To fill out and submit an AFC application, download your state’s current Adult Foster Care packet from the Medicaid or health-services agency that runs the program, gather identity, medical, financial, and caregiver documents before you start writing, complete every field so the numbers and dates match your attachments exactly, and file it through a method that gives you proof of delivery. There is no single national form. Every state administers Adult Foster Care under its own federal Home and Community-Based Services waiver, so the packet, the checklist of attachments, and the submission portal are all state-specific, even though the process follows the same federal rules everywhere.
Get the Current Packet From the Right Agency
Start on your state’s Medicaid or Department of Health and Human Services website, in the long-term care or home-and-community-based services section. Application packets are posted there as downloadable PDFs. If you cannot find them, call your state’s Aging and Disability Resource Center; staff can mail the forms or walk you through the online portal. Some states also let licensed AFC provider agencies hand out application materials directly.
Confirm the version before you fill anything in. States revise their packets, and an outdated form can be rejected on sight. If the PDF you downloaded has no revision date, call the issuing agency and ask whether it is still current.
What the Application Is Testing
AFC eligibility has two layers, and the forms are built around both. The functional layer asks whether you need the level of care a nursing facility provides, measured through a clinical assessment of your ability to perform activities of daily living such as bathing, dressing, eating, and transferring. Federal rules require each state to set functional criteria that match its institutional-care admission standards, so the threshold varies but always ties back to the same question: would this person otherwise need a nursing home?1Medicaid.gov. Home and Community-Based Services 1915(c) If the assessment shows you can manage independently, AFC will not be approved.
The financial layer is Medicaid eligibility. Income and asset limits differ by state. All states apply a 60-month look-back to asset transfers made on or after February 8, 2006, and gifts or below-market transfers within that window can trigger a penalty period during which Medicaid will not pay for long-term care services, AFC included.2Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets That look-back is why the financial section of the application asks for several years of bank records.
Gather Your Documents First
Pulling together the attachments before you open the forms is what keeps the application moving. Expect to produce paperwork in four areas.
Identity and citizenship: a birth certificate, state-issued ID, or Social Security card. Some states accept a U.S. passport or permanent-resident card.
Medical records: a recent physician evaluation confirming your diagnoses and the level of personal-care help you need. Many states require this to be signed within 60 to 90 days of the application date. Ask your doctor to address each activity of daily living you cannot do on your own, by name.
Financial records: bank statements, tax returns, pension and Social Security award letters, and documentation of any other income or assets. Plan on up to five years of bank statements covering deposits, withdrawals, and transfers.
Caregiver documentation: the proposed caregiver’s identity and residence documents, criminal background check, and proof of any required training such as CPR, first aid, or medication administration. Background-check fees generally run $27 to $143 depending on the state and whether the check includes both state and FBI databases. CPR and first-aid courses typically cost $35 to $150.
If someone else is signing on behalf of the participant, attach the power of attorney or guardianship order. Without that proof of authority, the agency will reject the signature.
Filling Out the Forms Without Triggering a Bounce-Back
Most packets contain several forms: a participant information sheet, a medical assessment or level-of-care form, a caregiver qualification form, a financial disclosure, and a provider agreement that both parties sign. Fill every field. Blank fields are the most common reason agencies send applications back, and each round trip costs weeks.
On the medical assessment, transfer the physician’s findings precisely. If the form uses a grid for activities of daily living, match your doctor’s language to the categories on the form. Overstating needs can trigger a fraud investigation; understating them can push you into a lower reimbursement tier or produce a denial.
In the financial section, monthly income from Social Security, pensions, and investments must match the attached bank statements and award letters to the dollar. Even small discrepancies will prompt a request for clarification and stop the clock on your file. List every asset the form asks about, including bank accounts, real property, vehicles, and life insurance, even if you believe an asset is exempt. The agency decides what counts. Leaving something off looks like concealment.
Emergency-contact fields should name someone who can make medical decisions if the primary caregiver is unavailable. If you have a health-care proxy or advance directive, note it on the form and attach a copy.
