Key Takeaways
- The biggest difference: Community First Choice (CFC) is a Medicaid benefit with no separate enrollment waitlist. The Community Options Waiver has a statewide Services Registry.
- What both require: A state assessment showing an institutional or nursing-facility level of care, plus the program’s other rules.
- What CFC covers: Approved help with bathing, dressing, eating, moving around, and some home safety supports.
- What the waiver adds: Extra options such as assisted living services, case management, and medical day care. Room and board are not paid by the waiver.
- Do not wait to ask: You can ask about CFC while your name remains on the Community Options Services Registry.
- Where to start: Call Maryland Access Point at 844-627-5465. A state review decides eligibility, approved services, and care hours.
If your parent needs daily help, you may hear two names: Community First Choice (CFC) and the Community Options Waiver. Both are part of Maryland Medicaid. Both help people stay in the community. But they do not work the same way.
Here is the short answer: CFC has no separate waiting list and mainly helps with personal care at home. The Community Options Waiver has a Services Registry and can add supports such as assisted living, medical day care, and case management. Which one fits depends on the person’s Medicaid coverage, care needs, and other state rules. This guide shows how to compare the two and what to ask next.
In Maryland, “the waiver” can mean several programs. This guide compares the Home and Community-Based Options Waiver (HCBOW) with CFC.
In This Guide
What Is the Difference Between Maryland Waiver and CFC?
CFC vs. Community Options Waiver: Side-by-Side
Which Program Should You Ask About First?
Who Qualifies for Each Program?
What Services Does Each Program Cover?
Why Does the Waiver Have a Registry but CFC Does Not?
Can You Apply for CFC While on the Waiver Registry?
How to Apply: Two Different Paths
Can a Family Member Be a Paid Caregiver?
What If You Need Help Before Approval?
How Cottage Home Care Maryland Can Help
Maryland Waiver vs. CFC FAQs
Official Maryland Program Sources
What Is the Difference Between Maryland Waiver and CFC?
CFC is a Medicaid state-plan benefit. It pays for approved personal assistance and related supports. There is no waiver slot or Services Registry to wait for. A person still needs an assessment, Medicaid eligibility, an approved Plan of Service, and a provider before care can begin.
The Community Options Waiver is a limited-enrollment home and community-based waiver. It serves adults who meet its medical, financial, and other rules. It includes extra waiver services. Most people applying from home begin by joining the statewide Services Registry.
Maryland lists the programs separately in its CFC overview and Community Options Waiver overview.
CFC vs. Community Options Waiver: Side-by-Side
This table answers the questions most families ask first. On a phone, swipe across the table to read every column.
| Feature |
Community First Choice |
Community Options Waiver |
| What kind of program? |
Medicaid state-plan benefit |
Limited-enrollment Medicaid waiver |
| Who can apply? |
No minimum age |
Adults age 18 and older |
| Care need |
Assessed institutional level of care |
Assessed nursing-facility level of care |
| Medicaid and income |
Must have full Medicaid; financial rules depend on the coverage path |
Separate waiver financial rules; income and assets are reviewed |
| Waiting list |
No separate enrollment registry |
Services Registry for most community applicants |
| Core services |
Personal assistance, nurse monitoring, supports planning, home safety supports when approved |
Additional waiver services such as assisted living, case management, medical day care, behavior consultation, and family training |
| Can a relative help? |
A qualified relative may be paid to give authorized CFC personal assistance, subject to worker and representative rules |
Waiver enrollment does not itself approve caregiver payment; any CFC personal assistance still follows CFC worker and service rules |
| Assisted living |
Not a stand-alone assisted living benefit |
Can cover approved assisted living services; not room and board |
| How to start |
Ask Maryland Access Point or the CFC program office for the correct assessment and Medicaid steps |
Join the Services Registry through Maryland Access Point, unless a special application route applies |
The programs can work together. Maryland states that eligible Community Options participants receive Medicaid-covered benefits, including CFC, along with approved waiver services. That does not mean two agencies can bill for the same personal-care task.
Which Program Should You Ask About First?
Need help bathing, dressing, or moving at home, and already have full Medicaid? Ask about CFC now. It has no separate waiver registry, although approval and staffing still take time.
- Need assisted living or medical day care? Ask about the Community Options Waiver and its Services Registry. Ask about CFC personal care too, if you may qualify.
- Already living in a nursing facility? If Medicaid has paid for at least 30 days of facility services, you may be able to apply for the waiver without waiting on the registry.
- Need help with one daily task but do not meet an institutional level of care? Ask whether Community Personal Assistance Services (CPAS) could fit. It is a separate Medicaid benefit.
- Do not have full Medicaid yet? Ask which financial application path applies before assuming CFC is available.
You can share your situation with Cottage Home Care Maryland at (667) 400-0648. We can explain the home care and intake side. Maryland makes the final program decisions.
