Maryland · state plan
Community First Choice (CFC) in Maryland
Community First Choice is a Maryland Medicaid state plan benefit that pays for personal assistance and related supports at home for people of any age who need an institutional level of care. Since October 1, 2023, participants can choose an agency model or a self-directed model, and a family member can be the paid personal assistant. Because CFC is a state plan benefit, there is no waiting list.
Also called: CFC · Community First Choice Program · Maryland CFC · CFC personal assistance · CFC self-directed
Who do you care for?
Quick facts
- Pay
- $16–$20/hr reported wage; agency rate $25.58/hr (FY2025)
- Adult children & other relatives
- Yes
- Spouse
- Sometimes
- Parent of a minor child
- Sometimes
- Waitlist
- none
Who qualifies for CFC
- Already has full Maryland Medicaid (the red and white card).
- Needs an institutional level of care (for example, nursing facility level of care), assessed with the interRAI tool.
- Lives in a community setting.
- No age limit.
Who can be paid as the caregiver
- Adult children & other relatives Yes
- participants may hire relatives such as adult children; the current CFC regulation bars only the participant's representative from being assigned as the worker.
- Spouse Sometimes
- current COMAR 10.09.84 text does not bar spouses, and states.json reports spouses can be hired, but an older Maryland Department of Health memo listed spouses and parents of minor children as barred; confirm with your supports planner.
- Parent of a minor child Sometimes
- not confirmed under CFC (the older memo barred parents of minor dependent children); paid-parent options are clearer in the DDA Community Pathways Waiver.
- Living together
- the worker does not have to live with the participant.
Who employs the caregiver: Either. In the agency model a personal assistance provider agency employs the worker; in the self-directed model (all CFC participants eligible since October 1, 2023) the participant hires and directs the worker and a fiscal intermediary handles payroll.
Spouse rules differ by program — see spouse pay in Maryland.
How much CFC pays
$16–$20/hr reported wage; agency rate $25.58/hr (FY2025). Medicaid paid personal assistance at $6.3962 per 15-minute unit ($25.58/hour) from July 1, 2024 (FY2025 transmittal), with a 3% yearly increase in rule subject to the budget. People needing more than 12 hours a day are paid a daily rate. That rate goes to the agency or the self-direction budget; workers' take-home pay is lower. Third-party sources report about $16–$20/hour for family caregivers; Maryland does not publish a family-caregiver wage.
Hours and budget: A supports planner writes a plan of service and the Department preauthorizes hours based on the interRAI assessment and standardized task times. Payment is in 15-minute units up to 12 hours a day, and a daily rate above that.
Compare with other Maryland programs on the Maryland caregiver pay page, or across states in pay rates by state.
Is there a waitlist?
CFC is a Medicaid state plan entitlement. Eligible people do not wait for a slot, though processing can take up to about three months.
How to apply for CFC
- Make sure you have full Maryland Medicaid; if not, apply through your local department of social services or Maryland Health Connection.
- Call Maryland Access Point at 844-627-5465 or the Community First Choice Program at 410-767-1739 to request CFC.
- Complete the interRAI level-of-care assessment and choose a supports planning agency.
- Build the plan of service, choose agency or self-directed, and name the family member you want as your personal assistant.
- Community First Choice Program (Office of Long Term Services and Supports) · 410-767-1739 · official site
- Maryland Access Point · 844-627-5465 · official site
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CFC questions
Can I get paid to take care of my parent in Maryland?
Yes, through Community First Choice if your parent has full Medicaid and needs an institutional level of care. Your parent can hire you through an agency or the self-directed model.
Is there a waiting list for CFC?
No. CFC is a state plan benefit, so there is no waiting list. Approval can still take up to about three months.
Can a spouse be paid under CFC?
It is not clear. The current CFC regulation only bars the participant's representative, and some sources say spouses can be hired. An older state memo said spouses could not. Ask your supports planner before counting on it.
What is the difference between CFC and CPAS?
CFC requires an institutional level of care and offers more services, like home-delivered meals and assistive technology. CPAS is for people who need help with at least one daily activity but do not meet institutional level of care.
How much does CFC pay per hour?
Medicaid paid $25.58 an hour for personal assistance in FY2025, but that goes to the agency or self-direction budget. Family caregivers are reported to earn about $16–$20 an hour.
Can I use CFC with the Community Options Waiver?
Yes. Community Options Waiver participants get all Medicaid benefits, including CFC personal assistance.
Sources: health.maryland.gov · dsd.maryland.gov · dsd.maryland.gov · health.maryland.gov · medicaidplanningassistance.org · Updated 2026-10-08. Program rules change — always confirm with the program.
Where most Maryland caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in Maryland — pick yours for the local picture.
Across the line
States that border Maryland
Each state writes its own rules, and they differ more than people expect — a spouse who can be paid on one side of the line often cannot be on the other.