Community First Choice Maryland: Medicaid Home Care Without a Waitlist

The Community Options Waiver has a waitlist exceeding 24,000 people and wait times measured in years. But Maryland's Community First Choice program — CFC — covers many of the same home care services with one critical difference: there is no waitlist. CFC is a state plan entitlement under the Affordable Care Act, meaning every Maryland resident who meets the eligibility criteria must be approved.

Eligibility Requirements

To qualify for CFC, your parent needs:

• Full Maryland Medicaid coverage (either categorically or through the medically needy spend-down)
• An institutional level of care — meaning they require the kind of hands-on assistance that would otherwise be provided in a nursing facility
• Residence in a community setting — their own home, a family member's home, or an assisted living program

The functional assessment is conducted using the interRAI-HC tool, which evaluates your parent's ability to perform activities of daily living like bathing, dressing, toileting, transferring, and eating. The assessment determines whether the level of care meets the institutional threshold.

What CFC Covers

CFC provides core supportive services that make it possible for a parent to stay home safely:

• Personal care assistance with daily living activities (bathing, dressing, grooming, meal preparation)
• Nurse monitoring and health maintenance tasks
• Home-delivered meals
• Personal emergency response systems
• Assistive technology devices
• Home accessibility modifications (grab bars, ramps, widened doorways)

Hiring a Family Member as a Caregiver

One of CFC's most important features is the self-directed care model. Under this option, your parent (or their representative) becomes the employer of record and can hire, train, and manage their own personal care workers — including family members.

This means an adult child, spouse, or other relative can be paid through Medicaid to provide the personal care assistance your parent needs. The self-directed model requires completing an employer orientation, maintaining timesheets, and following the program's fiscal management requirements.

How to Apply

Applications go through Maryland Access Point (MAP), the state's No Wrong Door intake system. Call 1-844-MAP-LINK (1-844-627-5465) or visit your county's local MAP site. A MAP options counselor will help evaluate your parent's needs, determine financial eligibility, and route the application.

Because CFC is an entitlement — not a capped waiver — the approval timeline depends only on completing the eligibility verification and functional assessment, not on slot availability.

CFC vs. the Community Options Waiver

CFC covers the essentials for aging in place. The Community Options Waiver adds services CFC doesn't include: assisted living placements, adult medical day care, professional case management, family training, and nutrition counseling. If your parent needs those additional supports, you may still want to apply for the COW — but CFC can start immediately while you wait.

The Maryland Hospital Discharge Guide includes step-by-step CFC application preparation, including the functional assessment checklist and the self-directed care contract template.

See more Maryland guides →