Community First Choice Maryland: Services, Eligibility & How to Apply
Key Takeaways
- CFC pays for hands-on help with daily tasks like bathing, dressing, and moving around the home, once Medicaid approves a plan.
- An eligible relative or friend may become a paid caregiver through Cottage. The person receiving care and the proposed caregiver must each meet separate requirements.
- Payment for CFC personal assistance can only begin once both your relative's plan and your hiring are approved, not for informal help already provided or given before authorization.
- CFC has no age limit, and it has no waiting list like the Community Options Waiver, though assessment, planning, and approval still take real time.
- To qualify, your relative needs full Medicaid, an assessed need for an institutional level of care, and a home or community setting.
- An assessment documents your relative's needs. Your relative works with a supports planner to develop a proposed plan, and Maryland Medicaid approves the services and hours.
- Your relative's representative, such as a legal guardian or a parent of a dependent minor child, cannot be hired to provide that same relative's paid personal assistance.
Community First Choice (CFC) is a Maryland Medicaid program that helps eligible people receive personal assistance at home or in the community. It can cover help with bathing, dressing, moving safely, and other approved daily tasks.
If you already help a parent or another relative with these tasks, you may be able to become their paid caregiver through Cottage. Your relative must qualify for the covered services, and you must meet the caregiver requirements. Cottage can help you understand both parts and support your family through the application and agency steps.
Call (667) 400-0648 to discuss paid family caregiving, your relative's care needs, and where to begin.
Table of Contents
What Is Community First Choice in Maryland?
Medicaid is government health coverage for people who meet certain income and other rules. CFC is one of Maryland's Medicaid programs, focused specifically on personal assistance with everyday tasks.
CFC is part of what the state calls Home and Community-Based Services. These are Medicaid services given where a person actually lives, not in an institution. What matters is whether the person needing care meets the state's assessed standard for the kind of care usually given in an institution, most often a nursing facility. This is called an institutional level of care. A person does not need to move into a nursing facility to explore CFC; they can meet this standard while still living at home (Maryland Department of Health, Community First Choice).
A few different roles work together under CFC. An assessment documents the daily help a person needs. The participant and a supports planner then develop a proposed Plan of Service based on that assessment. The Maryland Department of Health, or its authorized reviewer, approves eligibility and the services in that plan (Maryland Department of Health, Plan of Service Reviewer Training Manual). A home care agency like Cottage can coordinate with the participant and supports planner during planning, then provide personal assistance once the required approvals and service arrangements are in place. Cottage does not decide Medicaid eligibility or approve the plan.
What Help Can You Receive at Home Through CFC?
CFC covers hands-on help with the daily tasks that are hardest to manage alone. The exact help you get depends on your assessed needs and your approved plan of service. The table below shows common daily needs and what you might discuss with your assessor and supports planner.
| Daily need | What approved help may look like | What to discuss during planning |
|---|
| Bathing and grooming | An aide helps with washing, hair care, and basic skin care | How much hands-on help you need, and how often |
| Dressing | Help choosing and putting on clothing | Any mobility limits that make dressing hard |
| Toileting and continence | Help getting to the bathroom and managing continence supplies | What supplies and equipment you already use |
| Eating and meal preparation | Help preparing your own meals and eating them | Any dietary needs and who currently helps with meals |
| Mobility and transfers | Help moving safely around your home, and getting in and out of bed or a chair | Fall risk and any mobility equipment you use |
| Household tasks tied to your care | Light laundry or tidying connected to your own daily needs | What family or another program already handles |
| Cueing and reminders | Verbal reminders to safely complete a covered daily task | Which specific tasks need this kind of support |
Other Supports the CFC Program May Cover
Supports planning helps you develop and manage your Plan of Service. Nurse monitoring is required for participants actively receiving personal assistance (Maryland Department of Health, Plan of Service Reviewer Training Manual). Depending on your assessed needs and approval, CFC may also arrange additional benefits such as emergency response systems, assistive technology, home accessibility changes, consumer training, transition services, and home-delivered meals, a separate benefit from an aide helping you prepare your own meals (Maryland Department of Health, Community First Choice Overview). Each of these is arranged and approved through your plan, not automatically provided by any single agency.
How Personal Assistance Differs From Skilled Care
Cottage's Maryland services focus on non-skilled personal assistance, such as help with bathing, dressing, and mobility. Some CFC plans may include delegated nursing or medication-related tasks under Maryland's requirements (COMAR 10.09.84.14). Those tasks require appropriately qualified providers and the required nursing oversight. Ask your supports planner how any clinical care needs will be addressed alongside your personal assistance.
