For many families in Massachusetts, home health care is an essential lifeline — allowing seniors and individuals with disabilities to receive professional care in the comfort of their own homes. But navigating eligibility requirements for services like Adult Foster Care (AFC), Skilled Nursing, or Personal Care Attendant (PCA) programs can feel overwhelming.
At A Better Life Homecare, we simplify the process and ensure your loved one receives the right level of support. This guide answers the most common questions around qualifying for home health care in Massachusetts.
What Are the Requirements for Home Health Care?
To receive home health care in Massachusetts, individuals generally must meet the following criteria:
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Be homebound, meaning they cannot easily leave home due to a medical condition or disability.
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Have a medical necessity for skilled services such as nursing or therapy.
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Be under the care of a licensed physician, who certifies that home-based services are appropriate.
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Receive care from a certified home health agency, like A Better Life Homecare.
Covered services may include:
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Skilled nursing care (wound care, injections, medication management)
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Physical, occupational, or speech therapy
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Chronic illness management
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Help with daily tasks when medically necessary
Does MassHealth Pay for Home Care?
Yes, MassHealth (Massachusetts Medicaid) covers several home-based and community-based programs, including:
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Personal Care Attendant (PCA) Program – Assists with daily tasks like bathing, dressing, and meal prep for those with physical limitations.
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Skilled Nursing Services – Includes care provided by licensed nurses such as IV therapy, medication administration, and condition monitoring.
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Adult Foster Care (AFC) – Supports individuals living with a caregiver, including family members, who provide daily personal care and supervision.
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Group Adult Foster Care (GAFC) – Offers personal care services to individuals living in assisted living or shared housing settings.
These services are designed to promote independence and safety at home, avoiding unnecessary institutionalization.
To qualify, individuals must:
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Be enrolled in MassHealth Standard or CommonHealth
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Meet clinical eligibility requirements
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Have a documented need for services and undergo an assessment from a provider like A Better Life Homecare
Can a Person on Medicare Get Home Health Care?
Yes, Medicare (Part A or B) covers home health care for eligible beneficiaries, provided specific conditions are met:
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The individual must be under a doctor’s care and have an approved care plan.
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They must need intermittent skilled care such as nursing or therapy.
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The person must be homebound due to illness, injury, or disability.
Medicare-covered services may include:
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Skilled nursing care
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Physical or occupational therapy
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Medical social services
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Some durable medical equipment
Note: Medicare does not cover 24-hour care, meals, or full custodial care (like bathing or toileting) unless it is tied directly to skilled medical services.
What Is the Most Common Diagnosis for Home Health Care?
Home health care supports a wide variety of medical needs, but the most common diagnoses include:
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Heart disease, such as congestive heart failure (CHF)
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Diabetes-related complications
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Chronic obstructive pulmonary disease (COPD)
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Stroke recovery
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Alzheimer’s disease or other dementias
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Recent surgeries or hospital discharges
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Frequent falls or mobility issues
These conditions often require monitoring, skilled care, or rehabilitation services that can be safely delivered at home.
Who Qualifies for AFC, GAFC, PCA, and Skilled Nursing?
At A Better Life Homecare Massachusetts, we help families apply for and manage several MassHealth-covered programs, including AFC, GAFC, PCA, and Skilled Nursing. Here’s what it takes to qualify:
Adult Foster Care (AFC)
To qualify for AFC, the individual must:
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Be 16 years or older
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Be a MassHealth Standard or CommonHealth member
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Need daily assistance with at least one Activity of Daily Living (ADL) such as bathing or dressing
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Live with a caregiver (family member or non-relative), who is not their spouse or legal guardian
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Be clinically assessed by an approved provider agency
The caregiver receives a monthly tax-free stipend, training, and ongoing support.
Group Adult Foster Care (GAFC)
To qualify for GAFC:
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The individual must be 22 years or older
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Must reside in a group housing or assisted living facility
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Be enrolled in MassHealth Standard or CommonHealth
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Require assistance with ADLs or IADLs (Instrumental Activities of Daily Living)
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Must be able to live safely in the community with support
GAFC participants receive daily personal care, case management, and coordination services in their living community.
Personal Care Attendant (PCA) Program
To qualify for the PCA program:
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The individual must need hands-on assistance with ADLs due to a chronic or permanent disability
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Must be approved for MassHealth Standard or CommonHealth
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Must be able to hire, train, and manage their own personal care attendant — with help from a surrogate if needed
The PCA can be a family member or friend, and their work is funded by MassHealth.
Skilled Nursing Services
To qualify for in-home skilled nursing, the individual must:
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Have a clinical need for nursing care at home (e.g., medication management, wound care)
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Be under a doctor’s supervision with a prescribed care plan
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Be enrolled in MassHealth or Medicare, depending on the program
At A Better Life Homecare, our licensed nurses deliver quality skilled care while supporting recovery, independence, and safety.
Need Help Navigating Home Care Services in Massachusetts?
Whether you’re looking for Skilled Nursing, AFC, GAFC, or PCA services, A Better Life Homecare Massachusetts is here to help you understand your options, apply for programs, and receive high-quality, compassionate care at home.
📞 Call us today (413) 285-5929 or visit https://ablhomecare.com to schedule your free consultation. Let our care team help you or your loved one live a better, safer, and more independent life at home.
