Page Reviewed / Updated – May 6, 2024

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
In 2024, single applicants 65 years of age or older qualify for Community First Choice if their income is less than $350 a month. For a couple with both spouses applying, the monthly limit is $392

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.” 

Asset Limits
A single applicant’s assets cannot exceed $2,500. A couple, with both spouses applying, is allowed $3,000 in assets.

When only one spouse of a married couple is applying, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $30,828, the non applicant spouse can keep all of the assets, up to this amount.

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 $713,000 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.