Key Takeaways
- Covered help: CFC may pay for approved help with bathing, dressing, eating, and safe movement at home.
- Eligibility: Full Medicaid, assessed institutional-level care, and community living. No minimum age.
- Paid family care: Qualified relatives may help, but agency-managed and self-directed rules differ.
- No enrollment waitlist: Assessment, Plan of Service approval, and caregiver setup still take time.
- Apply: Call Maryland Access Point at 844-627-5465 or CFC at 410-767-1739.
If you care for a parent, partner, or another person at home, you may be doing far more than helping out. You may be helping them bathe, get dressed, eat, or move from bed to a chair each day. Community First Choice Maryland is one way Medicaid may pay for that kind of help when the person meets the state’s care and coverage rules.
This guide answers the questions families often have first: What does CFC cover? Can I get paid to care for a relative? Who decides the hours? How do I start? We also explain how Cottage Home Care Maryland can help with agency intake and next steps, without making promises about state approval.
In This Guide
What Is Community First Choice in Maryland?
What Help Can You Receive at Home Through CFC?
Can a Family Member Be Your Paid CFC Caregiver?
Who Qualifies for Community First Choice Maryland?
How to Apply for Community First Choice in Maryland
How Are CFC Hours Approved, and When Can Care Start?
CFC vs. CPAS vs. the Community Options Waiver
How to Choose or Change a CFC Home Care Agency
How Cottage Home Care Helps Maryland Families
Frequently Asked Questions
Talk With Cottage About Paid Family Caregiving
What Is Community First Choice in Maryland?
Community First Choice, often called CFC, is a Maryland Medicaid benefit for people who need a high level of help but want to live at home. The program can pay for approved personal assistance and other supports that help a person stay in the community instead of moving into an institution. It is a Medicaid state-plan benefit, not a limited-slot waiver.
You do not have to live in a nursing facility first. A state assessment must find that, without the right support, you would need an institutional level of care. This means a level of care normally provided in certain facilities. The care you receive may still be delivered in your own home. See the Maryland Department of Health’s CFC program page.
The person receiving care, a supports planner, a state assessor, and the chosen care provider all have different jobs. The assessor reviews the person’s needs. The supports planner helps the person write a Plan of Service. Maryland reviews and authorizes covered services. A provider such as Cottage delivers approved services once its own staffing and enrollment steps are complete. An agency does not decide who gets Medicaid or how many hours are approved.
What Help Can You Receive at Home Through CFC?
CFC personal assistance covers help with daily activities, called ADLs, and related home tasks, called IADLs, when they are part of an approved plan. Here is what that can look like at home.
| Daily need | What to tell the assessor |
|---|
| Bathing and grooming | Explain if you need someone to help you wash, get into a shower, or finish personal care. |
| Getting dressed | Share if pain, weakness, or balance makes clothing hard to put on. |
| Toileting and continence | Explain help needed to reach the bathroom, use supplies, or stay clean and safe. |
| Meals and eating | Describe help with eating or preparing meals for the person receiving care. |
| Moving and transfers | Explain help needed getting out of bed, standing, walking, or using a chair. |
| Care-related household tasks | Describe light laundry, cleaning, or shopping tied to the participant’s care. |
| Safety cues and reminders | Describe which daily tasks need supervision, cues, or hands-on help for safety. |
These are examples, not a promise of covered hours. A plan must name the tasks and level of help the person needs. CFC does not pay for general housekeeping for the whole family or services meant mainly for someone other than the participant. The rules are explained in COMAR 10.09.84.14.
Other CFC Services Beyond Caregiver Visits
Based on the assessment and plan, CFC may also cover nurse monitoring, supports planning, assistive technology, home accessibility changes, a personal emergency response system, home-delivered meals, and help moving from an institution back into the community. Not every person gets every service. Each service has its own rules and approval steps. Maryland’s February 2026 CFC overview lists these options.
What About Medication and Nursing Tasks?
