What is Adult Foster Care (AFC)?

Adult Foster Care (AFC) is a MassHealth-funded program in Massachusetts that provides supportive services to eligible adults who are unable to live alone safely due to medical, physical, cognitive, or mental health conditions. AFC allows individuals to receive care in a private home setting rather than in a nursing facility.

Who can receive Adult Foster Care services?

To qualify for AFC in Massachusetts, individuals must:

• Be 16 years of age or older
• Be eligible for MassHealth (Standard or CommonHealth)
• Require assistance with Activities of Daily Living (ADLs), such as bathing, dressing, eating, toileting, or mobility
• Live with a qualified caregiver

Eligibility is determined through a clinical assessment and MassHealth guidelines.

Who can become an Adult Foster Care (AFC) caregiver?

An AFC caregiver must:

• Be at least 18 years old
• Live in the same home as the member
• Be able to provide daily supervision and assistance with personal care needs

Family members (except spouses or legal guardians in most cases) and non-relatives may qualify.

Can a family member become a paid AFC caregiver?

Yes. In many cases, a family member (excluding a spouse or legal guardian) may become a paid caregiver if they meet program requirements and complete the approval process.

Can a spouse or legal guardian become an AFC caregiver?

No. A legal spouse cannot serve as a paid AFC caregiver.

In most cases, a legal guardian also cannot serve as the paid caregiver, unless otherwise approved under specific program guidelines.

How are caregivers screened and approved?

Caregivers must meet state requirements, which typically include:

• Criminal background checks (CORI)
• Reference Verification
• Health screenings (including TB/PPD testing)
• Home safety inspection
• Completion of required caregiver training

What responsibilities does an AFC caregiver have?

An AFC caregiver is responsible for:

• Assisting with Activities of Daily Living (ADLs)and Instrumental Activities of Daily Living(IADLs)
• Providing supervision as needed
• Supporting medication management (as approved by the member’s medical provider )
• Following the member’s individualized care plan
• Ensuring the member’s safety and well-being

How many members can one caregiver care for?

Typically, a caregiver may care for up to three AFC members at one time, depending on home capacity and program approval.

Do caregivers receive payment?

Yes. Approved caregivers receive a stipend through the AFC provider agency. Payment is not made directly by MassHealth to the caregiver.

What services are included in Adult Foster Care?

AFC services typically include:

• Assistance with Activities of Daily Living (ADLs)
• 24-hour supervision by a live-in caregiver
• Bi-monthly Case Management and Registered Nurse visits
• Development and monitoring of an individualized care plan
• Medication management support
• Coordination with physicians and healthcare providers

How often are visits conducted?

AFC programs provide ongoing monitoring, which generally includes:

• Bi-monthly Case Management visits
• Bi-monthly Registered Nurse visits
• Regular reassessments and care plan updates

What is the difference between AFC Level I and Level II?

A Registered Nurse conducts a comprehensive assessment to determine the appropriate level of care.

• Level I: For individuals who require supervision or cueing with Activities of Daily Living.
• Level II: For individuals who require hands-on physical assistance with at least three (3+) Activities of Daily Living.

How does Adult Foster Care differ from a nursing home?

A Registered Nurse conducts a comprehensive assessment to determine the appropriate level of care.

Adult Foster Care	Nursing Home
Care provided in a private home	Care provided in a facility
Small, family-like environment	Institutional setting
Limited number of residents	Larger resident population
Personalized care	Shared staffing model

Is the AFC home inspected?

Yes. The home must pass a safety inspection to ensure:

• Safe and adequate living conditions
• Proper sleeping arrangements
• Working smoke and carbon monoxide detectors
• Working fire extinguisher (expiration date must be current)
• Safe medication storage
• A clean and hazard-free environment

What rights do participants have?

Participants have the right to:

• Dignity and respect
• Privacy and confidentiality
• Freedom from abuse, neglect, and exploitation
• Participate in care planning
• File grievances without retaliation

What happens if care needs change?

If an individual’s medical or functional needs change, the care plan is reassessed and updated. If a higher level of care is required, referrals and transition support may be provided.

Is transportation provided?

AFC does not directly provide transportation services. However, caregivers can assist with transportation to appointments, and members may qualify for MassHealth transportation services (PT-1).

Is Adult Foster Care covered by insurance?

Yes. AFC services are covered by MassHealth (Massachusetts Medicaid) for eligible individuals. There is generally no out-of-pocket cost for qualified members.

What MassHealth plans cover the AFC program?

The following MassHealth plans typically cover AFC services:

• MassHealth Standard
• MassHealth CommonHealth
• SCO (Senior Care Options) and OneCare
• PACE (Program of All-Inclusive Care for the Elderly)

What MassHealth plans do not typically cover AFC?

Some limited benefit plans do not automatically include AFC:

• MassHealth Limited
• MassHealth Family Assistance
• MassHealth Family Assistance

How do I get started?

To begin the process:

1. Contact us.
2. Complete an initial eligibility screening.
3. Schedule nursing and home assessments.
4. Complete caregiver approval requirements.
5. Begin services upon final approval.