Understanding Adult Foster Care Matching Programs: A Comprehensive Guide

Life sharing is a unique and relationship-centered living arrangement designed to carefully connect adults aged 18 and older with disabilities with individuals or families. These individuals or families share their lives, experiences, and homes, providing support based on person-centered practices. Terms like “host home,” “shared living,” and “life sharing” are often used interchangeably to describe these relationship-based living arrangements. While various terms exist, this article will primarily use “life sharing” to explain the matching process and the living arrangement it creates within the context of adult foster care.

It’s important to note that life sharing is not currently a formal waiver service in all locations. However, existing disability waiver services can be effectively utilized to establish life-sharing arrangements. This guide provides essential information for lead agencies, service providers, and individuals or families interested in participating in life sharing.

This page will cover the following key areas:

Distinguishing Life Sharing from Similar Services
Eligibility for Life Sharing
Roles of Life Sharing Providers
The Phases of Life Sharing
Authorization and Funding
Selecting and Contracting with a Life Sharing Agency
Exploring Ongoing Support and Housing Options
Examples of Life Sharing Arrangements
Valuable Resources

How Life Sharing Differs from Other Adult Foster Care Options

Life sharing, at its core, is about creating meaningful relationships. It’s an Adult Foster Care Matching Program that pairs an adult (18+) with a disability with an individual or family who will open their lives and homes. This arrangement goes beyond just providing housing; it’s about sharing life experiences, building relationships, and offering support through person-centered approaches. In a life-sharing arrangement, the host individual or family owns or rents their home, and the local county or tribal nation provides licensing for the physical home to ensure safety and standards are met.

A key distinction of life sharing is that the host individual or family does not need to be enrolled as a Minnesota Health Care Programs (MHCP) provider with a 245D license, unlike traditional adult foster care in some contexts. Instead, they partner with a life-sharing agency. This agency, which holds the 245D license, provides essential oversight and manages the administrative and compliance aspects related to the individual’s support plan. This structure simplifies the process for families while ensuring quality and adherence to regulations.

If the individual or family chooses to become an MHCP provider with a 245D license themselves, the arrangement is then classified as family foster care, not life sharing. For those interested in the requirements for 245D licensing, detailed information is available from DHS – Licensing for 245D providers.

Life sharing can accommodate up to two adults who are using disability waiver services to live with a host individual or family. It’s important to note that the arrangement is limited to a maximum of two adults in the same home to maintain a personalized and family-like environment. Lead agencies are responsible for monitoring these homes to ensure this limit is not exceeded. For detailed eligibility criteria, please refer to the eligibility section.

Who is Eligible for a Life Sharing Adult Foster Care Program?

Eligibility for participating in a life-sharing arrangement as someone receiving support is straightforward. Adults aged 18 and over who are recipients of specific disability waivers are eligible. These waivers include:

Life sharing is designed to be flexible in terms of who can live together. An arrangement can include:

A single adult seeking a life-sharing arrangement.
Two adults who are partners or friends who wish to live together in a life-sharing setting.
Two adult siblings who choose to live together with a host family.

However, life sharing is designed for a maximum of two adults receiving support within a single household. Arrangements involving more than two individuals, or groups of two who are not already connected as partners, friends, or siblings, are not suited for life sharing. For situations involving larger groups, other service models like family residential services or community residential services may be more appropriate.

Understanding the Roles of Life Sharing Providers

Life-sharing arrangements are successful due to the collaborative effort of three key participants, each with distinct responsibilities:

The Individual Receiving Services: This is the adult with a disability who is seeking a life-sharing arrangement and will be matched with a host individual or family.
The Life Sharing Agency: This agency is a 245D-licensed provider that manages the matching process, provides ongoing support to both the individual and the host family, and handles third-party billing.
The Host Individual or Family: This is the individual or family who opens their home and life to the person receiving services, providing daily support within their licensed home (licensed for no more than two people by the county or tribal nation).