Cottage’s Maryland home care focuses on non-medical personal assistance. Some approved CFC services may involve medication-related or delegated nursing tasks. Those tasks require qualified workers and the nursing oversight set by Maryland law. A regular personal-care worker should not perform a skilled task outside their training or authority. Ask the supports planner and nurse monitor how the person’s medical needs will be met.
Can a Family Member Be Your Paid CFC Caregiver?
Yes, a family member or trusted friend may be able to provide paid CFC personal assistance. But there are two separate approvals to think about: the person receiving care must qualify for services, and the proposed worker must meet the rules for the way care is arranged. Caring for someone now does not mean past hours will be paid later.
Agency-Managed Care vs. Self-Directed Care
| Agency-managed CFC care | Self-directed CFC care |
|---|
| A Medicaid-enrolled personal assistance agency hires and oversees workers. A family member may be considered for an approved worker role if the rules allow. | The participant takes a greater role in selecting, hiring, training, and directing their workers, with financial management and counseling support. |
| The agency manages employee screening, work instructions, nurse oversight, and service records. | The participant works with a supports planner and the program’s financial management service for the required employer and payment steps. |
| Under COMAR 10.09.84.06, an agency cannot assign the participant’s representative to be that participant’s paid personal assistance worker. | Family relationships and decision-making roles still require a case-specific review. Ask the supports planner which worker rules apply in this model. |
Maryland has published information about CFC self-direction through its Community First Choice Self-Direction training program and state-plan notice. Do not assume self-directed services use the same agency hiring or payroll arrangement as standard agency-managed care.
Can a Parent, Spouse, or Legal Guardian Be Paid?
The answer depends on the person’s role and the model. Under Maryland’s agency-managed rule, the agency may not assign the participant’s representative as their paid personal assistance worker. The legal definition includes someone who signs or makes decisions about the Plan of Service, a legal guardian, and a parent or foster parent of a dependent minor child. COMAR 10.09.84.02 defines that role, and COMAR 10.09.84.06 explains the agency restriction.
If you are a spouse or another relative, explain your exact role before assuming you qualify or do not qualify. Ask the supports planner whether the agency-managed or self-directed arrangement applies, which relationship rules are in force, and who would be responsible for payroll. Cottage can explain its own caregiver hiring process if you are considering the agency route.
Important: Payment can begin only when the participant’s covered care is authorized and the worker is properly enrolled or hired for the approved role. CFC is not a way to bill Maryland for informal help you gave before approval.
For broader caregiver eligibility questions, see our guide to getting paid to care for a family member in Maryland.
Who Qualifies for Community First Choice Maryland?
Maryland says a person must meet all three main conditions:
- Have full Maryland Medicaid: Medicare alone, private health insurance, or limited Medicare premium assistance does not replace this condition.
- Need institutional-level care: A state assessment must confirm the level of help needed under the program rules.
- Live at home or in a community setting: The approved support is meant to help the person remain outside an institution.
There is no age minimum for CFC. A child, adult with a disability, or older adult can be considered if the other rules are met. Age or a diagnosis alone does not decide the case. The state also looks at whether the help needed is more than routine family or parenting care.
Do I Need to Meet a Special CFC Income Limit?
CFC does not use one income number for everyone. You first need an eligible full-Medicaid coverage category. Income, countable assets, and other financial rules can differ by age and Medicaid pathway. A Medicare Savings Program such as QMB-only or SLMB-only help does not, on its own, mean you have full Medicaid. If you are not sure what coverage you have, ask Maryland Medicaid to check before starting the CFC assessment.
Read our Maryland Medicaid eligibility guide for the broader financial rules. If Medicaid has not been approved yet, ask your local Department of Social Services or visit Maryland’s official Medicaid application page to find the right application route.
How to Apply for Community First Choice in Maryland
You can begin even if you are not sure whether CFC is the right program. The official Maryland CFC office can explain what to do next. If the person does not yet have full Medicaid, getting the proper coverage is an early step.
- Make the first call. Call Maryland Access Point at 844-627-5465 or the CFC program at 410-767-1739. Say that the person needs help with daily tasks at home and wants to ask about CFC.