Can a Family Member Be Your Paid CFC Caregiver?
Yes. Some relatives or friends may be hired through an agency to provide approved CFC personal assistance. If you already help someone with bathing, dressing, meals, or mobility, Cottage can discuss whether a paid caregiving arrangement may fit your situation.
Two things have to be true. First, the person receiving care must qualify for CFC and have the relevant personal assistance services approved. Second, you, as the proposed caregiver, must meet the applicable worker and agency hiring requirements. These are separate questions, and one does not automatically decide the other.
Maryland restricts one specific role: the participant's representative cannot be assigned by the agency to provide that same participant's paid personal assistance. A representative is someone authorized to represent the participant for CFC, someone who signs the participant's Plan of Service on their behalf, or someone who makes decisions about that plan for them (COMAR 10.09.84.02, definitions). This also includes a legal guardian and a parent or foster parent of a dependent minor child (COMAR 10.09.84.06). The representative role is different from the supports planner, who helps build the plan but does not necessarily make decisions on the participant's behalf.
If you are not your relative's representative, you may be considered for hire through the home care agency, subject to the same background check and training steps as any other worker. This is not automatic. Cottage can explain the hiring steps, training requirements, and current pay information for the proposed caregiving role.
If a spouse is being considered as a paid caregiver, ask the supports planner to confirm how the representative rule and other requirements apply to your specific situation, since roles can differ from family to family.
If someone in your life is looking for caregiving work rather than asking about a specific relative's care plan, our careers page covers that separate path.
Already caring for a relative? Call Cottage at (667) 400-0648 to discuss their care needs and whether you could be considered as their paid caregiver.
Who Qualifies for Community First Choice Maryland?
To qualify for CFC, you generally need:
- Full Medicaid coverage, not only limited Medicare cost-sharing help
- An assessed need for an institutional level of care
- A home or community setting where you plan to receive care
- CFC has no age limit, so age alone will not stand in your way (Maryland Department of Health, Community First Choice)
The assessment looks at the real, daily help you need, not just a diagnosis or a hospital stay. A disability, an age, or a need for occasional chores does not by itself establish eligibility. Your assessment documents your care needs, and Maryland uses those findings to determine whether you meet the required level of care.
Full Medicaid Coverage and Financial Eligibility
There is no single income or asset number that applies to everyone applying for CFC. Maryland Medicaid uses different eligibility groups and pathways, and the right one for you depends on your age, income, assets, and household. If your income is above the regular Medicaid limit, you may still qualify through a Medicaid waiver pathway, which has its own rules.
It also matters whether you have full Medicaid or only a Medicare Savings Program benefit, like QMB (Qualified Medicare Beneficiary) or SLMB (Specified Low-Income Medicare Beneficiary). QMB-only or SLMB-only assistance does not, by itself, meet CFC's full-Medicaid requirement (Maryland Department of Health, Medicare Savings Programs). Some people have a Medicare Savings Program benefit and full Medicaid at the same time, so seeing QMB or SLMB on your record does not, by itself, tell you whether you also have full Medicaid. Ask your local Medicaid office to confirm your coverage, and do not close any existing benefit while you check your options.
If your income is too high for regular Medicaid, ask your local office about a spend-down or waiver option. Our Maryland Medicaid eligibility guide has more background, though the state's review always governs your case.
Children, Adults With Disabilities, and Older Adults
CFC has no age limit. Families of children with chronic conditions may ask about support with disability-related daily needs. Children go through an age-appropriate, individualized review, not the same process used for every adult, and ordinary parenting tasks are not automatically the same as payable, disability-related care. CFC will not duplicate help a child already gets through another Medicaid service.
A temporary need, such as recovering from a short hospital stay, does not by itself establish CFC eligibility. The program is built around an ongoing, assessed need for help with daily activities.
How to Apply for Community First Choice in Maryland
Applying for CFC involves a few connected steps. Some, like the assessment and your supports planner assignment, can move forward around the same time rather than in one fixed order for every county.
- Start the inquiry. Contact Maryland Access Point at 844-627-5465 or the CFC program directly at 410-767-1739. Cottage can also explain what to expect from agency intake, though our phone line is separate from the state's application line.
- Confirm your Medicaid coverage. Cottage works through the Local Department of Social Services Medicaid route. If your situation fits a different path, the Maryland Department of Health's guide to applying explains the other options.
