Adult Foster Care (AFC)
MassHealth regulation is specific when addressing member eligibility. MCS Adult Foster Care has incorporated these regulations into its policy.
To be eligible for MCS Adult Foster Care an individual must:
- Be 16 years of age or older.
- Be unable to live alone due to a medical, physical, cognitive, or mental condition.
- Need daily assistance with one or more activities of daily living (ADL), such as bathing, dressing, eating, toileting, or ambulation/transferring.
- Be willing to live with a caregiver.
- Be eligible for MassHealth or able to pay privately.
- Be referred to AFC by their primary care physician and/or Aging Service Access Point.
- Be willing to live with a caregiver, who cannot be your spouse or anyone legally responsible for you.
- And, does not require continuous skilled nursing
Caregiver Details
AFC Members will live in a qualified setting with trained, paid independent contractors/ Caregivers. Caregivers will receive a tax-free stipend to provide daily support with personal care needs in a family setting rather than a nursing home or other residential facility. Caregivers provide meals, companionship, personal care assistance and 24-hour supervision. Caregivers may be individuals, couples or families.
Caregivers submit invoices bi-monthly for care payment.
- Level I Caregivers receive $27/day
- Level II Caregivers receive $51/day
AFC payments rates are determined by MassHealth 101 CMR 351.00: ADULT FOSTER
Caregivers are entitled to a Room & Board payment which is equal to 75% of the Members’ social security benefits and will be delivered by the 10th of each month from the Members’ representative payee.
For non-family placements and when personally requested, a room and board agreement is developed to ensure financial aid is provided as needed.
- A private bedroom meeting the standards of MassHealth regulations, including; a bed, lamp, bedding (seasonally appropriate), sheets, towels.
- Hygiene and sanitary products.
- Food (including healthy snacks and school lunches)
- Money for any temporary caregiving arrangements outside of approved alternative caregiving in a MCS AFC qualified setting.
MCS AFC conducts on-site visits with each member at the qualified setting based on the Level of Service as defined in MassHealth regulation.
As of August 2025:
For both AFC level I and level II services, the RN or LPN must conduct on-site visits every other month, or more often if necessary. These visits alternate with the required visits by the care manager to ensure that the member receives one visit from either the nurse or the care manager every month, as determined by the multidisciplinary team (MDT). A community support specialist may conduct up to three nonconsecutive on-site visits per 12-month period, per calendar year.
Additional Bulletin updates can be found at https://www.mass.gov/masshealth-provider-bulletins
MassHealth Payments
- The effective date of the prior authorization from the MassHealth agency; or
- The first date on which AFC is provided to the member.
- The person receiving AFC is eligible;
- The member meets the clinical eligibility criteria for AFC;
- The AFC provider has obtained prior authorization for AFC;
- The Member resides in an AFC-qualified setting;
- The AFC provider bills at the payment level authorized by the MassHealth agency or its designee; and
- The AFC provider is not billing for days that are non-covered days.
Level 1 Service Payment. The MassHealth agency will pay the level I service payment rate if a member requires hands-on (physical) assistance with one or two of the ADL’s listed below or requires cueing and supervision throughout the task in order for the member to complete the activity.
Level II Service Payment. The MassHealth agency will pay the level II service payment rate for members who require hands-on (physical) assistance with at least three of the ADL’s described below or hands-on (physical) assistance with at least two of the activities and management of behaviors that require frequent caregiver intervention.
Masshealth requires that the member has a medical or mental condition that requires daily hands-on (physical) assistance or cueing and supervision throughout the entire activity in order for the member to successfully complete at least one of the following activities:
- Bathing – a full-body bath or shower or a sponge (partial) bath that may include washing and drying of face, chest, axillae (underarms), arms, hands, abdomen, back, and peri-area plus personal hygiene that may include the following: combing or brushing of hair, oral care (including denture care and brushing of teeth), shaving, and, when applicable, applying make-up;
- Dressing – upper and lower body, including street clothes and undergarments, but not solely help with shoes, socks, buttons, snaps, or zippers;
- Toileting – member is incontinent (bladder or bowel) or requires assistance or routine catheter or colostomy care;
- Transferring – member must be assisted or lifted to another position;
- Mobility (ambulation) – member must be physically steadied, assisted, or guided during ambulation, or is unable to self-propel a wheelchair appropriately without the assistance of another person; and
- Eating – if the member requires constant supervision and queuing during the entire meal, or physical assistance with a portion or all of the meal.
- Management of Behaviors that include but are not limited to,
- wandering: moving with no rational purpose, seemingly oblivious to needs or safety;
- verbally abusive behavioral symptoms: threatening, screaming, or cursing at others;
- physically abusive behavioral symptoms: hitting, shoving, or scratching;
- socially inappropriate or disruptive behavioral symptoms: disruptive sounds, noisiness, screaming, self-abusive acts, disrobing in public, smearing or throwing food or feces, rummaging, repetitive behavior, or causing general disruption; or
- Resisting care.