Page Reviewed / Updated - September 20, 2020
In the last few years, a new type of MassHealth (Medicaid) program has emerged in Massachusetts: Adult Foster Care. Instead of living in a nursing home or another institutional facility, elderly participants, including those with Alzheimer's disease or related dementias, move into a caregiver's home, or alternatively, have a caregiver move into their home. Sometimes, the caregivers have more than one elder in their home at the same time.
Most commonly, the caregivers are friends or family members of the care recipient. Although it is not a requirement that the caregiver and care recipient be acquainted. The state pays the caregivers for the 24-hour personal care that they provide. Typically, personal care assistance includes the Activities of Daily Living (ADLs), like bathing, toileting, grooming and other personal hygiene, as well as the Instrumental Activities of Daily Living (IADLs), such as meal preparation, housekeeping, and laundry.
The Adult Foster Care program does not pay for the individual's room and board. Care recipients are expected to pay an approximate $420 - $580 per month to their caregivers for those costs. However, often when family members are providing the care, they cover those costs themselves.
Eligible family members that can be paid as caregivers include siblings, adult children, and other relatives. But they cannot be the care recipient's spouse, a parent of a minor, or the legal guardian. It is unclear whether ex-spouses can be paid as caregivers.
The Adult Foster Care program is operated by the Massachusetts Executive Office of Health and Human Services and is part of the state’s MassHealth program.
To qualify for the Adult Foster Care program, Massachusetts’ residents must be elderly or disabled (and age 16 or over). Applicants must also require assistance with at least one of their activities of daily living on a day-to-day basis, as well as have a doctor’s prescription indicating that this is the case. However, of course, the residents must not require a significant level of care that would be only available in a nursing home. In addition to the medical requirements, program participants must be financially eligible for MassHealth (Massachusetts' Medicaid program).
For 2020, the income limits are $1,063 per month for an individual or $1,437 per month for a couple, in which both spouses are applying for services. (These limits are based on 100% of the Federal Poverty Level, which changes on an annual basis). While these are limits, families should not be overly concerned if the candidate's income is over these limits. Massachusetts has a Medically Needy Medicaid program in which individuals whose medical expenses are extraordinarily high can qualify even though their income is greater than the limits. (This program works similarly to an insurance deductible). MassHealth financial planning advisers can help re-organize a candidate's income so that they become compliant.
MassHealth also considers the applicant's financial resources. Depending on the situation, the resource limit differs. A single applicant is limited to $2,000, and a married couple with both spouses applying may not have assets greater than $3,000. In the case of a married couple where only one spouse is an applicant, the non-applicant spouse is able to retain up to $128,640 in assets. This is in addition to the $2,000 in assets the applicant spouse is allowed. However, many assets are considered exempt or can be considered exempt if they are allocated appropriately. Examples include one’s home, given the applicant or his or her spouse lives in it and the equity value is at or below $893,000, household items, personal effects, and burial trusts.
Persons unsure of their financial eligibility should consult with a MassHealth planning expert. Any planning must be done before applying. Read more.
Care recipients receive companionship, non-medical and medical transportation, housecleaning, medication reminders, and 24-hour personal care services from their caregivers, including assistance with bathing, dressing, meals, and transitioning, such as help getting out of bed, among other activities. Eligible applicants continue to receive nursing care in their place of residence or in the home of the caregiver from trained medical professionals.
As of May 2019, caregivers receive payment from MassHealth of between $9,000 and $18,790 / year. (Payment is determined based on one’s level of care needs). They also receive as many as 14 respite care days per year. Some caregivers also receive an additional $420 - $580 / month for room and board. (These are approximate figures). However, the room and board payment comes from the care recipients directly and is not paid for by MassHealth.
If a family chooses to work with an intermediary agency that helps manage the process, provide training, backup caregivers, and assist with paperwork, they should expect the agency to take between 20 - 40 percent of the total compensation. For some family caregivers focused on the needs of their loved one, an intermediary can make the difference between managing the program requirements and being able to receive the payments.
The Caregiver Homes / Adult Foster Care Program is available in all counties in the state. Interested individuals can learn more about the program and apply by calling the Mass AgeLine at 1-800-243-4636 or contacting their local Aging Services Access Point. While sometimes there are long waiting times on the Mass AgeLine, one can leave a voicemail and have their call returned by a staff member.
A detailed PDF about the program is available for download from this link.