- Complete a functional assessment. A state assessor reviews your daily needs. Around the same time, you work with a supports planning agency, one you choose or one assigned to you, to start building your proposed plan.
- Develop your proposed Plan of Service. This is the written plan listing your needs, current supports, and proposed services and providers. You and your supports planner build it together, and it becomes the plan the state reviews for approval.
- Complete provider arrangements and authorization. You and your supports planner coordinate with your chosen agency during planning. Your initial Plan of Service must identify your providers and start date. Services can begin once the required approval, enrollment, and agency preparations are complete.
What to Have Ready Before the First Call
Before you call, it helps to have:
- Your county or ZIP code
- Your contact information
- Any Medicaid coverage information you already have
- A description of the daily tasks you need help with
- Details about any current care or supports in place
- Assessment or plan information, if you already have any
The office handling your case may ask for identity, residency, income, or financial documents, depending on your application route. For your safety, do not put your Social Security number, Medicaid ID, bank statements, or medical records into an ordinary website form or email.
If you want help thinking through these steps, call Cottage Home Care Maryland at (667) 400-0648. We can talk about where you are in the process, what to expect next, and whether we currently have availability for your county and schedule.
How Are CFC Care Hours Approved, and When Can Care Start?
Your approved hours come from your assessed needs, your Plan of Service, and Maryland's review process, not a fixed formula. The assessment documents the daily tasks you need help with, and your proposed plan is built with your supports planner from that assessment, along with any support you already have from family or another program. Describing your typical day accurately, what you need help with and when, gives your assessor and supports planner what they need to build a plan that reflects your real situation.
Maryland uses standardized time guides to help reviewers think through common tasks (Maryland Department of Health, Standardized Times SOP). These guides support the review. They are not a promised number of hours, and they are not a formula you can use to calculate your own total in advance.
CFC does not have the same kind of enrollment registry as the Community Options Waiver, but assessment, plan review, authorization, worker preparation, and service arrangements still take real time. Starting care also depends on an agency having staff available to match your schedule. If your needs change after your plan is approved, contact your supports planner about a reassessment or a revised plan. A reassessment reviews your current situation; it does not guarantee more hours.
Maryland has more than one program for personal assistance and long-term care, and each one has its own rules. Here is a simple comparison.
| | Community First Choice (CFC) | CPAS | Community Options Waiver |
|---|
| Program type | Medicaid state plan benefit | Medicaid state plan benefit | Medicaid waiver |
| Level of care needed | Institutional level of care | Help with at least one daily activity, subject to full eligibility requirements | Nursing facility level of care |
| Age rule | No age limit | No age limit | Age 18 and older |
| Main services | Personal assistance, required nurse monitoring for participants receiving personal assistance, and other supports based on your approved plan | Personal assistance, nurse monitoring, and supports planning | Waiver services such as assisted living, medical day care, and case management; participants may also receive personal assistance through CFC, subject to its requirements |
| Enrollment route | No registry; state plan enrollment | State plan enrollment | Registry-based waiver enrollment (a nursing-facility route is explained below) |
| Next step | Contact Maryland Access Point or the CFC program | Ask your assessor if CPAS fits your needs | Ask about the registry and required assessment |
CPAS, the Community Personal Assistance Services Program, is included here as background; it has no age limit, but it has its own full eligibility requirements for help with daily activities (Maryland Department of Health, CPAS). Ask your assessor whether it fits your case. Community Options participants can access CFC benefits alongside their waiver services; CFC remains its own program with its own scope, not simply extra hours added to the waiver.
If you are currently in a nursing facility and Medicaid has paid for your care there for at least 30 days, Maryland allows you to apply for the Community Options Waiver without waiting on the registry (Maryland Department of Health, Community Options Waiver). You still need to meet the waiver's other eligibility rules; a past nursing-facility stay by itself does not establish this route.
How to Choose or Change a CFC Home Care Agency
If you are choosing an agency for the first time, or thinking about a change, a few practical questions can help:
Does the agency serve your county and your specific address?
Can they match the shifts and schedule your plan calls for?
Are their caregivers trained for the specific tasks in your plan?
How do they communicate updates about your care?
What happens if your regular caregiver is unavailable?
How do they work around your preferences and daily routine?
How will they coordinate with your supports planner and your approved plan?
If you already have an approved CFC plan and want to change agencies, start by talking with your supports planner and your current and new agencies about the change. Confirm the new agency can accept you and has staff available in your area. Then work through the needed changes to your plan and authorization. Confirm the exact transition date before your current agency stops providing care, so your services continue without a gap.