Who Qualifies for CFC and the Community Options Waiver?
Community First Choice eligibility
- Full Maryland Medicaid. Medicare by itself or a Medicare Savings Program benefit by itself is not enough.
- An institutional level of care. The state reviews the care the person needs; a diagnosis alone does not prove eligibility.
- Community living. The person receives services in an eligible home or community setting.
- No age limit. Maryland does not set a minimum age for CFC.
Community Options Waiver eligibility
- Age 18 or older and a nursing-facility level of care.
- Medical and financial eligibility. The waiver uses its own income and asset rules. Maryland lists an income ceiling of 300% of the SSI benefit amount and asset tests that vary by eligibility group.
- Community safety and program rules. The person must be able to live safely in an approved community setting with the waiver’s help. Other waiver or PACE enrollment restrictions may apply.
Married applicants may have different financial protections from single applicants. If your family has savings, a home, or a spouse still living at home, ask the state or a qualified benefits advisor to review the correct rules before moving assets or withdrawing an application. For general financial eligibility, see our Maryland Medicaid eligibility guide.
What Services Does Each Program Cover?
Covered help through CFC
CFC can pay for approved personal assistance, such as help with bathing, dressing, eating, toileting, and safe movement. A plan may also include nurse monitoring, supports planning, a personal emergency response system, home accessibility changes, assistive technology, or home-delivered meals. Not every service is approved for every person.
Extra support through the waiver
The Community Options Waiver adds services that CFC alone does not provide. Maryland lists assisted living services, medical day care, case management, behavior consultation, family training, Senior Center Plus, and dietitian or nutritionist services. The approved plan determines which services the person can use.
Important assisted living cost detail: Waiver funding can pay for approved assisted living services, but not room and board. Ask the facility and the supports team what charges remain your responsibility.
If you only need help with lighter daily tasks, CPAS is another program to ask about. Maryland says it covers personal assistance, nurse monitoring, and supports planning for eligible members who need help with at least one daily activity. See the official CPAS rules.
Why Does the Waiver Have a Registry but CFC Does Not?
CFC is a state-plan benefit. It has no separate enrollment cap or Services Registry. But there can still be time between the first call and the start of care. The state must review eligibility and the Plan of Service, and an approved provider must be ready.
The Community Options Waiver has limited enrollment. Maryland uses a Services Registry, often called a waiting list, for people applying from the community. Joining the registry is not the same as being approved for Medicaid waiver services.
The registry is also not simply first come, first served. Maryland’s published report explains that the state uses a Level One Screen and priority groups to identify people at higher risk of entering a facility. Ask Maryland Access Point whether your screening information is current and what to do if the person’s needs have changed. Read the Maryland Department of Health registry report (PDF).
What if someone is already in a nursing facility?
Maryland says someone in a nursing facility may apply for the Community Options Waiver without waiting on the registry if Medicaid has paid for at least 30 days of facility care. Talk with the facility social worker or an options counselor. Other waiver rules must still be met.
Can You Apply for CFC While on the Waiver Registry?
Yes, it is worth asking about CFC while you are on the waiver registry. CFC is a separate state-plan benefit. You do not have to leave the Community Options Services Registry to ask whether you qualify for it.
If a person later joins the Community Options Waiver, their approved care can include CFC benefits plus separate waiver services. A supports planner helps explain how the services fit into one Plan of Service. No program pays twice for the same help or pays for informal care before authorization.
If a family has received a waiver invitation, follow the instructions and deadlines on that notice. Do not ignore the invitation because CFC services have already started.
How to Apply: Two Different Paths
If you want to ask about CFC
- Call the right program. Reach Maryland Access Point at 844-627-5465 or the CFC program office at 410-767-1739.
- Check full Medicaid coverage. If you do not have it, ask the proper Medicaid eligibility office how to apply.
- Complete the assessment. The state reviews the person’s daily needs and required level of care.
- Work on the Plan of Service. A supports planner helps describe the proposed care, services, and providers.
- Wait for approval and provider setup. Approved services can begin once authorization and staffing arrangements are complete.
If you want to ask about the Community Options Waiver
- Join the Services Registry. Call Maryland Access Point at 844-627-5465 and ask about the Level One Screen.
- Keep your contact details current. Ask how to report changes in health or risk.
- Watch for an invitation. When invited, follow its deadlines for the Medicaid financial application and the medical and technical reviews.
- Ask about the facility route. If Medicaid has paid for at least 30 days in a nursing facility, discuss applying without registry waiting.
- Set up approved services. A plan and provider arrangements are needed before Medicaid-covered waiver services start.
Have ready: the person’s county, Medicaid status, a short list of tasks they need help with, and a summary of current support. Do not send Social Security numbers, bank statements, or full medical files through an unsecured email or website form.
Can a Family Member Be a Paid Caregiver?
