When a parent needs more help than the family can give
It often starts small. A father in Canton skips showers because the tub feels unsafe. A daughter drives in from Dundalk every morning before work and every evening after, and it isn’t enough anymore.
If the person already has Maryland Medicaid, Community First Choice may pay for a trained worker to help at home. Here is how it works and how to apply from Baltimore.
What is Community First Choice in Maryland?
Community First Choice is a Maryland Medicaid program for people who need nursing-facility-level help but want to stay at home. MDH lists ten CFC services: accessibility adaptations, assistive technology, consumer training, environmental assessments, home-delivered meals, nurse monitoring, personal assistance, personal emergency response systems, supports planning and transition services. Participants keep all their regular Medicaid benefits (MDH Community First Choice page).
CMS approved Maryland’s current CFC plan amendment, MD-23-0012, effective July 1, 2023. It added a self-directed model and changed electronic visit verification rules (SPA MD-23-0012).
CFC services can be given in homes and apartments, small congregate settings serving 3 or fewer unrelated people, at work or in the community. They can’t be given in a nursing facility, a hospital, or a setting the provider owns or controls.
CFC is one of several programs on our Maryland Medicaid home care overview. It’s the main Medicaid route to personal assistance for adults with higher care needs.
Community First Choice eligibility in Maryland
All of these must be met.
| Rule | What it means | Where it comes from |
|---|---|---|
| Medical | MDH finds the person needs the level of care given in a hospital, nursing facility or similar institution | COMAR 10.09.84.04 |
| Technical | No age limit; the person must live at home in a community setting | MDH program page |
| Financial | Full Medicaid in an eligibility group under COMAR 10.09.24. MDH: “You have full Medicaid if you have a red and white card.” | MDH program page |
| Plan of service | An active plan naming the personal assistance provider, signed by the participant or representative, the supports planner and the provider agency | COMAR 10.09.84.04 |
MDH re-evaluates eligibility every 12 months, or sooner if needs change a lot.
If the person doesn’t yet have full Medicaid, that comes first. Our Medicaid eligibility guide covers the financial side. If needs fall below a nursing facility level, CPAS may be the better fit.
What CFC personal assistance covers, and what it doesn’t
Under COMAR 10.09.84.14, personal assistance covers help with daily activities, delegated nursing functions, tasks that need judgment to keep the participant safe, household tasks done alongside those services, and help with self-administered medications.
| CFC can cover | CFC does not cover |
|---|---|
| Bathing, dressing, toileting and moving around the home | Housekeeping unrelated to the participant’s care, like cleaning unused rooms or other people’s laundry |
| Supervision and cueing for someone who forgets steps | Shopping without the participant along |
| Household tasks tied to the participant’s care | Room and board, or the cost of food |
| Adaptations and technology, up to $15,000 combined over 3 years | Escort expenses for trips; experimental technology |
| Help with medications the participant takes on their own | Personal assistance outside Maryland for more than 30 days a calendar year |
The exclusions come from COMAR 10.09.84.23. Services also can’t be given to anyone other than the participant, so a worker can’t cook for the whole household.
Transition services help someone leave a nursing facility, are capped at $3,000 per move, and aren’t covered more than 60 days after the move. That makes CFC useful after a long rehab stay, alongside post-hospital home care.
Agency model vs self-directed Community First Choice
Since October 1, 2023, every CFC participant can choose either model. The main difference is who acts as the employer.
