Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Adult Family Care Homes (11)


Adult family-care homes (AFCHs) are defined as a family-type living arrangement in a private home providing room, board, and personal care for no more than five disabled adults or frail elderly persons. Persons who provide room, board and personal care services in their own homes must obtain an AFCH license unless they are caring for one or two adults who do not receive a state supplement, or they are caring only for relatives. Persons who wish to care for more than five disabled adults or frail elders must obtain an assisted living facility license. A maximum of two residents may share a room.

AFCHs are an alternative to more restrictive, institutional settings for individuals who need housing and supportive services, but who do not need 24-hour nursing supervision. The personal care available in these homes, which may be provided directly or through contract or agreement, is intended to help residents remain as independent as possible in order to delay or avoid placement in a nursing home or other institution. A terminally ill resident who no longer meets the criteria for residency may continue to reside in the AFCH if receiving hospice services from a licensed provider who coordinates any additional care needed. In 2002, the state had 416 adult family care homes with 1784 beds.12


  1. The information in this section draws heavily from Manard, B. et al., op.cit., with some additional comments from personal interviews with current state staff. Adult Family Care Homes were originally called Adult Foster Home (AFHs), a licensing category created in 1968 to provide a community housing alternative for mental hospital patients being de-institutionalized. While some de-institutionalized mental health clients were also sent to Adult Congregate Living Facilities, proportionally more were in Adult Foster Homes. Over time the program evolved to serve elderly persons almost exclusively.

  2. Personal communication.



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