Page Reviewed / Updated - Apr. 2018
One can say, on the whole, that Medicaid pays for adult foster care. However, that is a simplistic and incomplete answer. Medicaid is not a single program, but a collection of many different programs and these programs’ rules and benefits change in every state. That said, in the majority of states, adult foster care is an option covered by Medicaid. What exactly defines adult foster care? That as well, differs in each state. In fact, even the term adult foster care is not used consistently across the fifty states. Our brief definition of adult foster care is care provided to persons of adult age in a home-like environment. A more robust definition is available here.
Each state has multiple types of Medicaid programs. Some states may cover adult foster care as a benefit in more than one of their programs. Before reviewing your specific state’s options, it is helpful to understand the different types of Medicaid programs that might pay for adult foster care and the benefits and limitations of each type.
Regular Medicaid – often called Medicaid State Plan, is an entitlement program. Should one meet the eligibility requirements, then the state must provide them with services. Regular / State Plan Medicaid typically covers adult foster care through a Personal Care benefit. This benefit covers the cost of a personal care attendant and does not limit the locations where that attendant can provide services. Therefore, a beneficiary can reside in their own home, in an adult foster care home, or in the home of a friend or family member. Regular Medicaid’s eligibility requirements are dependent on the demographics of the participant. Usually, adults aged 18-64 are subject to one set of eligibility criteria and those over 65 years of age to a different set of eligibility criteria.
HCBS / 1915 Waivers – Home and Community Based Services (HCBS) and 1915 Waivers are programs that states are authorized to offer residents in place of nursing home care. Services are provided at home or in the community. “In the community” can include locations such as adult foster care homes. Most state Medicaid programs that cover adult foster care do so through a HCBS waiver. Waivers are not entitlement programs. They are approved by the national Center for Medicaid Services to provide services to a set number of participants. Consequently, demand often exceeds the supply of open slots and waiting lists are common.
Managed Medicaid Long Term Care – A recent trend among states is to outsource their Medicaid programs to managed care organizations. While the intent is to simplify, the transition process to managed care is anything but simple for most states (and most beneficiaries). Regardless if a Medicaid State Plan has adult foster care as a covered benefit, they will likely have mandated that all participating managed care organizations continue to offer that benefit. However, because multiple managed care organizations are involved, they each may put their own spin on how the service is provided.
Adult foster care is not a single Medicaid benefit in itself, but a collection of services provided to individuals living in adult foster care environments. These services differ in each state and with each program. What follows is not inclusive or exhaustive but is typical of what types of services are provided to persons living in adult foster care.
In no state does Medicaid pay for room and board in adult foster care. By law, Medicaid is prohibited from doing so. However, many states offer SSI / OSS benefits that increase should the beneficiary reside in adult foster care. There are also nuances, while Medicaid is not allowed to pay for food, the program is permitted to pay for the preparation and serving of food as well provide assistance with eating, should the beneficiary require it.
What follows may not be exhaustive for several reasons. 1) There are Medicaid programs which cover adult foster care which are not relevant to elderly persons. These programs are intended for developmentally disabled persons and are not included here. 2) Sometimes, a state will cover “assisted living,” but not provide an accessible definition of what defines assisted living and how that differs from adult foster care. For this reason, should the reader not find an eligible program below, it is strongly suggested that they also visit our Medicaid and Assisted Living page.
Medicaid Policies and Programs Funding Adult Foster Care (updated April 2018)
Alabama defines adult foster care as caring for a single resident. The phrase “family assisted living facility” is used for homes caring for two to three residents. Regardless, Alabama does not provide Medicaid assistance for individuals in any of these living situations.
Alaska draws the line between adult foster care and assisted living at two persons. Homes caring for one to two people are considered adult foster care and require no licensing, and those with three or more, are licensed as assisted living. However, an adult foster care home can elect to be licensed as an assisted living home with less than three residents. If they do so, they can receive Medicaid funding through the Alaskans Living Independently Waiver or the Adults with Physical & Developmental Disabilities Waiver. Phrased another way, Alaska Medicaid will pay for services in adult foster care if the home is willing to become a state licensed provider.