- Check full Medicaid coverage. Confirm which Medicaid coverage the person has. If they still need to apply for Medicaid, ask which application system and local office fit their case.
- Complete a state care assessment. An authorized assessor looks at bathing, dressing, mobility, safety, and other daily needs. Tell them what a normal day is like, including difficult days.
- Work with a supports planner. The participant and supports planner develop a proposed Plan of Service. The plan explains needs, requested tasks, providers, and other supports.
- Wait for the service decision. Maryland or its authorized reviewer decides what services and hours can be covered. If the decision is unclear, ask for the notice and next steps.
- Finish worker and agency setup. Choose an agency or discuss self-direction with your supports planner. Complete staffing, screening, any required nurse assessment, and service arrangements before the approved start date.
A Simple Checklist for the First Call
- The person’s county, ZIP code, and best contact number
- Whether they already have full Maryland Medicaid
- Daily tasks they cannot complete safely without help
- Any current caregiver, nurse, family support, or existing Plan of Service
- Any letters about assessments, Medicaid status, or service approval
The appropriate office may request identity, income, residency, or health records later. Do not send Social Security numbers, Medicaid ID numbers, bank records, or detailed medical files through an unsecured email or ordinary contact form.
Where Cottage fits: We can discuss the care your family needs, help you organize intake questions and paperwork, explain the agency hiring route, and coordinate approved personal assistance. The supports planner develops the plan with you; Maryland makes the eligibility and service decisions. Call (667) 400-0648 to ask where to start.
How Are CFC Hours Approved, and When Can Care Start?
There is no standard number of CFC hours for every person. The assessor records what the person needs, the supports planner uses that information to prepare a Plan of Service, and the state reviews the services and hours requested. The approved plan—not a verbal estimate or a fixed online formula—controls what Medicaid can pay for.
A useful way to prepare is to write down which tasks are hard, how often help is needed, how long they usually take, and where safety risks arise. Include evenings, weekends, and tasks the family is already doing. Be clear about what the person can do alone and when hands-on help is essential.
CFC has no waiver-style enrollment waitlist, but an assessment, plan review, authorization, and worker or agency setup can still take time. If a person has newly approved care, the start date also depends on provider availability and other required steps. No provider can promise a specific number of hours or an automatic start date.
If health needs change after approval, tell the supports planner. The team can ask for a reassessment or plan change when appropriate; that request does not guarantee more hours.
Maryland uses different programs for different care needs. A person who does not meet CFC’s institutional-level requirement may still want to ask about CPAS. The Community Options Waiver is separate and has a registry.
| Program | Main eligibility point | Enrollment route |
|---|
| Community First Choice (CFC) | Full Medicaid; institutional level of care; home or community; no age limit. | State-plan benefit; no Community Options registry. |
| Community Personal Assistance Services (CPAS) | Full Medicaid; needs help with at least one activity of daily living; community setting; no age limit. | State-plan benefit; ask about a CPAS assessment. |
| Community Options Waiver | Age 18+; nursing-facility level of care; separate financial and other rules. | Waiver registry for most community applicants, with limited exceptions. |
The Maryland CPAS program page explains its daily-living requirement. The Community Options Waiver page explains its waitlist and the special application route for certain nursing facility residents. Someone on the waiver registry may still ask about CFC without waiting for an invitation to the waiver.
For help arranging agency services rather than understanding the rules, visit our Maryland Community First Choice service page or read about Maryland Community Options services.
How to Choose or Change a CFC Home Care Agency
If you are looking for a CFC agency, ask practical questions about the care the person needs. A provider may serve your county but not have a caregiver available for every shift. A good conversation covers:
- Does the agency accept the approved services and serve our address?
- Can it staff the days and times listed in the Plan of Service?
- What training and nurse oversight support the specific tasks?
- What happens if the regular caregiver is sick or unavailable?
- How will the agency communicate with the participant and supports planner?