How Cottage Home Care Helps Maryland Families
As a licensed home-care agency, Cottage brings practical experience with Maryland home-care applications and service coordination. We've helped many families understand what's needed, organize their next steps, and move forward with confidence.
We can help with:
- Daily personal-care needs, like bathing, dressing, and mobility
- Intake preparation and application next steps
- Our Local Department of Social Services application-assistance route
- Arranging your approved personal assistance
- Questions about hiring an eligible family member as a paid caregiver
- Coordination when you are changing agencies
We help with application preparation, document requests, follow-up, and coordination of approved personal assistance. Your supports planner works with you to develop and manage your Plan of Service. Maryland determines Medicaid eligibility and approves covered services.
Our Maryland office is at 6310 Stevens Forest Rd, Suite 100, Columbia, MD 21046, and we serve families across Maryland's 23 counties and Baltimore City, including Baltimore City, Baltimore County, Anne Arundel County, and Howard County; see our full Maryland care programs overview for other areas. Staffing can vary by address and shift, so check current availability when you reach out.
Facing a Problem With Your Application or Home-Care Services?
You do not need to know exactly what is wrong before asking for help. Tell us what you have applied for, what information you have received, and where you feel stuck. Our team can help you understand the issue and work through the next steps with you.
| Your situation | How Cottage can help |
|---|
| "I care for my parent. Could I become their paid caregiver?" | Discuss your relative's care needs and CFC status, and explain the caregiver requirements you would need to meet. |
| "My relative does not have Medicaid yet." | Explain the Local Department of Social Services application route and what to prepare. |
| "We received a request for more documents." | Help you understand the request and organize what is needed for your response. |
| "Our application seems stuck." | Review where things stand, identify open questions or paperwork, and help you follow up with the right office. |
| "We received a decision we do not understand." | Help you understand the stated reason and identify the right contact and next steps, including any deadlines in the notice. |
| "My relative has approved hours, but we need an agency." | Discuss the authorized personal assistance, check availability for the address and schedule, and coordinate arrangements. |
| "We want to change agencies." | Explain the agency-change steps and coordinate with the supports planner where needed. |
Already helping a relative or stuck on an application? Call Cottage at (667) 400-0648. We can discuss your relative's care needs, explain the caregiver requirements, and help you work through the next steps. You can call even if you are unsure about their Medicaid status.
If you are exploring options outside of Medicaid, our private-pay home care page covers that separate path, and our personal care assistance page explains what that support usually looks like.
Frequently Asked Questions
Is Community First Choice the same as Medicare home health care?+
No. CFC is a Medicaid program, and Medicare home health care has its own separate rules and coverage. If you have Medicare, ask your local Medicaid office how your CFC eligibility works alongside any Medicare services you already receive.
Can I apply for CFC if I am already on the Community Options registry?+
Yes. Being on the Community Options Waiver registry does not stop you from applying for CFC. Since CFC does not use that same registry, ask Maryland Access Point or your local Aging and Disability office how to apply for CFC while you wait.
Can I receive CFC care if I do not have a family member who can be my caregiver?+
Yes. CFC personal assistance is delivered through a licensed home care agency's paid caregivers. You do not need a family member available to receive approved care. A family caregiver is only one possible option, not a requirement.
Can I choose Cottage if I already have an approved CFC plan?+
Yes. If your CFC plan is already approved, you can ask about arranging your personal assistance through Cottage right away. You are also welcome to contact us earlier, while your application or assessment is still in progress.
Does CFC cover 24-hour care or every hour my family helps me?+
Not automatically. Your approved Plan of Service sets the specific hours and tasks Medicaid will pay for, based on your assessed needs. CFC does not pay for every hour of informal family help, and approved coverage varies from person to person.
Is CDPAP available under that name in Maryland?+
No. CDPAP is a program name used in New York, not Maryland. Maryland's Medicaid program for personal assistance, including certain family-caregiver arrangements, is Community First Choice, and it follows its own separate rules.
Talk With Cottage About Paid Family Caregiving
If you already help a parent or another relative with daily care, contact Cottage to explore whether you could become their paid caregiver. We can explain the requirements, help with application preparation and follow-up, and coordinate approved personal assistance.
Call (667) 400-0648 or use our Maryland contact page. Tell us your county, your relationship to the person needing care, the daily help they need, and their Medicaid or CFC status if you know it. Whether you are starting an application or already have approved services, we can discuss your next step.
Alex TullaoRegistered Nurse