Key Requirements for Life Sharing Agencies

The choice of life-sharing agency is a collaborative decision, made by the individual receiving services and the host individual/family at the outset of the matching process. Together, they establish an agreement outlining the specific supports needed from the agency. It’s also possible to choose one agency for the matching phase and a different one for ongoing support if desired.

To operate as a life-sharing agency, several requirements must be met:

Licensure and Enrollment: The agency must hold a 245D license and be authorized to provide family training and counseling and family residential services. These are the service categories through which life sharing is facilitated and funded.
Mandated Training: Completion of the DHS Vulnerable Adults Mandated Training is essential to ensure the safety and well-being of vulnerable adults in life-sharing settings.
Person-Centered Thinking Training: Agencies must demonstrate completion of a two-day person-centered thinking training within the past year. This training is crucial for ensuring that services are delivered in a way that truly honors the individual’s preferences and needs. Proof of completion is required before billing for services. Updates on person-centered training opportunities are typically announced through DSD eList announcements. More information on person-centered practices can be found at DHS – Person-centered practices.
Transportation Requirements: If the agency will be transporting individuals, they must possess a valid driver’s license and adequate automobile insurance.
Financial Impartiality: To avoid conflicts of interest, the agency must not have any direct or indirect financial interest in the property where the person will be living.
Caseload Limits: Agencies must not match any individual/family with more than two people receiving services to maintain the quality and personalization of the support. In practice, most life-sharing arrangements involve a one-to-one match.
Home Licensing Assistance: Agencies are responsible for guiding and supporting the host individual/family through the process of licensing their home with the county or tribal nation.
Financial Administration: The agency administers the family residential services daily rate to the host individual/family, obtaining a service agreement from the lead agency to facilitate this process (refer to the authorization section).

The life-sharing agency is the conduit for support, utilizing family training and counseling during the matching phase and family residential services for ongoing support. These are DHS enrollment-required services, further detailed in CBSM – Waiver/AC service provider overview.

The compensation received by the life-sharing agency for ongoing support via family residential services is determined by the specific needs of the person being supported and the host individual/family’s capacity to meet those needs.

Key Requirements for Host Individuals and Families

Becoming a host individual or family in a life-sharing arrangement is a deeply rewarding but also demanding role. It requires a commitment to understanding and learning what is truly important to and for the person they are supporting. They must be ready to use positive, strength-based practices in their daily interactions. Creating a supportive and healing environment is paramount, especially if the person has experienced trauma or has disabilities or personality traits that require additional understanding and patience.

A true life-sharing arrangement integrates the person into the family’s life. It is not considered life sharing if the person is isolated from family activities, such as shared living spaces, meals, vacations, friendships, or contact with other family members or neighbors. The host family should actively support the person in maintaining and expanding their own network of friends and meaningful relationships.

Minimum requirements for host individuals/families include:

Home Licensing: The home must be licensed as a family foster care setting by the county or tribal nation. This ensures that the home meets safety and quality standards.
Required Training: Host individuals/families must complete all required 245D staff orientation and annual training, including the DHS Vulnerable Adults Mandated Training. While they do not need a 245D license themselves, this training, supported by the life-sharing agency, is critical for providing competent support.
Person-Centered Thinking Training: Completion of a two-day person-centered thinking training is also required, as these trainings become available. This reinforces the commitment to individualized, respectful support. Announcements for training opportunities are made through DSD eList announcements. Additional information is available at DHS – Person-centered practices.
Team Participation: Active participation in team meetings with the person receiving services, their case manager, and other important individuals in their life is essential for collaborative planning and support.

To formally participate in a life-sharing arrangement, the host individual/family must contract with a life-sharing agency. This agency can be either:

An MHCP-enrolled provider organization that employs life-sharing staff.
An individual who is enrolled as an MHCP provider with a 245D license.

Further details on choosing and contracting with a life-sharing agency are provided in the section below.

