Adult Foster Care and Group Adult Foster Care
Both programs are MassHealth services for people who need daily help with at least one personal-care task. In Adult Foster Care, a live-in caregiver (who can be a relative but not a spouse) receives a payment through an AFC agency. Group Adult Foster Care provides aide help, nurse oversight and case management to members 22 and older, often in assisted living or supportive housing.
The numbers
| Coverage required | MassHealth Standard or CommonHealth (also SCO, One Care, PACE members for AFC) |
| Minimum age — AFC | 16 |
| Minimum age — GAFC | 22 |
| Help needed | daily hands-on help, or cueing and supervision, with at least 1 activity of daily living |
| AFC payment levels | Level I (1–2 activities) and Level II (3+, or 2 plus behaviour needs) |
Who qualifies
Your primary care provider must order the service, and you must need daily help — hands-on or cueing and supervision throughout — with at least one of: bathing, dressing, toileting, transferring, walking or eating.
Adult Foster Care (AFC)
A caregiver lives with you, either in your home or theirs, and is paid a daily stipend through an AFC agency, which also provides a nurse and care manager. The caregiver can be a family member, such as an adult child, but not a spouse, the parent of a minor, a legally responsible relative or a legal guardian. The name is still Adult Foster Care in MassHealth's regulations.
Group Adult Foster Care (GAFC)
A GAFC provider sends direct care aides for daily help, with a registered nurse and case manager overseeing care. Many GAFC providers are assisted living residences. GAFC pays for care, not rent or meals.
How to start
Ask your doctor for an order, then contact an AFC or GAFC agency, or ask Elder Services or MassOptions which agencies serve your town.
Mistakes families make
- Assuming a spouse can be the paid AFC caregiver; they cannot.
- Expecting GAFC to cover assisted living rent; it pays only for the care services.
- Not getting the doctor's order first; both programs require it.
Who to call on Cape Cod
| Who | Number | For |
|---|---|---|
| MassOptions | (800) 243-4636 | Statewide line that connects you to elder and disability services |
| Elder Services of Cape Cod & the Islands | 1-800-244-4630 (508-394-4630) | Free home assessment, home care, Frail Elder Waiver, nursing-home screening; South Dennis |
| MassHealth Customer Service | (800) 841-2900 (TTY 711) | Applications, forms, questions about your case |
What we could not confirm: MassHealth does not publish a town-by-town list of AFC or GAFC providers, so none is listed here. The program is still named Adult Foster Care; there has been no official renaming. Daily stipend amounts were not verified and are not included.
Next: All the ways to pay for care · Two-minute benefits check · What care costs on the Cape · Elder law attorneys
This page explains the rules; it is not legal advice. For your own situation, talk to an elder law attorney or SHINE.