FAQ

Adult Foster Care (AFC) is a MassHealth program for people who cannot live alone safely and need daily help with Activities of Daily Living (ADLs). The senior lives in a private home with a trained caregiver who provides meals, personal care, supervision, and companionship. The caregiver receives a monthly non-taxable stipend

Group Adult Foster Care (GAFC) is a MassHealth program that provides daily personal care services for people living in GAFC-approved housing such as assisted living residences or subsidized senior housing. Care staff help with ADLs like bathing, dressing, and meal preparation, but unlike AFC, the caregiver does not live with the member

• AFC: Requires living with a caregiver 24/7.
• GAFC: Care is provided in supportive housing; a caregiver does not live with the senior

• Insurance Requirement: Must have MassHealth Standard or CommonHealth coverage (other plans like Limited are not enough).
• Age Requirement: Must be 16 or older (many participants are seniors, but adults with disabilities may also qualify).
• Medical/Behavioral Need: Have a medical or mental health condition that requires daily help with at least one Activity of Daily Living (ADL).
• Non-Duplication Rule: Cannot receive duplicate services from other programs (e.g., PCA, certain home health aides).
• Clinical Approval: A physician’s order and a MassHealth-approved nursing/case management assessment are required.
• Living Arrangement:
  • AFC: Must live full-time with a trained caregiver in a private home.
  • GAFC: Must live in a GAFC-approved housing setting (assisted living or designated subsidized housing).

ADLs (Activities of Daily Living) are the essential tasks people must do every day to live safely and independently, such as: bathing, dressing, toileting, transferring, walking, and eating. MassHealth uses ADLs to measure a person’s level of need — the more assistance someone requires with ADLs, the more likely they qualify for programs like AFC or GAFC. This ensures that support is provided to those who truly cannot manage daily life alone

A caregiver provides daily hands-on help and supervision to a member who cannot safely live alone. This includes assistance with personal care, meals, medication reminders, companionship, and ensuring a safe home environment. Caregivers also keep daily care logs and work closely with Clare’s nurse and case manager team

• Caregivers receive:
  • Access to respite, resources, and community programs that reduce caregiver stress.
  • A non-taxable monthly stipend through MassHealth for the care they provide.
  • Training and ongoing support from Clare’s nursing and case management team.
  • The ability to keep loved ones at home, avoiding nursing home placement.

• To become a caregiver with Clare:
  • Apply with Clare Senior Care – complete caregiver intake forms and background checks.
  • Meet eligibility requirements – cannot be the member’s spouse or legal guardian; must live in the same home for AFC or support GAFC-approved housing.
  • Complete training – learn documentation, ADL support, emergency plans, and caregiving skills.
  • Get approved by MassHealth – a nurse and case manager assessment confirms the arrangement.
  • Once approved, caregivers begin receiving stipends and ongoing support from Clare

No. AFC stipends are considered “difficulty of care” payments under IRS Notice 2014-7 and are not taxable

1. Intake & eligibility check (MassHealth card, ID, ADL review).
2. Nursing intake & assessment at home.
3. Physician order & prior authorization submitted to MassHealth.
4. Caregiver training & approval.
5. Start receiving monthly visits & support

• AFC Level I: At least every other month (alternating nurse & case manager).
• AFC Level II: Monthly visits by both nurse and case manager

• AFC Level I
  • Member needs supervision or physical help with 1–2 ADLs.
  • Caregiver provides cueing, safety monitoring, and limited daily assistance.
  • Nurse or case manager visits alternate every other month (at least one visit per month).
• AFC Level II
  • Member needs hands-on help with at least 3 ADLs, or 2 ADLs plus behavioral support (such as wandering, aggression, or resisting care).
  • Requires a higher level of caregiver involvement, 24/7 supervision, and more frequent care.
  • Nurse and case manager each visit monthly

If you don’t qualify, Clare can still help with Private Home Health Services, community referrals, or applying for other programs

Private Home Health Services are care options paid directly by families rather than MassHealth. At Clare, these services provide extra support beyond AFC/GAFC, such as nursing visits, medication management, care coordination, wellness coaching, telehealth, and concierge-style assistance. This option is flexible and available even if a senior does not qualify for MassHealth programs

Our care rates start at just $40 per hour, with customizable packages designed to help seniors live independently and comfortably at home.

For those seeking an enhanced experience, we provide concierge services to our Elite Members, including personalized case management, travel support, and event coordination.

Contact Clare Senior Care for a free consultation. We’ll design a personalized plan and explain payment options.