The Key Phases of a Life Sharing Arrangement

Every life-sharing arrangement is built around a person-centered support plan, tailored to the specific needs and preferences of the individual receiving services. The life-sharing process can be broadly divided into three phases:

Matching and Planning the Move: This initial phase focuses on finding the right match between the individual and the host family and preparing for a smooth transition.
Ongoing Support from the Life Sharing Agency: The agency provides continuous oversight, resources, and support to both the individual and the host family to ensure the arrangement is successful and sustainable.
Daily Support from the Host Individual/Family: This encompasses the everyday support and relationship-building provided by the host family within their home.

Phase 1: Matching and Planning the Move

The matching process is crucial to the success of life sharing. The life-sharing agency and the lead agency work together to facilitate a thoughtful matching process. This process aims to connect individuals and families based on shared preferences, interests, personality styles, responsibilities, mutual agreements, and the potential for building positive relationships.

Face-to-face meetings are a cornerstone of the matching process. These meetings should take place in a variety of settings and activities that reflect the person’s interests. Examples include attending sporting or community events, preparing meals together, or spending weekend time at the family’s home. In situations where in-person meetings are challenging (such as during a pandemic), alternative methods like video calls can be utilized, provided all parties agree and it is deemed appropriate. For additional insights into effective matching strategies, the video Roommate matching – Derrick Dufresne (video) offers valuable perspectives.

Throughout the matching process, the life-sharing agency is responsible for employing person-centered practices to develop a comprehensive support plan. This plan must address the needs of both the individual receiving services and the host family to ensure a mutually beneficial arrangement. More information on person-centered practices can be found at CBSM – Person-centered practices.

In some cases, a formal matching process may not be necessary. If all parties involved already know each other and are confident in their compatibility, the lead agency may waive the formal matching process.

Once a suitable match is identified, the life-sharing agency takes on several key responsibilities to facilitate the move:

Lease Agreement Education: The agency helps the person and their support team understand the details of any lease agreements involved in the living arrangement.
Agreement Facilitation: Working collaboratively with the person and the host family, the agency helps to draft and finalize any necessary agreements. These agreements can cover aspects like shared space, access to personal belongings, transportation arrangements, and the contractual obligations between the host family and the life-sharing agency.
Moving Resources: If needed, the agency assists the person in finding resources to help with the physical move of their belongings to the new home.

For guidance on how lead agencies should authorize services during this matching phase, refer to the family training and counseling authorization section below.

Phase 2: Ongoing Support from the Life Sharing Agency

Ongoing support from the life-sharing agency is critical for the long-term success of the arrangement. All regulations outlined in Minn. Stat. §245D.081 are applicable to life-sharing arrangements, ensuring quality and accountability.

The contract between the host family and the life-sharing agency ensures that the necessary support and oversight are in place for the person receiving services. This support can include a range of activities:

Service Coordination and Evaluation: Assisting with the coordination and ongoing evaluation of service delivery to ensure it aligns with the person’s needs and goals.
Support Plan Implementation: Providing active support to help the person achieve the outcomes outlined in their person-centered support plan.
Program Management and Oversight: The agency provides essential program management and oversight, including quality evaluations and continuous improvement of the services delivered by the host family.
Guidance and Training for Host Family: Offering instruction and ongoing assistance to the host family in implementing the person’s support plan. This may include direct observation of service delivery to ensure best practices.
Service Effectiveness Evaluation: Evaluating the effectiveness of the services and methodologies used, and monitoring progress towards the person’s desired outcomes using measurable criteria.
Training Compliance: Ensuring that all individuals providing direct support complete the required 245D staff orientation and annual training to maintain standards of care.
Positive Behavior Intervention Coordination: Coordinating referrals and support for positive behavior interventions if needed, promoting a positive and supportive living environment.
Backup Support Coordination: Arranging for backup support systems to be in place for the host family, providing reassurance and resources in unforeseen circumstances.
Emergency Planning: Developing and maintaining comprehensive emergency plans to ensure the safety and well-being of the person in any situation.
Daily Documentation: Maintaining necessary daily documentation to track services, progress, and any important events.
Medication Support: Providing support and guidance related to medication administration, ensuring safety and adherence to prescribed regimens.
Person-Centered Practices Support: Continuously reinforcing and supporting the use of person-centered practices in all aspects of the life-sharing arrangement.
Rights and Responsibilities Education: Ensuring that both the person receiving services and the host family understand their rights and responsibilities within the life-sharing agreement.

