The Group Adult Foster Care (GAFC)
The Group Adult Foster Care (GAFC) program is a MassHealth program that provides personal care services in either a community or assisted living setting to individuals who are elderly and/or disabled. GAFC provides assistance with Activities of Daily Living (ADLs), nursing oversight and care management. Individuals must meet the criteria and guidelines set forth by MassHealth:
Participant Eligibility:
Member Qualifications:
•
Must be age 22 years of age or older;
Must be age 22 years of age or older;•Must meet the financial criteria for MassHealth* (Standard of CommonHealth)
Must meet the financial criteria for MassHealth* (Standard of CommonHealth)•A physician’s summary confirming the appropriateness of GAFC services;
A physician’s summary confirming the appropriateness of GAFC services;•Requires daily assistance with at least one ADL
Requires daily assistance with at least one ADL (e.g., bathing,dressing,eating, continence care, ambulation or transfer);
•Requires clinical approval from the MassHealth designated clinical screening
Requires clinical approval from the MassHealth designated clinical screening agent, Coastline Elderly Services, Inc; and
•Must reside in identified community housing for individuals who are elderly or disabled OR live in an assisted living residence.
Must reside in identified community housing for individuals who are elderly or disabled OR live in an assisted living residence.Financial Eligibility for GAFC
Financial eligibility for GAFC in an assisted living setting is determined by the
Social Security Administration through the Supplemental Security Income Program
– Category G (SSI-G).
What is SSI-G?
Supplemental Security Income (SSI) is a Federal program administered by the Social Security Administration (SSA);
•Massachusetts implemented the SSI State Supplemental Living Arrangement (L/A) Category G, Assisted Living, as of 1998 to assist individuals who clinically meet the criteria for GAFC in an effort to assist in the payment of Room and Board in assisted living facilities;
Massachusetts implemented the SSI State Supplemental Living Arrangement (L/A) Category G, Assisted Living, as of 1998 to assist individuals who clinically meet the criteria for GAFC in an effort to assist in the payment of Room and Board in assisted living facilities;•The Commonwealth of Massachusetts, depending and individual’s living arrangement (must live in a certified assisted living that participates in the GAFC program), supplements the Federal SSI payment;
The Commonwealth of Massachusetts, depending and individual’s living arrangement (must live in a certified assisted living that participates in the GAFC program), supplements the Federal SSI payment;•The income guidelines for SSI-G change on an annual, calendar year basis; and
The income guidelines for SSI-G change on an annual, calendar year basis; and•The 2009 income guideline for an individual is $1128.00 per month with assets of $2000. or less and for a member of a couple $846.00 per month with assets of $3000. or less. It is important to note that SSI applies a general $20.00 disregard of income.
The 2009 income guideline for an individual is $1128.00 per month with assets of $2000. or less and for a member of a couple $846.00 per month with assets of $3000. or less. It is important to note that SSI applies a general $20.00 disregard of income.Qualifications
Requires clinical approval for GAFC services from the MassHealth designated clinical screening agent, Coastline Elderly Services, Inc.;
•Must file an SSI application with the local SSA Field Staff Office;
Must file an SSI application with the local SSA Field Staff Office;•Must meet all other SSI requirements; and
Must meet all other SSI requirements; and•Requires a Residence Verification form completed by the assisted living facility
Requires a Residence Verification form completed by the assisted living facility and Coastline Elderly Services, Inc., confirming residency at the assisted living facility