Knowingly putting false information on a health-care benefit application is a federal crime. A materially false statement in connection with the delivery of or payment for health care services carries a fine, up to five years in prison, or both.3Office of the Law Revision Counsel. 18 USC 1035 – False Statements Relating to Health Care Matters
Prepare the Caregiver’s Home for Inspection
The caregiver’s home must pass a safety inspection before services can begin, and the inspection is part of the application review, not a separate step after approval. Federal HCBS rules require states to protect the health and welfare of waiver participants, so checklists are broadly similar across states.1Medicaid.gov. Home and Community-Based Services 1915(c) Common items include:
- Working smoke detectors on every level, a fire extinguisher rated at least 2A:10BC, a written escape plan posted in a common area, and combustibles kept away from heating sources.
- Exit doors and windows that open from the inside without obstruction; interior doors that can be unlocked from the outside in an emergency.
- Hot water held at or below 120°F.
- Cleaning chemicals, medications (especially controlled substances), sharp objects, and firearms stored in locked or inaccessible locations, away from food and living areas.
- A home and property free of debris, pests, and exposed wiring, with exterior walkways maintained and clear of ice or snow.
Failing the inspection is not necessarily fatal. Many states let you correct the deficiencies and schedule a reinspection, and the caseworker usually spells out what needs to change and by when.
Submit With Proof of Delivery
Check which submission methods your state accepts. Most states offer at least one electronic option, either a secure upload portal or an email address that accepts encrypted attachments. Online portals typically generate a confirmation number and a digital timestamp, which is your proof of filing. Federal law requires states to allow electronic signatures on Medicaid applications, though authentication rules vary by state.1Medicaid.gov. Home and Community-Based Services 1915(c)
If you file on paper, send it by certified mail with return receipt so you have proof of the delivery date. Hand delivery to your regional caseworker’s office works too and gets you an immediate receipt. Either way, keep a complete copy of every page, every attachment, and every signature. If anything disappears in processing, your copy is the fastest way to put it back.
How Long the Decision Takes
Federal regulations cap how long the state can take. For most Medicaid applications, the eligibility determination is due within 45 calendar days; if the application is based on a disability, the deadline extends to 90 calendar days.4eCFR. 42 CFR 435.912 – Timely Determination of Eligibility The clock starts the day the agency receives your application, and it pauses for delays caused by the applicant, such as missing documents or a skipped assessment. Because AFC eligibility usually runs through a disability-based Medicaid group, expect the 90-day window.
Within that window the agency verifies your financial information, arranges the clinical assessment, and conducts the home visit. If everything checks out, a formal approval letter follows, often with a parallel posting to your online Medicaid portal.
If You Are Denied
Every Medicaid applicant has a federal right to a fair hearing on a denial or on an application the agency does not act on in time.5Office of the Law Revision Counsel. 42 USC 1396a – State Plans for Medical Assistance The denial notice must state the reason, explain how to request a hearing, and give the deadline, which varies by state but cannot exceed 90 days from the mailing date of the notice.6eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries
You can represent yourself or bring a lawyer, family member, or friend. You have the right to examine your case file before the hearing, bring witnesses, present evidence, and cross-examine the state’s witnesses. The hearing officer must be someone who was not involved in the original decision.7Medicaid.gov. Understanding Medicaid Fair Hearings If delay would cause serious harm to your health, ask for an expedited hearing.
The state must generally issue a final decision within 90 days of receiving your request. A favorable decision gets implemented retroactively to the date of the incorrect denial. An unfavorable one must explain any remaining appeal rights, which in most states means judicial review.
After Approval
Approval is not permanent. States reassess participants annually, sometimes more often, to confirm continued functional and financial eligibility and that the caregiver’s home still meets safety standards. Missing a reassessment or failing to send updated financial documents can suspend or terminate services, and any significant change between reviews, in health, residence, or finances, should be reported to the caseworker promptly to avoid overpayment recovery later.