Instructions for lead agencies on authorizing services for this ongoing support phase are detailed in the family residential services authorization section below.

Phase 3: Daily Support from the Host Individual/Family

The host individual or family is the heart of the life-sharing arrangement, providing daily support and fostering meaningful relationships. Their role includes:

Relationship Building and Shared Experiences: Sharing their lives and relationships, and actively helping the person experience new things that are important to them and aligned with their support plan goals.
Health and Safety Support: Providing support to ensure the person’s health and safety, such as assisting with attending doctor’s appointments and promoting overall well-being.
Direct Service Delivery: Delivering direct services as identified and aligned with established service frameworks such as CBSM – Adult foster care, CBSM – Family residential services, or CBSM – Residential habilitation – SLS in a provider-controlled setting.
Transportation Support: Providing or facilitating transportation, whether directly or by supporting the use of public transportation, to ensure community access and participation.

Guidance for lead agencies on authorizing services for the support provided by the host family is available in the family residential services authorization section below.

How Life Sharing Services Are Authorized and Funded

Lead agencies play a crucial role in authorizing and funding each phase of a life-sharing arrangement through the person’s service agreement. The authorization structure is as follows:

Matching and Planning Phase: Authorized under Family Training and Counseling, for up to 50 hours (200 units). See details in the matching and planning the move section.
Ongoing Agency Support Phase: Authorized as a percentage of the Family Residential Services rate, typically covering 6-12 hours of agency support per month. See details in the ongoing support from the life-sharing agency section.
Host Family Support Phase: Authorized under Family Residential Services in a provider-controlled setting. See details in the support from the individual/family section.

Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF) provides specific rate information and coding for both the matching phase and the ongoing family residential services in life sharing. Refer to DHS-3945 for the following service codes:

Family Training, Life Sharing, Match (S5110 U2)
Family Residential Services, Adult, Life Sharing Daily (S5140 UC U2).

In addition to these core services, lead agencies can authorize other needed supports for the individual, such as positive support services, respite care, or employment services.

Family Training and Counseling Authorization for Matching and Planning

The life-sharing agency’s matching services are authorized by the lead agency using family training and counseling service codes.

The duration of the matching phase can vary, typically taking between 3 to 6 months to allow individuals and families to get to know each other and assess compatibility. The authorized amount for the matching phase is typically 50 hours (200 units). Family training and counseling services have an annual limit of 500 15-minute units per service recipient.

Family training and counseling is a market rate service. Rates should reflect typical market costs, as guided by CBSM – Market rate services. Lead agencies should follow the instructions in CBSM – Family training and counseling for authorization procedures.

It’s also important to note that family training and counseling can be authorized for matching purposes even when the individual is considering other types of living situations, not just life sharing. See the other ongoing support and housing options section for more details.

Family Residential Services Authorization for Ongoing Agency Support

Ongoing support from the life-sharing agency is authorized using family residential services.

The typical level of ongoing agency support is between 6 to 12 hours per month, depending on the assessed needs of the person and the complexity of the life-sharing arrangement. During the initial transition period (1-6 months), a higher level of support may be authorized to ensure a successful adjustment. Lead agencies are responsible for monitoring these service levels. As support needs evolve, the host family can negotiate adjustments to the level of agency support.

