By Marc Gilman
For additional information, please call: (800) 927-9326 or email:
Key Takeaways:
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Adult Foster Care (AFC) is a MassHealth (Medicaid) program — not a Medicare benefit — that pays an eligible family caregiver a tax-free monthly stipend to provide daily care at home.
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The care recipient must be a MassHealth Standard or CommonHealth member, age 16+, and need hands-on help or supervision with at least one Activity of Daily Living (ADL).
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Caregiver and care recipient must live together in the same private home.
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Stipends are tax-free and depend on level of care: roughly $1,000/month at Level I, up to $1,500–$1,800/month at Level II — potentially over $18,000 a year.
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A legal spouse cannot serve as the paid AFC caregiver, but adult children, siblings, grandchildren, and other relatives or close friends generally can.
Many families caring for an aging parent or relative at home don’t realize there’s a program that can compensate them for it. It’s easy to assume Medicare must cover something this common — it doesn’t. The program that actually pays family caregivers in Massachusetts runs through MassHealth, the state’s Medicaid program, and it’s called Adult Foster Care (AFC).
What Is Adult Foster Care?
Adult Foster Care — sometimes called Adult Family Care — is a MassHealth benefit that allows someone who needs help with daily activities to remain in a private home, cared for by a live-in caregiver, instead of moving into a nursing facility. That caregiver can often be a family member or close friend who’s already providing the care, now getting compensated for it.
AFC is a Regular State Plan Medicaid benefit, which means it’s an entitlement — if you meet the eligibility requirements, the state doesn’t cap enrollment or maintain a waitlist the way it does for some other Medicaid waiver programs.
Who Qualifies for AFC?
Two sets of requirements have to be met — one for the person receiving care, one for the caregiver.
The care recipient must:
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Be enrolled in MassHealth Standard or CommonHealth
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Be at least 16 years old and a Massachusetts resident
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Need hands-on assistance or continuing supervision and prompting with at least one Activity of Daily Living (ADL) — bathing, dressing, toileting, eating, mobility, or transferring
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Not require around-the-clock skilled nursing care (AFC is not a nursing-level-of-care program)
The caregiver must:
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Be at least 18 years old
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Live in the same private home as the care recipient
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Not be the care recipient’s spouse or legal guardian
Adult children, siblings, grandchildren, nieces, nephews, and close friends can all qualify as the paid caregiver — it’s really only a spouse or legal guardian who’s excluded.
How Much Does AFC Pay?
Payments are structured as a tax-free monthly stipend, not an hourly wage, and they’re set based on how much hands-on care the recipient needs:
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Level I — supervision/cueing with at least one ADL: ~$1,000/month
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Level II — hands-on assistance with two or more ADLs: ~$1,500–$1,800/month
At the higher end, Level II compensation can add up to more than $18,000 over a year — money that goes directly to the family caregiver, tax-free, rather than to a facility. MassHealth doesn’t cover room and board under AFC; if the care recipient is living in the caregiver’s home, that arrangement is worked out separately between the two parties.
How Is AFC Different From Group Adult Foster Care?
Standard AFC requires the care recipient to live in a private home — either their own or the caregiver’s. If your loved one lives in an assisted living residence instead, they may qualify for Group Adult Foster Care (GAFC), a related MassHealth program designed for that congregate-living setting. AFC participants cannot reside in a rest home, assisted living residence, or group home.
How Does the Process Work?
AFC isn’t administered directly by MassHealth caseworkers — caregivers and care recipients work through a MassHealth-contracted AFC provider agency. In general, the process looks like:
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Confirm the care recipient has (or can enroll in) MassHealth Standard or CommonHealth.
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Contact an AFC provider agency, who will assess the care recipient’s needs and determine the applicable level of care.
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The caregiver is screened, and the home is reviewed for basic safety requirements.
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Once approved, the caregiver begins receiving the tax-free monthly stipend, along with ongoing nursing oversight and care management from the provider agency.
Approval can take several weeks, so it’s worth starting the process as soon as it looks like this could be the right fit.
Does Medicare Cover Any of This?
No. This is the most common point of confusion, and it’s worth being direct about: Medicare does not pay family members to provide personal or custodial care at home, and it does not fund Adult Foster Care. AFC is entirely a MassHealth (Medicaid) benefit, which is why MassHealth enrollment — not Medicare enrollment — is the qualifying factor for the care recipient.
What If My Loved One Isn’t on MassHealth Yet?
If your family member needs this kind of help but isn’t currently enrolled in MassHealth, that’s usually the first step before AFC becomes an option. Eligibility depends on income and asset limits that are separate from Medicare eligibility, so it’s worth reviewing where things stand before assuming the door is closed.
If you’re caring for a loved one at home and want help sorting out whether MassHealth and Adult Foster Care could apply to your situation, reach out to me — I am happy to walk through it with you.
