Medicaid & Adult Foster Care: State by State Benefits & Eligibility

Introduction

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.

Types of Medicaid Programs Covering Adult Foster Care

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 live 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.

Services Covered (and Not Covered) in Adult Foster Care

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.

• Personal Care – assistance with activities of daily living, such as bathing, eating, transferring, grooming, and mobility.
• Homemaker – assistance with housekeeping, laundry, and cleaning.
• Meals – the preparation, serving and cleaning associated with a meal, but not the food costs.
• Medication Management –assistance administering medications or reminders about taking medications. As an aside, this is highly regulated and varies dramatically by state. 
• Transportation – assistance with transportation or assistance arranging transportation.

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.

List of State Programs Covering Adult Foster Care

What follows may not be exhaustive for several reasons. 1) There are Medicaid programs that cover adult foster care that 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.