Family Residential Services Authorization for Host Family Support

Support provided directly by the host individual/family is also authorized under family residential services. The life-sharing agency receives the full family residential services rate. The agency then retains a portion of this rate to cover its ongoing support services (as agreed upon with the host family) and distributes the remaining funds to the host family for the direct support they provide.

All aspects of the Disability Waiver Rate System (DWRS) must be followed, including:

Rate management worksheets, DHS-6790 (PDF)
Rate Management System (RMS) User Manual – Family residential services: Quick reference guide on business rules for residential staffing (Note: The asleep overnight staffing rule does not apply to life sharing).

Lead agencies use the RMS within the MnCHOICES Support Plan to calculate the daily rate. They should follow the established processes for CBSM – Adult foster care, CBSM – Family residential services, or CBSM – Residential habilitation – SLS in a provider-controlled setting as applicable.

Choosing and Contracting with a Life Sharing Agency

Selecting the right life-sharing agency is a crucial step. The host individual/family chooses an agency that will provide the necessary support and oversight to ensure the person’s support plan is effectively monitored and implemented. The host family uses funds from family residential services to purchase these agency services.

A formal agreement or contract between the host family and the life-sharing agency is essential. It is strongly recommended that legal counsel be consulted when drafting this agreement. Key components of this agreement may include:

Backup Support Plans: Clearly defined plans for backup support for the host family when they need respite or are unavailable.
Licensing Support: Outline of the agency’s responsibilities in supporting the host family to meet and maintain licensing standards for their home, according to county/tribal nation guidelines.
Intensive Training and Support: Provision for access to specialized training and intensive support related to the specific needs of the person receiving services.
Payment Terms and Processes: Clear and detailed language specifying payment processes and amounts, including payments to the life-sharing agency, deductions for payroll taxes and benefits (if applicable).
Insurance Documentation: Requirements for the host family to maintain adequate homeowner’s or renter’s insurance and car insurance, and documentation of these policies.
Billing Services: Confirmation that the life-sharing agency will handle billing services on behalf of the host family.
Daily Census Keeping: Requirement for the host family to maintain a daily census to track when the person is in the home and provide this information to the life-sharing agency for accurate billing and record-keeping.
LLC Formation Guidance: Guidance on whether the host family needs to form a Limited Liability Company (LLC) for licensing purposes, depending on local regulations.
Tax Implication Guidance: Consideration and guidance on any potential tax implications for the host family related to the life-sharing arrangement.

The life-sharing agreement typically becomes effective when the person officially moves into the host family’s home.

Exploring Other Support and Housing Options After Matching

The matching process itself can be a valuable tool for individuals seeking various living arrangements, not exclusively life sharing. Lead agencies can authorize the matching process through family training and counseling for individuals interested in finding a roommate or caregiver for different housing models. This includes those who wish to live:

In Their Own Home: Matching can help individuals find a compatible roommate to share their own home. A person’s own home is defined as a single-family home or apartment where they or their family owns/rents and maintains control. Service providers cannot have a financial interest in this housing. More details are available in CBSM – Requirements for a person’s own home.
With Caregiver Living Expenses Support: Matching can facilitate finding a live-in caregiver who provides ongoing support through caregiver living expenses. This service helps fund certain expenses for unrelated caregivers living with an adult (18+) receiving waiver services. More information at CBSM – Caregiver living expenses.
In Family Foster Care: Matching can assist in finding a suitable family foster care provider. Family foster care involves a licensed home owned or rented by a family who lives there and is an enrolled MHCP provider with a 245D license. Family foster care can accommodate up to four unrelated adults. See CBSM – Adult foster care and CBSM – Family residential services for further details.

Examples of Life Sharing Arrangements

CBSM – Life-sharing scenarios offers practical examples of how life-sharing arrangements function and what to expect during the planning phase. These scenarios are beneficial resources for individuals with disabilities, their families, case managers, and providers to better understand the possibilities and nuances of life sharing.