Some CFC participants can choose a qualified relative or friend to provide approved personal assistance. The person receiving care must qualify, and the caregiver must meet worker rules. Pay is for services that the state has authorized, not for earlier unpaid care.
Caregiver arrangements depend on the approved service model. A family member may work through an approved agency arrangement or a permitted self-directed model. Those are not identical payroll setups. Under CFC agency rules, a provider agency cannot assign the participant’s representative to be that participant’s paid worker. That role may include someone who makes decisions about the Plan of Service or signs it for the participant. See COMAR 10.09.84.06.
The Community Options Waiver does not automatically make a family member a paid worker. If the person is also receiving CFC personal assistance, the CFC plan and worker rules matter. Read our separate Maryland family caregiver pay guide for those details.
What If You Need Home Care Before Approval?
If someone is going home from a hospital soon, tell the discharge planner what help they cannot safely do alone. Ask what Medicare-covered home health, local support, or another short-term option may be available. Those services are not the same as CFC personal assistance.
A family can also ask about private-pay home care while Medicaid paperwork is in progress. Ask for a written cost estimate and current staff availability. Medicaid does not automatically repay earlier private-pay charges.
If you were told “there is a Medicaid home care waitlist,” ask one more question: “Were you talking about the Community Options Waiver, or have we been assessed for CFC and CPAS too?”
How Cottage Home Care Maryland Can Help
Cottage Home Care Maryland provides non-medical home care and helps families understand the intake steps for approved personal assistance. We can talk about a relative’s daily needs, explain what to prepare, discuss agency and family-caregiver options, and coordinate with a supports planner when services are authorized.
We can also help you understand where a request or document step stands and which office handles the next decision. Maryland makes the eligibility and service-approval decisions; Cottage cannot promise approval, a set number of care hours, or an immediate start date.
Want to talk through CFC versus the waiver? Call (667) 400-0648 or use our Maryland contact page. Tell us your county, whether the person has full Medicaid, and what daily help they need. You can also review Cottage’s CFC service page and Community Options service page.
Maryland office: 6310 Stevens Forest Road, Suite 100, Columbia, MD 21046. Email: maryland@cottagehomecare.com.
Maryland Waiver vs. CFC: Frequently Asked Questions
Is CFC a Medicaid waiver in Maryland?+
No. Community First Choice is a Medicaid state-plan benefit. The Community Options Waiver is a separate, limited-enrollment waiver. Both can help eligible people receive care in the community.
Which has a waiting list: CFC or the Community Options Waiver?+
The Community Options Waiver uses a statewide Services Registry for most applicants living in the community. CFC has no separate enrollment registry. Both still require review and authorization before services begin.
Can I get CFC while waiting on the Community Options Waiver?+
You can ask about CFC while your name is on the waiver registry. CFC uses its own eligibility and authorization process. A registry listing by itself does not make you eligible for CFC.
Can one person receive CFC and Community Options Waiver services?+
Yes, when eligible and approved. Maryland says Community Options participants receive Medicaid-covered benefits, including CFC, as well as authorized waiver services. Services must be coordinated without duplicate payment for the same task.
Does the waiver pay for assisted living room and board?+
No. The waiver may cover approved assisted living services, but room and board are generally the resident’s responsibility. Ask for a full written breakdown of charges.
Can my daughter or son get paid to care for me?+
Possibly, through approved CFC personal assistance if the care recipient and worker meet the rules. Representative restrictions and agency or self-direction requirements matter. Pay cannot start for unapproved past hours.
What if I need help bathing but do not meet a nursing-facility level of care?+
Ask Maryland Access Point about Community Personal Assistance Services (CPAS). It is a separate state-plan benefit for certain full-Medicaid members who need help with at least one activity of daily living.
Is the waiver registry first come, first served?+
Not entirely. Maryland’s published registry report describes screening and priority groups based on risk of institutional care. Ask Maryland Access Point how current screening information affects your case.
Can someone in a nursing home skip the waiver registry?+
Maryland allows a person to apply without waiting when Medicaid has paid for at least 30 days of nursing-facility services. The person must still meet the waiver’s other rules.
What if my parent has Medicare but not full Medicaid?+
Medicare alone does not meet CFC’s full-Medicaid rule. Ask a Maryland Medicaid eligibility office about possible coverage pathways, and ask the discharge team about any other care options available now.
Who should I call about Maryland Waiver vs. CFC?+
For official program steps, call Maryland Access Point at 844-627-5465. To discuss Cottage Home Care’s intake and care arrangements, call (667) 400-0648.
Official Maryland Sources and Next Steps
These Maryland sources explain the program rules. For changes in coverage, waiver enrollment, and financial limits, use the official pages rather than an old blog estimate.
Program facts checked against Maryland Department of Health information in October 2026. Only the state can decide eligibility and authorize services.
Alex TullaoRegistered Nurse
