Page Reviewed / Updated – June 27, 2023

Program Description

Maryland Medicaid’s Community First Choice (CFC) state plan option aids elderly and disabled state residents who would otherwise require care in a nursing home or intermediate care facility. Via CFC, care services are provided at home, the home of a loved one, or in a foster care home. The best part is that under CFC, there are no caps on the number of eligible people who can be enrolled simultaneously. This means that anyone who meets the eligibility requirements is able to receive services through this program.

The level of assistance provided varies per the needs of the individual. But the primary focus is personal assistance with their 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.

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 family members to act as their caregivers. The state sets caregivers’ wages within a given range.

Other Maryland programs that provide similar services that might be of interest to seniors are:

Community Options Waiver
Community Personal Assistance
Medical Day Care

Eligibility Guidelines

General Requirements

In addition to being a resident of Maryland, applicants must require a nursing home level of care. The higher the level of care needed, the greater the range of assistance services an applicant can receive.

Financial Requirements

Income Limits
Single applicants 65 years of age or older qualify for Home and Community Based Services Medicaid Waivers if their income is less than 300% of the Supplemental Security Income (SSI) limit. In 2023, this means a gross monthly income of $2,742 or less. Seniors who are enrolled in a Medicaid Waiver qualify for CFC.

Seniors may also qualify for Community First Choice by being eligible for Medicaid via Maryland’s state plan. For the Aged, Blind, and Disabled, this income limit is very low and has not changed in many years. As of 2023, the income limit is $350 a month for a single applicant, and $392 a month for a married couple. That said, persons over the income limits are able to spend their “excess” income on medical and care expenses. Once they have “spent down” their income to the income limit, they are able to qualify for Medicaid. This is known as the “medically needy pathway.” 

It’s important to mention that persons who receive SSI automatically qualify for Medicaid.

Asset Limits
A single applicant’s assets cannot exceed $2,000 or $2,500, depending on the Medicaid eligibility route. (The asset limit for qualification via a Medicaid waiver is $2,000, and for qualification via the Aged, Blind, and Disabled pathway it is $2,500.) A couple, with both spouses applying, is allowed $3,000 in assets.

Married applicants whose spouses are not applying for assistance may keep significantly more money. As of 2023, up to $148,620 in jointly held assets can be allocated to the healthier spouse. This is called the community spouse resource allowance.

In addition, some assets are not counted toward the asset limits. Exempt assets include the value of a person’s home, given its equity is valued under $688,000 and the applicant (or his or her spouse) lives in the home, and certain other personal items.

Benefits and Services

Community First Choice budgets are flexible and are 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 list of common benefits includes:

  • Supports planning
  • Personal assistance with daily tasks
  • Home health
  • Technology equipment that reduces the need for hands-on assistance
  • Durable medical equipment
  • 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
  • Lab work
  • Mental health services
  • Disposable medical supplies
  • Doctor / hospital visits
  • Financial assistance to enable a move from a nursing facility back to a home

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How to Apply / Learn More

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.

More information about Community First Choice can be found here. One can also call Maryland Department of Health’s Long Term Services and Supports at 410-767-1739, or Maryland Access Point at 844-627-5465.

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