MassHealth Adult Foster Care: Coverage and Eligibility
MassHealth Adult Foster Care helps eligible Massachusetts residents receive daily assistance in a qualified home setting. MassHealth funds the program, establishes eligibility and service requirements, and authorizes approved services. Families participate through an approved provider such as Mass Care Link.
Understanding the roles of MassHealth, the provider, the member, and the caregiver can make the application process easier and help families know what to expect.
What Is MassHealth?
MassHealth is the Massachusetts Medicaid and Children’s Health Insurance Program. It provides health coverage and access to certain long-term services and supports for eligible Massachusetts residents.
Having a MassHealth card does not automatically mean someone qualifies for every MassHealth service. Adult Foster Care has its own clinical, residential, caregiver, and coverage requirements. Eligibility and service authorization must be confirmed through the assessment process.
What Is MassHealth Adult Foster Care?
Adult Foster Care, sometimes called Adult Family Care, is a MassHealth-funded service for eligible people who need daily help with personal care and want to live in a qualified home rather than an institutional setting. A trained caregiver provides the day-to-day assistance, while an approved provider supplies professional oversight and support.
The service can support older adults and people with disabilities. Despite the word “adult,” a MassHealth member may be considered beginning at age 16 when all program requirements are met.
What MassHealth Coverage Is Generally Required?
The person receiving care generally needs an eligible MassHealth coverage type, such as MassHealth Standard or CommonHealth. Other coverage types may not include Adult Foster Care services. Mass Care Link can verify the member’s current coverage during intake.
Coverage rules and individual circumstances can change. Families should avoid canceling or changing insurance based only on general online information. MassHealth can provide an official determination about coverage.
Who May Qualify for Adult Foster Care?
Under Massachusetts program requirements, the person receiving care must generally:
- Be a Massachusetts resident and an eligible MassHealth member.
- Be at least 16 years old.
- Need daily physical assistance, or cueing and supervision, with at least one activity of daily living.
- Live with the caregiver in a qualified residential setting.
- Receive approval after the required assessments and documentation are completed.
Activities of daily living include bathing, dressing, eating, toileting, walking, and transferring. A diagnosis by itself does not establish eligibility. The assessment considers the assistance the person needs each day.
Who Can Be the Caregiver?
The caregiver must be at least 18 years old, live with the member, meet program requirements, and be able to provide the authorized care safely. A relative or trusted non-relative may qualify.
A spouse or court-appointed legal guardian cannot serve as the paid caregiver. A parent cannot be paid through this program to care for a child under age 18. Other restrictions may apply based on the relationship, setting, or services already being received.
What Does MassHealth Fund?
MassHealth pays the approved provider for covered Adult Foster Care services. The provider then supports the member and caregiver in accordance with program requirements. Services generally include:
- Daily personal care from the qualified caregiver
- Care management and nursing oversight
- Caregiver education and training
- Development and monitoring of the plan of care
- Regular home visits and ongoing communication
- Coordination with healthcare professionals and community resources
Adult Foster Care is not the same as hourly employment, visiting home health services, or the Personal Care Attendant program. Review our comparison of Massachusetts caregiver programs for important differences.
What Does Mass Care Link Do?
Mass Care Link helps families understand the requirements, complete intake documents, obtain necessary medical information, participate in clinical and home assessments, and prepare for MassHealth authorization. If services are approved, our nurses and care managers provide ongoing support.
Mass Care Link cannot guarantee eligibility or approval. Final authorization depends on MassHealth requirements, documentation, assessments, the qualified setting, and the member’s individual needs.
Can a Caregiver Receive a Monthly Payment?
An approved caregiver may receive up to $1,520 per month, based on the member’s needs and MassHealth approval. The actual amount is determined through assessment and authorization. Learn more in our guide to getting paid to care for a family member in Massachusetts.
Frequently Asked Questions
Does every MassHealth plan cover Adult Foster Care?
No. The member needs an eligible coverage type and must meet all other program requirements. Mass Care Link can check coverage during intake.
Can someone qualify based only on a medical diagnosis?
No. The person must also meet the program’s functional, residential, coverage, and other requirements. Assessors review the daily assistance the person needs.
Do the caregiver and member have to live together?
Yes. They must live together in the same qualified home setting before services begin.
Can Adult Foster Care be combined with every other home-care program?
No. MassHealth restricts certain duplicative services. The provider should review current services before enrollment.
How do we start?
Review how to qualify and then submit an application. Mass Care Link will help verify coverage and explain the next steps.
This article provides general educational information. MassHealth makes coverage and authorization determinations based on current rules and individual circumstances.
Official Sources
This article provides general educational information. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.