Homes with less than four care recipients are consider adult foster care homes in Arizona, while those serving more than four are assisted living facilities. Arizona Medicaid, through the managed care program called Arizona Long Term Care System (ALTCS), will pay for services in adult foster care homes.
In Arkansas, adult foster care is referred to as adult family homes and these are limited to provide care to three or less persons. The state’s regular Medicaid program under the Personal Care benefit can be used in different living environments such as at home or in adult family homes. To be clear, the benefit will pay for personal care in adult foster care but not the room and board portion of the cost. The state also has a Medicaid waiver for assisted living. The AR Choices in Homecare Waiver can also be used in adult foster care.
From a licensing perspective, California does not differentiate between adult foster care and assisted living. They are all considered Residential Care Facilities for the Elderly. Therefore, the Assisted Living Waiver can be used to pay for services in adult foster care homes. Note this waiver is not statewide.
Colorado licenses adult foster care homes as Alternative Care Facilities, which serve three or more adults. The Elderly, Blind and Disabled Waiver can be used to pay for services. However, at the time of writing, it was unclear whether this waiver could be used for homes serving two or less persons. Fortunately, the state offers a non-Medicaid program for this purpose.
Connecticut covers adult foster care in homes that serve one or two residents. This is called adult family living. CT does so under its Medicaid Home Care for Elders and Personal Care Assistance programs.
In Delaware, adult foster care homes are called Family Care Homes or Residential Care Homes, depending on the level of care they provide. These homes provide care for either two or three residents maximum. The state has switched to a managed Medicaid plan called Diamond State Health Plan Plus that covers personal care services in these homes. It is uncertain whether the program will cover care when there is only a single resident.
District of Columbia
A Community Residence Facility is the District’s phrase for adult foster care. No distinction is made regarding the number of residents. Therefore, the Elderly and Persons with Disabilities Waiver will cover services in adult foster care homes.
Adult foster care in Florida is provided in Adult Family Care Homes (AFCH). These serve between one and five persons and are covered benefits under the Statewide Managed Medicaid Care - Long Term Care program.
Georgia considers adult foster care homes to have two or more residents. The state offers two Medicaid programs relevant to the elderly which cover services in (using the state’s phrase) Community Living Homes. These are the CCSP and SOURCE programs. It could not be determined whether these programs will cover care in adult foster care with a single resident.
Adult Foster Care in the Islands is referred to as Community Care Foster Family Homes (CCFFHs). These can serve up to three residents. The state’s managed Medicaid program, QUEST, will pay for services.
Idaho pays for personal care services through the state’s regular Medicaid Personal Care Services Program. Persons can receive up to 16 hours per week of assistance in their home or in the private home of another individual (an adult foster home). The Aged and Disabled Waiver will also cover care services in "certified family homes". Finally, for dual eligibles, there is the Medicare Medicaid Coordinated Plan.
Illinois does not differentiate between adult foster care and assisted living based on the number of residents. Therefore, the same program that can be used for assisted living can be used for adult foster care. Read about the HCBS Waiver for Supportive Living Facilities.
Adult foster care home in Iowa must have between three and five residents. This differs from the idea of single resident foster care, but if the care recipient is willing to reside in an “elder group home,” Iowa’s Elderly Waiver will cover personal care services and support services (but not room and board).
Kansas’ HCBS/ FE Waiver can be used to cover adult foster care costs. It can also be used for assisted living, which in Kansas is defined as a home serving six or more individuals.
Adult foster care in Kentucky is defined as a home providing care to between one and three persons unrelated to the homeowners. The state’s Medicaid program, under the Waiver for the Aged, allows for consumer direction, meaning participants can choose their caregivers and the location in which they receive care.