- If a relative wants to be the caregiver, what worker rules and hiring steps apply?
If you already receive CFC through another agency, speak with your supports planner and both agencies before changing providers. Confirm the new agency can serve you and the service plan and authorizations will be updated as needed. Ask for the confirmed transition date before ending existing care so you reduce the chance of a gap.
How Cottage Home Care Helps Maryland Families
Cottage Home Care Maryland works with families seeking non-medical personal assistance through Maryland home care programs. You can contact us before an assessment, while paperwork is still being reviewed, or after you have an approved Plan of Service.
- Not sure whether you have the right Medicaid coverage? We can explain which official office to contact and what information is useful to have ready.
- Have daily-care needs but no assessment yet? We can explain the CFC steps and how to ask for a state assessment.
- Already caring for a parent or other relative? We can talk about whether an agency-managed paid caregiver role may be an option and explain the hiring steps.
- Asked for more forms or paperwork? We can help you review the request and organize your next response.
- Approved and looking for a provider? We can review your service needs, address, and schedule and check current staffing availability.
- Want to switch agencies? We can explain the intake process and coordinate with your supports planner when applicable.
Our Maryland office is at 6310 Stevens Forest Rd, Suite 100, Columbia, MD 21046. We support families across Maryland’s 23 counties and Baltimore City, subject to staffing availability. Cottage cannot approve state benefits, set Medicaid care hours, or promise when the state will finish an application.
Already feeling stuck? You do not need to know every program rule before calling. Tell us who needs care, which county they live in, which daily tasks are hard, and whether Medicaid is active. Call (667) 400-0648 for a conversation about next steps.
Frequently Asked Questions
Is Community First Choice the same as Medicare home health care?+
No. CFC is a Maryland Medicaid personal assistance benefit. Medicare home health care uses different coverage rules and usually focuses on eligible skilled medical care. Having Medicare alone does not establish CFC eligibility.
Is there a waitlist for Community First Choice Maryland?+
CFC has no limited-slot registry like the Community Options Waiver. However, the person still must meet Medicaid and care requirements, complete an assessment, and receive approval for an active Plan of Service.
Can I apply for CFC while on the Community Options Waiver registry?+
Yes. The two enrollment routes are different. If you already have full Medicaid, ask Maryland Access Point about a CFC assessment even if you are waiting for the waiver.
Can my adult child or sibling be my paid CFC caregiver?+
Possibly. The care recipient must qualify for CFC, the worker must meet the applicable hiring rules, and the arrangement must be approved. Ask whether agency-managed or self-directed care applies to your case.
Can a spouse or legal guardian be paid under CFC?+
Relationship and representative rules matter. Under the agency-managed regulation, an agency cannot assign the participant’s representative as the paid worker. Ask your supports planner to check any different rules that may apply under an approved self-directed arrangement.
Does CFC cover 24-hour care or every hour my family helps?+
Not automatically. The state reviews the person’s assessed needs and approves specific services and hours. Unapproved or past informal caregiving is not automatically payable.
Can I use CFC without a family caregiver?+
Yes. A participant may choose an eligible agency to provide approved personal assistance. A relative is not required.
Is CDPAP a Maryland program?+
No. CDPAP is a program name associated with New York. Maryland calls this Medicaid benefit Community First Choice, and its own rules apply.
Can Cottage help before my CFC plan is approved?+
Yes. We can discuss the person’s needs, explain agency intake and caregiver hiring requirements, and point you to the right official application steps. Maryland—not Cottage—decides eligibility and covered hours.
Talk With Cottage About Paid Family Caregiving
If you already care for a parent or another relative, or you need a caregiver to help at home, Cottage can discuss whether Maryland’s CFC agency services may fit your needs. We can help you plan the next conversation with Medicaid and your supports planner.
Talk to Cottage Home Care Maryland
Call with your county, a short list of daily care needs, and any Medicaid or CFC status you know. You can ask about agency availability or whether a qualified relative may be considered as a worker.
Official Sources and Further Reading
Alex TullaoRegistered Nurse
