Massachusetts Adult Foster Care for People with Disabilities

Adult foster care in Massachusetts places an adult with a disability in the home of a trained caregiver who provides daily supervision, meals, and personal care. For families who want a home-like alternative to a group home or institutional setting, AFC is one of the most underused residential options in the state's disability services system.

What Adult Foster Care Actually Looks Like

An AFC arrangement pairs one adult (sometimes two) with a caregiver who lives with them full-time. The caregiver manages medication administration, meal preparation, transportation to medical appointments, and day-to-day support with activities of daily living. The caregiver's home becomes the individual's primary residence, and AFC agencies provide oversight through regular visits and care plan reviews.

Massachusetts AFC operates under MassHealth's Office of Long-Term Services and Supports (OLTSS). Unlike group homes run through the Department of Developmental Services, AFC arrangements are coordinated by licensed AFC agencies that recruit, train, and supervise caregivers. The individual retains their own MassHealth coverage, and the AFC agency bills MassHealth directly for the care coordination and caregiver payments.

Eligibility Requirements

To qualify for MassHealth-funded adult foster care, an individual must meet three conditions:

• MassHealth enrollment: The individual must be enrolled in MassHealth Standard or another qualifying MassHealth coverage type. Adults with intellectual or developmental disabilities who transitioned from SSI-based Medicaid or who qualified through the MassHealth Adult Disability Supplement generally meet this requirement.
• Clinical need: A physician must certify that the individual has a medical or mental condition requiring physical assistance or cueing/supervision with at least one activity of daily living.
• Community-based setting: AFC is specifically designed for individuals who do not require 24-hour licensed nursing facility care but cannot live independently without daily support.

Adults who receive DDS services can also use MassHealth AFC, but DDS and the AFC provider must coordinate to avoid duplicating services. Discuss the combination with the DDS area office and the AFC provider.

How AFC Differs from DDS Shared Living

Families often confuse AFC with DDS shared living programs, and the two do overlap conceptually — both involve living with a caregiver in a home setting. The critical differences are administrative:

• Shared living is arranged directly through DDS. The caregiver is typically matched through the individual's DDS service coordinator, and the caregiver receives a stipend through DDS.
• Adult foster care is coordinated through a licensed AFC agency under MassHealth authority. The caregiver is recruited and supervised by the AFC agency, and payment flows through MassHealth billing.

In practice, shared living tends to serve individuals who are already DDS-eligible and have an active Individual Service Plan. AFC can serve a broader population — including adults with physical disabilities, traumatic brain injuries, or mental health conditions — because its funding comes through MassHealth rather than DDS-specific waiver slots.

Finding an AFC Provider

Massachusetts licenses AFC agencies regionally. To start the process, families can contact the individual's MassHealth-enrolled primary care provider for a referral or contact MassHealth Customer Service at (800) 841-2900. DDS-eligible individuals should also discuss AFC options with their DDS area office service coordinator, since the DDS team can help determine whether a DDS-funded shared living arrangement or a MassHealth-funded AFC placement better fits the individual's needs and support level.

What to Watch For

AFC works well when the caregiver match is strong, but families should verify several things before committing:

• The AFC agency's track record with disability-specific placements (some agencies primarily serve the elderly population and have less experience with younger adults with IDD)
• Whether the caregiver has received training specific to the individual's disability and communication needs
• The agency's emergency backup plan if the primary caregiver becomes ill or unavailable
• How the arrangement interacts with the individual's existing DDS services, day programs, or employment supports

The Massachusetts Adult Benefits Guide includes a residential options comparison worksheet that walks families through the differences between AFC, shared living, group homes, and independent living with supports — so you can evaluate which model fits your family's situation before committing to a placement.

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