Adult Foster Care in Massachusetts: 10 Myths and Facts
Families often hear conflicting information about Adult Foster Care in Massachusetts. Some assume it is connected to foster care for children, requires a professional caregiver, or provides automatic payment whenever someone helps a relative. The facts are more specific.
Adult Foster Care is a MassHealth-funded service with rules concerning the member’s coverage, age, care needs, living arrangement, caregiver relationship, assessments, and authorization. Here are 10 common myths and the facts families should know.
Myth 1: Adult Foster Care Is the Same as Foster Care for Children
Fact: They are different programs. Adult Foster Care in Massachusetts is a MassHealth service for eligible members who need daily personal-care assistance and live with a qualified caregiver. Foster care for children is administered through the child-welfare system and provides temporary homes when children cannot safely remain with their parents or guardians.
Myth 2: Adult Foster Care Is Only for Older Adults
Fact: An eligible member may be age 16 or older. Younger adults and some teenagers may qualify when they meet the coverage, clinical, living-arrangement, and other program requirements.
The caregiver must generally be age 18 or older. A parent cannot be paid through the program to care for a child under age 18. A parent may be considered as the caregiver for an adult child age 18 or older when all other requirements are met.
Myth 3: The Caregiver Must Be a Nurse or Medical Professional
Fact: The live-in caregiver does not ordinarily need to be a nurse or other licensed medical professional. The caregiver must meet the program’s qualifications, complete required screening and training, and be able to provide the approved daily personal care safely.
The Adult Foster Care provider supplies nursing oversight and care management. The service is not continuous skilled nursing, and the caregiver should not perform clinical tasks outside their training or lawful role.
Myth 4: Any Family Member Can Be the Paid Caregiver
Fact: A qualified relative, friend, or other individual may potentially serve as the caregiver, but important relationship restrictions apply. A spouse or court-appointed legal guardian cannot be the paid caregiver. A parent cannot be paid through the program to care for a child under age 18.
The proposed caregiver must also live with the member in the same qualified home and satisfy the applicable age, screening, training, and other requirements.
Myth 5: The Member Must Be Completely Dependent
Fact: A person does not necessarily have to be completely unable to perform personal care. The clinical requirement generally involves needing daily physical assistance or cueing and supervision with at least one qualifying activity of daily living.
Activities may include bathing, dressing, eating, toileting, walking, or transferring. The nurse evaluates what help is needed, how often it is required, and why the person cannot safely complete the activity without that assistance. Read our guide to Activities of Daily Living for Adult Foster Care.
Myth 6: A Diagnosis Automatically Means Someone Qualifies
Fact: A diagnosis of dementia, stroke, arthritis, multiple sclerosis, cerebral palsy, brain injury, or another condition does not automatically establish eligibility. The assessment focuses on the functional assistance required each day because of the person’s medical, cognitive, or behavioral impairment.
Two people with the same diagnosis may have very different personal-care needs. Eligibility also depends on coverage, age, living arrangement, caregiver relationship, and other program rules.
Myth 7: The Member and Caregiver Must Already Live Together Before Applying
Fact: They do not necessarily need to live together when the family first asks about the program. They must live together in the same qualified home before services begin. The member may move into the caregiver’s home, the caregiver may move into the member’s home, or they may already share a home.
The proposed setting must satisfy the applicable home and program requirements. Families should discuss a planned move with the provider before making decisions based on expected eligibility or payment.
Myth 8: Having Any MassHealth Plan Is Enough
Fact: The member generally needs an eligible MassHealth coverage type, such as MassHealth Standard or CommonHealth, subject to verification. Simply having a MassHealth card does not by itself confirm eligibility for this particular service.
Questions about income and financial eligibility are handled through the MassHealth eligibility process. The Adult Foster Care provider verifies the member’s coverage and determines what additional program review is required.
Myth 9: Adult Foster Care Can Be Added to PCA or Any Other Home-Care Program
Fact: Some services are considered duplicative and ordinarily cannot be received at the same time as Adult Foster Care. The PCA program, another Adult Foster Care program, GAFC, PACE and certain other home-care services may create a duplication issue.
Do not stop an existing service solely because you plan to apply. Ask the provider and the appropriate MassHealth or managed care representative how the programs interact and what steps would be required if a change is approved.
Myth 10: Caregiver Payment Is Automatic and Always Tax-Free
Fact: Payment is not automatic. An eligible caregiver may receive up to $1,520 per month, based on need and MassHealth approval. The actual amount is determined through the assessment and authorization process, and payments begin only after the required approval and placement steps are complete.
Tax treatment can depend on the facts and applicable law. Families should not rely on a blanket statement that every payment is tax-free and may wish to consult a qualified tax professional. Learn more about getting paid to care for a parent in Massachusetts.
What Does the Application Process Include?
The application involves more than three simple forms. Depending on the situation, the process generally includes:
- An initial intake review
- MassHealth coverage verification
- Member and caregiver forms and documentation
- Clinical, psychosocial, and home-setting assessments
- A current physical examination and primary care provider order
- Caregiver qualification and screening requirements
- Submission for authorization
- Placement, signatures, training, and onboarding after approval
Mass Care Link helps families understand each step and identify missing information, but no provider can guarantee eligibility, payment, or an approval date. Read what happens after applying for Adult Foster Care.
Basic Eligibility Facts
A potential member generally must:
- Be a Massachusetts resident age 16 or older
- Have eligible MassHealth coverage, subject to verification
- Need daily physical assistance or cueing and supervision with at least one qualifying activity of daily living
- Live in the same qualified home as an eligible caregiver
- Meet all other applicable program requirements
Review our detailed guide on how to qualify for Adult Foster Care in Massachusetts.
Find Out Whether Your Family May Qualify
If you provide daily personal-care assistance to a family member or friend, complete the Mass Care Link prequalification form. Our intake team can review the person’s MassHealth coverage, living arrangement, caregiver relationship, and care needs and explain the next steps.
You may also call 866-880-8889. Eligibility and caregiver payment require assessment and MassHealth approval.
Official Sources
This article provides general educational information. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.