MassHealth Adult Foster Care (AFC)

MassHealth Adult Foster Care (AFC) pays a live-in caregiver to provide daily care to a MassHealth member in a private home. Caregivers can be adult children or other relatives, but not a spouse. It sits alongside our Massachusetts Long-Term Care Medicaid guide, which covers the nursing home rules.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

Adult Foster Care in brief

Put simply, responsibility for Adult Foster Care sits with MassHealth, through AFC provider agencies. Its target group is 16 and older; on care need, the rule is: Needs daily help with at least one activity of daily living. Waiting list status in 2026: No. Each of these points is covered in more depth below, alongside the general Massachusetts rules from our state guide. Other Massachusetts programs, and general guides on care at home, are linked at the end of this page for comparison with Adult Foster Care.

What the program is

Despite its name, Adult Foster Care does not mean moving in with strangers. Most AFC caregivers are relatives or friends who already live with the member. An AFC provider agency assesses the member’s needs, approves the home and the caregiver, and pays the caregiver a tax-free stipend based on the member’s level of need. A registered nurse and a care manager from the agency visit regularly, help with care planning and provide caregiver training. AFC is a MassHealth state plan service, so it is not limited to a fixed number of slots.

Programs like Adult Foster Care pay a family member or other caregiver who lives with the person and provides care full time. An agency supports the caregiver with coaching and regular check-ins. It is designed for people who would otherwise need a nursing home. See Structured family caregiving.

Who qualifies in 2026

Eligibility for Adult Foster Care comes down to these points. The person:

• Has MassHealth Standard
• Needs daily hands-on help or cueing with at least one activity of daily living
• Lives with a qualified caregiver

Income and assets. The person must have MassHealth Standard. Our state guide covers the rules. Figures shown above are the 2026 Massachusetts long-term care limits from our state guide. The home (up to the equity limit, when the person or a spouse lives there or plans to return), one vehicle, belongings and a small burial fund are generally not counted by MassHealth. When one spouse applies for Adult Foster Care and the other stays at home, the spouse at home keeps a protected share of the couple’s assets and may receive part of the applicant’s income. See Spousal impoverishment rules.

What the care test means in practice. For Adult Foster Care, an assessor checks how much help the person needs with bathing, dressing, eating, toileting, mobility and medications, and whether memory loss calls for supervision. The visit is normally face to face, at home or in a hospital or facility. Have a relative present to describe the hard days, and keep a medication and diagnosis list handy. See Nursing home level of care and Activities of daily living.

What services it can pay for

What a participant receives under Adult Foster Care follows the care plan. Possible services include:

• Daily personal care by a live-in caregiver
• Nurse oversight
• Care management
• Caregiver training

The menu is broad, but the plan is built from need, and unpaid family help is factored in. When needs grow, request an updated assessment.

How to apply

There are two tracks, a financial one and a care one, and both must say yes. The usual path for Adult Foster Care is:

1. Contact an AFC provider agency.
2. A nurse assesses needs.
3. The agency approves the caregiver.

For the paperwork, use our documents checklist before applying for Adult Foster Care; Applying for a waiver explains the general process.

Waiting lists

AFC is a MassHealth state plan service with no waiting list. Delays usually come from the agency’s home visit, caregiver approval and the MassHealth application.

See Waiver waiting lists for general tips.

How it relates to nursing home Medicaid

AFC is one of the most important ways MassHealth supports family caregivers. It lets a parent with significant needs stay at home with an adult child instead of moving to a nursing home. MassHealth financial rules apply, as described in our state guide, and AFC can sometimes be combined with other services. AFC and the PCA Program generally cannot both pay for the same help.

Where the nursing home rules still apply. Most money rules carry over from nursing home Medicaid. The five-year look-back for gifts generally applies, so a gift or transfer for less than fair value can cause a period when Medicaid will not pay for long-term care services. After death, estate recovery can reach services paid from age 55 on. Some participants pay a monthly share of income toward services.

Personal needs allowance. If the person does move to a nursing home, Massachusetts’s 2026 personal needs allowance is $72.80 a month. Most of the rest of their income goes toward the cost of care. The state guide explains the nursing home side.

Tips for families

• Start early. If there is a waiting list or a slow assessment, the clock usually starts when you ask, not when the crisis comes.
• Document everything, from forms and letters to who you spoke with at MassHealth and when.
• Watch the deadlines on notices. A denial or cut can be appealed through a fair hearing, and a timely request can keep services going meanwhile.
• Report changes in income, assets, address or living situation to MassHealth when they happen.
• Plan for renewals. Medicaid and the care assessment are both renewed, usually once a year. See Renewals.
• Think about the spouse at home. Couples have extra protections, but they have to be claimed. A certified Medicaid planner or a legal aid office can explain how the rules apply to a particular family.

Common questions

Can a spouse be paid as an AFC caregiver? No. Spouses and legal guardians cannot be paid AFC caregivers, but adult children and other relatives can.

Does the caregiver need special training? The AFC agency provides training and ongoing support from a nurse and care manager.

Is the stipend taxable? AFC payments to live-in caregivers are often excludable from income under federal tax rules for certain care payments. A tax professional can explain how this applies.

Do we have to live together? Yes. The caregiver must live with the member, in the member’s home or the caregiver’s.

Related pages

• Massachusetts Long-Term Care Medicaid guide
• Paid family caregivers
• Three kinds of Long-Term Care Medicaid
• PACE programs

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.