In Louisiana under the Community Choices Waiver, there is a benefit called Monitored In-Home Caregiving. MIHC is a benefit very similar to adult foster care and even allows certain family members to serve in the capacity of paid caregiver / host.
An Adult Family Care Home (AFCH) or a Private Non-Medical Institution (PNMI) are Maine terminology for adult foster care. Services provided in these homes are covered under two Medicaid programs: the CDAS Program and the Older Adults / Adults with Disabilities Waiver.
Adult foster care, also referred to as Certified Adult Residential Environment (CARE) home in Maryland, is a covered Medicaid benefit under the Community Options Waiver. For group, adult foster care with a minimum of four residents, there is also the Assisted Living Subsidy. Finally, the Community First Choice Program will also provide care to persons residing in adult foster care homes.
The state offers several Medicaid assistance options for persons desiring to reside in adult foster care, or Enhanced Adult Family Care, as they are also known in Massachusetts. The Medicaid state plan, Personal Care Attendant program helps, as does Group Adult Foster Care, for foster care with multiple residents.
Two programs in Michigan offer support for elderly residents living in adult foster care homes, or Homes for the Aged, as they are called locally. Neither will pay for room and board, but both cover personal care. These are the Choice Waiver Program and the Health Link Program.
Housing with Services is local Minnesota terminology for adult foster care which can provide assistance for up to four unrelated persons in the home. Programs relevant to aging state residents are the Elderly Waiver, the CADI Waiver, Personal Care Assistance and the new managed care programs MSC+ & MSHO.
Mississippi covers adult foster care under its Assisted Living Waiver. This Medicaid program does not distinguish based on the number of beds in the residence, so it can serve one or many persons under the same roof.
The state has a Consumer Directed Personal Care program under its Medicaid state plan. This allows participants to choose from whom they receive care. Beneficiaries can elect to receive care from an adult foster care home that will accept the Medicaid reimbursement rate.
The Home and Community Based Services Medicaid Waiver cover the cost of assisted living. However, the state does not define assisted living based on the number of residents. Therefore, “assisted living” residences with 1-2 residents can qualify provided they meet the state’s other requirements.
Adult Family Homes, as adult foster care is called in Nebraska, can provide assistance to no more than three persons. Low resident count assisted living, which can be considered the same as adult foster care, can be covered under the Nebraska Aged and Disabled Waiver. It is unclear whether this waiver can be used to pay for single resident foster care.
Nevada does not offer funding assistance for adult foster care, but does so for Residential Facilities for Groups, more commonly thought of as assisted living. The state does not define the number of beds the residence must have. Therefore, small group homes, similar to adult foster care can be covered. This benefit is called Augmented Personal Care.
In New Jersey, adult foster care with two or more residents are licensed as assisted living residences. Managed Long Term Services and Supports (MLTSS), the state managed Medicaid program covers assisted living. It is undetermined whether single resident adult foster care would be covered.
New Mexico does not license adult foster care homes separately from assisted living. The state’s managed Medicaid program, Centennial Care Community Benefit, includes assisted living, and therefore can be used for adult foster care as well.
“Family Type Homes for Adults” as adult foster care is called in New York is restricted to one to four residents. The state has Managed Long Term Care Medicaid, which includes a personal care benefit. The rules do not restrict the locations in which personal care can be provided. Therefore, residents of adult foster care homes can receive personal care assistance funded by Medicaid.
Adult Care Homes or Family Care are the local North Carolina terms for adult foster care. These serve between two and six residents. NC offers two Medicaid programs relevant to the elderly. These are CAP/ DA Medicaid Waiver and Adult Care Home Assistance.
North Dakota’s Home and Community Based Service Waiverincludes adult foster care as a benefit. Adult foster care residences are limited to providing services to one to four persons. Homes with greater than four are subject to different licensing. Residents may also find assistance under Personal Care Services of the Medicaid State Plan.
