Maryland's Community First Choice and Caring for Aging Loved Ones

 What are Community First Choice Programs?  Until recently Medicaid provided services to the elderly 3 ways: in nursing homes, at home through "HCBS Waivers" and through regular Medicaid "personal care."  Each has its shortcomings. The Affordable Care Act allows states a fourth option to provide aging care that addresses some of these limitations.

Program Description

Maryland Medicaid's new Community First Choice (CFC) aids elderly state residents who would otherwise require nursing home or intermediate care facility care. Care services are provided at home, in adult day care, or in assisted living. The best part is that, under CFC, there are no caps on the number of eligible people who can be enrolled simultaneously.

The level of assistance provided varies per the needs, but the primary focus is personal assistance with basic activities of daily living (ADLs), such as bathing and dressing, as well as instrumental activities of daily living (IADLs), such as meal preparation and transportation. 

 Under Community First Choice, participants can hire their family members to provide them with care and assistance.

The CFC Program emphasizes self-directed care and home and community-based services (HCBS). This means the program encourages participants to play an active role in the selection of the caregivers who will help them in their homes. With a few exceptions, program participants are permitted to hire their family members to act as their caregivers. The state sets caregivers’ wages. Medicaid approved caregiver rates are estimated at between $12 - $16 per hour.

CFC and Maryland's Medicaid Waivers 
Prior to Community First Choice, Medicaid paid for "home and community based services" (meaning non-nursing home care) through the Waiver for Older Adults and Medical Assistance Personal Care. With the launch of CFC, services have been re-aligned and programs renamed, but these waivers still exist. Beneficiaries can still receive the same services, but personal care is now provided under CFC. It is also possible to receive services from both regular Medicaid or a waiver and through CFC, if the services provided are not duplicated. Readers can read more about these other programs at the links below.

Community Options Waiver (formerly the Waiver for Older Adults)
Maryland Community Personal Assistance (formerly Medical Assistance Personal Care)
Maryland Medical Day Care

Eligibility Guidelines

Functional Need
At a minimum, applicants must have a diagnosed medical condition that demands the need for personal care assistance. A higher level of care need, such as a nursing facility level of care, increases the range of assistance services an applicant can receive.


Financial Need

CFC is a Medicaid program and its requirements mirror those requirements. To be eligible for Community First Choice in Maryland, an individual must be a Maryland resident and must qualify financially and demonstrate a medical need for personal assistance. 

In Maryland, single applicants, 65 years-old or older qualify with incomes less than 300% of the Supplemental Security Income Limit.  In 2017, this means a gross monthly income of $2205 or less.

For adults under 65, Medicaid rules say that their income must be less than 138% of the Federal Poverty Level (FPL), which equals $1,387 per month in income in 2017.

People who are not eligible for a nursing facility level of care may still qualify for CFC services if his/her income is below 150% of the FPL, which totals $1,508 for a single person in 2017.

Eligibility limits for assets, which exclude the value of a person’s home and certain other personal items, cannot exceed $2,500. Married applicants whose spouses are not applying for assistance may keep significantly more money. Up to $120,800 in jointly held assets can be allocated to the healthier spouse.

Assistance is available to help families or individuals qualify for Medicaid. Read more.

Benefits and Services

Community First Choice budgets are flexible and based on a person’s need. Services are focused on helping individuals stay at home when at risk of nursing home institutionalization. Participants are able to select an agency provider or choose someone from their family or community to provide care.  A non-exhaustive list of common benefits follows:

  • Personal assistance with daily tasks
  • Equipment that reduces the need for hands-on assistance (limited to $15,000 over a 3 years)
  • Nurse monitoring
  • Home-delivered meals
  • Personal emergency response services (a.k.a. PERS & MedicalAlert) installation and monthly fees
  • Environmental assessments for home or vehicle modifications
  • Laboratory work
  • Mental health services
  • Disposable medical supplies
  • Financial assistance to enable a move from a nursing home back to a home (up to $3,000)


How to Apply / Learn More

Community First Choice, unlike Maryland's Medicaid Waiver programs, by law has no waiting list for services.

To apply for Community First Choice, one must apply for Medicaid. For those who are confident they meet the program's eligibility requirements, the best way to start an application is through the state’s online Medicaid application. Persons uncertain about their eligibility should consult with an adviser who is familiar with the Maryland eligibility rules before applying. Read more about Medicaid planning. To find out more about Community First Choice, contact your local area agency on aging.