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Find answers to the most commonly asked questions about our 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 Enrich Wellness 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: Enrich Wellness 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.
A person selected, supervised and paid by MassHealth through the AFC Provider for the provision of direct care for member. The Caregiver provides 24/7 hours AFC Services to the member.
Caregiver Requirements: A Enrich Wellness Health Care Manager and an Registered Nurse will meet with potential Caregivers at his/her home to discuss the AFC Program and to assess whether the Caregivers meets the following requirements:
- Be a responsible person who is at least 18 years of age;
- Not abuse alcohol or drugs;
- Be able to devote appropriate time necessary to provide needed personal care to the member to ensure the Member’s safety and well-being at all times;
- Have a physical and tuberculosis test within prior 12 months
- Meet all other requirements of the AFC regulations
Certain relatives of a MassHealth member may serve as that member’s AFC Caregivers in a qualified setting. Excluded relatives are: a spouse, parent of a minor member, including adoptive parent, or any legally responsible relative of the member.
Caregivers Home Requirements: During the visit to the Caregivers Enrich Wellness Health’s AFC Social Worker will conduct an assessment of the home to ensure it meets all requirements including:
- A private residence located in Massachusetts; not subject to state licensure as another type of facility (e.g. group home);
- Physically accessible to meet specific needs of its residents;
- In good repair; compliant with local health, fire, occupancy and state building codes for residential dwellings; equipped with appropriate safety equipment; and
- Occupied by no more than three AFC Member’s, no more than two of whom require Level II AFC services, regardless of type and payment source.