Adult foster care homes in Ohio are defined as having one to two residents. Those homes with three or more are called Residential Care Facilities (RCF). The Assisted Living Waiver Program provides for services in RCFs, but not foster care homes. Phrased differently, the Assisted Living Waiver will pay for care in foster care homes provided there are three or more residents. There is also Residential State Supplement, which provides financial assistance for needy persons in adult foster care. Finally, MyCare Plan should be investigated as the program allows for self-direction of care.
Oklahoma defines homes for two or more persons as assisted living or residential care homes. The ADvantage Program can used to pay for care services in these homes. Foster care with a single resident can receive financial help under the Medicaid State Plan Personal Care.
Adult foster care in Oregon limits residences to five occupants. Homes that care for a greater number are called Residential Care Facilities (RCF). The Aged & Physically Disabled Waiver covers personal care and support services in both types of locations. The newer K Plan does as well.
Adult foster care in PA is defined as a home-like setting that provides care for up to four persons. Unfortunately, the state’s Medicaid program does not provide assistance. However, there is a non-Medicaid program called the Domiciliary Care Program, which does provide financial help.
RI considers any home providing care for two or more adults to be an assisted living residence. What many people think as adult foster care, the state considers to be assisted living. The state’s Global Consumer Choice Compact Waiver covers assisted living including small group homes. Single resident adult foster care is also covered through a program called RIte @ Home.
Adult foster care with two or more residents in South Carolina are called Community Residential Care Facilities (CRCFs). The Community Choices Waiver pays for care services, not room and board, in these types of residences. Personal care services in single resident foster care is covered under the Medicaid State Plan.
Adult foster care homes with more than four residents are regulated as assisted living. The HCBS Waiver for the Elderly covers personal care in assisted living. Foster care for adults in homes with less than four residents is covered by a state-funded ASA Program.
In Tennessee, adult foster care homes can serve between one and five persons. TennCare CHOICES in Long-Term Care Program will provide personal care services to residents in these environments.
Adult Foster Care (AFC) in Texas limits occupants to three. Larger homes are subject to a different level of licensing. The STAR PLUS program covers personal care, but not room and board.
Utah covers adult foster care under the New Choices Waiver. Adult foster care is defined as care provided by the home owner for up to three residents in their home.
Adult Foster Care, or Adult Family Care, as it is called in Vermont, is covered under the new Global Commitment to Health Waiver. Adult family care is limited to homes serving one to two residents. However, persons in higher resident count homes can still receive assistance under this program, though it simply would not be called adult family care. Two additional programs which provide support are Assistive Community Care Services and Enhanced Residential Care, and pay for extra residential supports for Medicaid-eligible Residential Care Home residents.
Adult foster care is defined as Care Homes for three or fewer residents. While no Medicaid program was found to serve that type of residence, larger residences can receive Medicaid reimbursement through the soon to expire, Alzheimer's Assisted Living Waiver. As of writing it was uncertain whether the new Commonwealth Coordinated Care (CCC) Plus Medicaid Waiver will offer this benefit.
Boarding Homes, Washington parlance for adult foster care, serve between two and six adults. Two Medicaid programs in the state provide financial support for adult foster care. These are the COPES Program and Personal Care under the state’s regular Medicaid program.
There is conflicting information regarding whether WV Medicaid Personal Care can be provided to persons in adult foster care living situations. However, the state does offer a non-Medicaid program that might be used to pay for personal care services provided in an adult foster care residence. Interested parties should investigate the Ron Yost Program.
Adult foster care homes in Wyoming can serve between one and five adults. Wyoming offers the Assisted Living Facility Waiver, but it was unclear at the time of writing how the waiver defines assisted living, and whether or not it can be used to pay for care services in small group homes. No regulation could be found that defined assisted living by the number of residents, so it is suggested parties pursue this option.