ontario Health atHome reviews your submission. If it is complete and compliant, your next funding deposit is issued within 14 days. The cycle then repeats.
Eligible Expenses
In addition to funding for care services, your agreement includes a monthly allowance for eligible administrative expenses. The specific caps for each category are set out in your individual Schedule "I" - confirm the amounts with your Care Coordinator, as they are specific to your agreement. Your agreement includes a separate allowance for administrative expenses, each with a defined monthly cap. These caps are not interchangeable and must be tracked by category.
Recognized Expense Categories
Items requiring pre-approval must be approved in writing before you spend. The eligible expense caps do not include applicable taxes - applicable taxes may be reported separately and, if approved, will be funded.
Confirming Your Expenses Will Be Approved
- For service provider payments: Divide the total monthly cost by the total hours of service received. The result must be equal to or less than the maximum approved rate set out in Schedule "B".
- For hours of service: The total claimed must not exceed the monthly limit authorized in your care plan.
- For eligible expenses: Each category has a monthly cap as specified in Schedule "I". All transactions must be supported by documentation.
Items that exceed approved limits will be flagged in red in the reporting spreadsheet and must be repaid to the FMHC bank account within 30 days.
Key Deadlines
10th of each month
Monthly financial report and supporting documents due
Within 14 calendar days
Ontario Health atHome deposits approved funds (after receiving complete report)
Within 30 days
Repay any ineligible amounts to your FMHC bank account
Before hiring any provider
Confirm qualifications, insurance, and PVSC results
Within 48 hours
Notify your Care Coordinator of hospitalizations, emergency visits, or significant health changes
Record Retention
You must retain all financial records and non-financial documents for seven years from the date the agreement expires or is terminated, or longer if required by applicable law. Do not rely on Sync for record keeping - save local copies of everything.
Common Mistakes and How to Avoid Them
Most issues in the program don't come from misunderstanding the rules - they come from small operational misses that compound over time. These are the situations we see most often:
Editing the Sync Excel Report Offline
All updates to your Schedule G&H report must be made on the live web version via Sync. Editing the file offline and re-uploading it causes version control issues that can affect your submission and delay your funding.
Overpaying providers
Payments to service providers must not exceed the approved hourly rate set out in your budget. Any amount paid above the approved rate is considered ineligible and will need to be repaid to your FMHC bank account.
Incomplete documentation
Every expense and every payment must be supported by proper documentation - invoices, timesheets, and proof of payment. Ontario Health atHome requires documentation for each transaction before it can be approved, so keeping organized records throughout the month is far easier than trying to reconstruct them at reporting time.
Spending without pre-approval
Training, medical supplies, and diagnostic services all require written pre-approval from your Care Coordinator before the cost is incurred. Seeking approval after the fact is not an option - these expenses will not be reimbursed unless pre-approval was obtained in advance.
Not monitoring your surplus
When unused funds in your FMHC account exceed two months of your approved funding, the next month's deposit is automatically skipped. Ontario Health atHome does not notify you when this happens, so it is important to keep a close eye on your account balance and flag any concerns with your bookkeeper before a deposit is due.
Commingling funds
Your dedicated FMHC bank account must be used exclusively for FMHC transactions. Personal funds and FMHC funds must remain completely separate at all times.
Hiring without PVSC confirmation
All service providers must disclose their Police Vulnerable Sector Check results to you before starting - or, in urgent situations, as soon as results are available. Hiring without this step in place puts you in breach of your agreement.
No contingency plan
You are responsible for arranging replacement care if a provider is unavailable. Ontario Health atHome will not pay for services that were not delivered to the client, and the obligation to have a backup plan in place rests entirely with you.
Frequently Asked Questions
What qualifications must my bookkeeper have?+
A registered business number, a professional designation (CPA, PCP, CPM, or CPB), proof of insurance, and - where service providers are independent contractors or employees - membership in the Canadian Payroll Association.
Can I hire a family member as my bookkeeper?+
Generally no. The agreement prohibits using FMHC funds to pay a bookkeeper who is an immediate family member or household member unless Ontario Health atHome has granted written permission.
Can I hire a family member as a care provider?+
Also generally no, with the same exception - written permission from Ontario Health atHome is required.
What is the difference between an employee and an independent contractor?+
Employees require payroll deductions, T4s, and employer remittances to the CRA. Independent contractors handle their own taxes and invoice you for services. The CRA determines which applies based on the actual working relationship, not just what the contract says.
What happens if I submit my report late?+
Late reports may delay your funding deposit or trigger a compliance follow-up from Ontario Health atHome.
What if a care worker is unavailable?+
You are responsible for arranging replacement care. Ontario Health atHome will not pay for services that were not delivered to the client.
Can services be provided outside Ontario?+
In limited circumstances - specifically where the client is a child with complex medical needs - funding may cover services provided outside Ontario for up to three weeks per calendar year, provided you give advance notice to your Care Coordinator and confirm the provider is authorized to provide services in that location.
How do I contact Ontario Health atHome?+
For financial reporting: fmhcfinance@ontariohealthathome.ca | For general inquiries: 310-2222 (no area code required)
Where Tabber Fits In
Tabber was built to support families through the financial and reporting side of FMHC - from organizing and tracking expenses to preparing and submitting monthly reports in the format Ontario Health atHome expects.
Our FMHC bookkeeping services are structured to fit within the program's approved funding allocation, which means there is no out of pocket cost to families.
When paperwork needs to be handled properly, we're here for you - so you can focus on what matters most.
Reach out today to get started.
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Helpful External Links
Ontario Health atHome - FMHC Page
Ontario Health atHome - FMHC Fact Sheet
Ontario Health atHome - FMHC Process Guide
Ontario Health atHome - FMHC YouTube Playlist
Tabber is an independent bookkeeping provider and is not affiliated with Ontario Health atHome. Program requirements can change and may vary by agreement. This page provides general information only and is not legal, tax, payroll, medical, or eligibility advice. Families should follow their own signed agreement and confirm current requirements with their Ontario Health atHome care coordinator. For legal, employment, payroll, tax, or SDM questions, consult an appropriate qualified professional.