Maryland Community First Choice (CFC)
Community First Choice (CFC) is a Maryland Medicaid state plan program for people who already have full Medicaid, live in the community and need an institutional level of care. It pays for personal assistance and related supports and has no waiting list of its own. For the wider picture, see our Maryland Long-Term Care Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
At a glance
| Item | Details |
|---|---|
| Type of program | Community First Choice (state plan home care benefit) |
| Who runs it | Maryland Department of Health (MDH) |
| Age | Medicaid members of any age |
| Care need | Institutional level of care |
| Maryland 2026 income rule (long-term care) | No fixed cap for nursing home care: medically needy route (income goes toward care) |
| Maryland 2026 asset limit (single applicant) | $2,500 (medically needy, used for nursing home care); $2,000 categorically needy |
| Waiting list | No |
Maryland CFC in brief
In short, Maryland CFC is run by Maryland Department of Health (MDH). Who it is for: medicaid members of any age. Care need required: Institutional level of care. As for waiting: No. Each of these points is covered in more depth below, alongside the general Maryland rules from our state guide. If Maryland CFC is not the right fit, the related pages at the end point to other Maryland programs and general guides.
What the program is
A supports planning agency helps the person write a plan of service. Personal assistance can be agency-based or self-directed. CFC services are often combined with the Community Options Waiver.
Community First Choice is an option in federal Medicaid law that lets a state offer attendant care as part of its regular Medicaid program, with extra federal funding. There are no slot limits, because it is not a waiver. Core services are attendant help with daily activities, plus skill-building and backup supports.
Who qualifies in 2026
A person generally must meet all of these conditions:
- Has full Maryland Medicaid in a community eligibility category
- Needs an institutional level of care
- Lives in the community
The money test. The person must already have full Maryland Medicaid in a community category. Maryland’s rules are in our state guide. Figures shown above are the 2026 Maryland long-term care limits from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. If only one spouse needs Maryland CFC, spousal impoverishment rules protect assets and income for the other. See Spousal impoverishment rules.
What the care test means in practice. The care test looks at how much help a person needs with everyday activities such as bathing, dressing, eating, using the toilet, moving around and taking medicines, and at memory problems and supervision needs. The visit is normally face to face, at home or in a hospital or facility. Have a relative present to describe the hard days, and keep a medication and diagnosis list handy. See Nursing home level of care and Activities of daily living.
What services it can pay for
The plan of care decides which services are used. Maryland CFC can cover:
- Personal assistance services
- Supports planning
- Personal emergency response systems
- Technology to increase independence
- Home-delivered meals (limited)
- Environmental assessments
- Consumer training
- Transition services
No program pays for everything. Maryland CFC services are based on assessed need, and a family caregiver who is already helping is usually counted when the plan is written. When needs grow, request an updated assessment.
How to apply
Applying usually involves two decisions: one about money (financial eligibility for Medicaid) and one about care needs. In plain terms, the steps are:
- Contact Maryland Access Point.
- Complete the level of care assessment.
- Choose a supports planning agency.
Before contacting Maryland Medicaid, see Applying for a waiver and the documents checklist for what to gather.
Waiting lists
CFC has no waiting list for people who qualify.
See Waiver waiting lists for general tips.
How it relates to nursing home Medicaid
CFC participants meet the level of care for a nursing home. The key requirement is already having full Medicaid in the community.
What is the same as nursing home Medicaid. Most money rules carry over from nursing home Medicaid. Gifts and below-value transfers in the five-year look-back can trigger a penalty period for home care as well as nursing home care. After death, estate recovery can reach services paid from age 55 on. Under Maryland CFC, income above an allowance may go toward the cost of care each month.
Income in a nursing home. In 2026, Maryland lets a nursing home resident keep $106 a month for personal needs; the rest of their income mostly pays toward care. Details are in our state guide.
Tips for families
- Start early. If there is a waiting list or a slow assessment, the clock usually starts when you ask, not when the crisis comes.
- Keep a paper trail: copies of forms and notices, plus the names and dates of every call to Maryland Medicaid.
- Use your appeal rights. Notices that deny or reduce services explain how to request a fair hearing; acting quickly can protect current services.
- Report changes in income, assets, address or living situation to Maryland Medicaid when they happen.
- Expect yearly reviews of both Medicaid eligibility and the care assessment. See Renewals.
- Protect a spouse at home. Spousal protections must be claimed; a certified Medicaid planner or legal aid office can explain them for your family.
Common questions
Is there a waiting list for CFC? No. CFC is a state plan benefit, so anyone who has full Medicaid in a community category and meets an institutional level of care can get it.
Can I hire a relative, including my spouse? Maryland’s CFC rules do not bar relatives as a group. But a person who acts as your representative, such as a legal guardian or someone who signs or makes decisions about your plan of service, cannot also be your paid worker. Your supports planner can explain how this applies in your family.
Can I use CFC with the Community Options Waiver? Yes. Many waiver participants get personal assistance through CFC and other services through the waiver.
What if I do not have Medicaid yet? CFC is only for people who already have full Medicaid in the community. If you need long-term care Medicaid first, the Community Options Waiver registry or the nursing home route may be the way in.
Related pages
- Maryland Long-Term Care Medicaid guide
- Maryland CPAS
- Maryland Community Options Waiver
- Three kinds of Long-Term Care Medicaid
- PACE programs
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.