FAQ

Who Pays For Adult Family Care (AFC) Services?

Who Pays for AFC Services: MassHealth “Standard” pays for the Adult Family Care (AFC) services. Private Insurance or HMO’s do not cover or pay for AFC services.

Member’s Eligibility for AFC: A Fortcom Health RN and Care Manager meet with members interested in receiving services through the AFC Program for a complete assessment of their needs. Member eligibility is determined for Level I or Level II service within the AFC Program. If the Member is eligible a Comprehensive Care Plan is created.

Eligibility (Level I): Adult Family Care services are provided to (LEVEL I) MassHealth member who meet the clinical criteria for AFC. MassHealth agency pays for AFC at Level I if a member requires:

  • At least 16 years of age or older;
  • A physician must write an order for AFC;
  • The member must have a medical or mental condition that requires daily physical assistance or cueing and supervision during the task in order for the member to successfully complete at least One ADL;
  • A member must be clinically approved for AFC services by MassHealth to receive benefits.

Eligibility (Level II): Adult Family Care services are provided to (LEVEL II) MassHealth member who meet the clinical criteria for AFC. MassHealth agency pays for AFC at Level II if a member requires:

  • Physical assistance with THREE ADLs (bathing, dressing, toileting, transferring, ambulating and eating); or
  • Physical assistance with TWO ADLs and management of behaviors that require caregiver intervention: i.e. wandering, verbally abusive behavioral symptoms, socially inappropriate or disruptive behavioral symptoms and resisting care.

Ongoing Support: Fortcom Health AFC Care Managers and RN’s are in regular contact with the Member and Caregiver, visiting the home a minimum of one time per month. The staff provides on-going training to ensure that the needs of the Member are being met.

How to join AFC Program: For more information or to become a Member of the AFC Program Staff at 617-229-6161, Monday to Friday from 9.00a.m to 6.00pm

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