| Agency model | Self-directed model | |
|---|---|---|
| Who employs the worker | A licensed residential service agency under contract | The participant |
| Budget | Services set in the plan of service | A plan of service plus a service budget |
| Payroll, taxes, insurance | The agency | A state-contracted Financial Management and Counseling Services (FMCS) contractor |
| Setting the pay rate | The agency, as employer | The participant, with FMCS help |
| Worker training | The agency’s delegating nurse trains and assesses the worker on every task in the plan | The participant trains the worker; FMCS offers education and training support |
| First aid and CPR | Required | Required |
| Background check | Agency verifies it, including a state criminal history check | Required before hiring; the participant may waive action on results unless they show a history of harmful behavior |
| Visit tracking (EVV) | MDH’s EVV system | The FMCS contractor’s EVV system |
In the agency model, a worker doing delegated nursing tasks must be a CNA, and one giving medications must be a Certified Medicine Aide or Medication Technician. Agencies collect the participant’s signature verifying services at least monthly, under COMAR 10.09.84.06. Either way, participants can choose, train, schedule and dismiss their workers.
With an agency, the agency recruits, trains and employs the worker. Self-direction gives the participant more control over who is hired and how the budget is used.
Can a family member be paid through Community First Choice?
Here is what the official text supports.
In the self-directed model, the participant hires their own workers. Maryland’s CFC plan says the participant may permit “family members, or any other individuals” to provide CFC services, provided they meet the qualifications. Those include first aid and CPR certification and a background check.
Some details depend on the family’s situation, including who acts as the participant’s representative. In the agency model, for example, an agency may not assign the participant’s representative to serve that participant. A worker who lives with the participant may be exempt from EVV.
Before anyone in the family starts working, call the Community First Choice Program at 410-767-1739 and get an answer for your specific case.
How much does Medicaid pay caregivers in Maryland?
There’s no single published wage. MDH sets payment rates, and agencies or self-directing participants set worker pay within them. What the sources do say:
- The budget comes from an assessment. The interRAI assessment produces a Resource Utilization Group (RUG) score. The highest RUG gives a recommended initial budget of $43,680 a year, a soft limit that can be exceeded for medical necessity through prior authorization.
- Billing depends on hours. People approved for up to 12 hours of personal assistance a day are billed in 15-minute units. People assessed as needing more than 12 hours a day are paid at a daily rate.
For market context only: in May 2025, home health and personal care aides in the Baltimore metro area earned a median of $18.10 an hour, with a mean of $18.73 (BLS OEWS, Baltimore MSA). The Maryland minimum wage is $15 an hour for most employees.
How to apply for Community First Choice from Baltimore
Most CFC referrals come from Maryland Access Point specialists. Expect these steps:
- Call. Phone Maryland Access Point at 844-627-5465 or the Community First Choice Program at 410-767-1739. City residents can also call MAP of Baltimore City at 410-396-2273. County residents can call the Baltimore County Department of Aging at 410-887-2594.
- Confirm full Medicaid. If it isn’t active, apply for Medicaid first.
- Assessment. Per a 2019 MDH training deck, a Local Health Department nurse or social worker completes the interRAI assessment to see whether the person meets a nursing facility level of care.
- Supports planner. Choose a supports planning agency. The planner builds the person-centered plan of service with you.
- Pick a model and provider. Choose agency or self-directed, then name the provider or hire your worker.
- Approval. MDH or its designee reviews the plan and approves, denies or asks for clarification.
- Care starts. Visits are logged through EVV. MDH’s consumer portal shows provider timekeeping.
Our Medicaid application walkthrough lists the documents to gather. To go over your situation with someone, call our Canton office at 410-421-1041.
If the person needs assisted living or medical day care, which CFC doesn’t include, ask MAP about the Community Options Waiver registry at the same time.
Where Beulah fits
Beulah Home Care is a Canton home care agency serving Baltimore City neighborhoods and nearby Baltimore County communities. We serve Baltimore families who use Maryland Medicaid personal assistance programs, and our office helps families through the application steps.
We don’t decide eligibility, set the budget or speed up approval. MDH and the Local Health Department do that work.
Once a plan is approved, our caregivers can provide personal care at home and support for people living with dementia or a physical disability. Some families add private-pay hours, such as respite for a family caregiver. Others need live-in care. See all our home care services.
Book a free in-home consultation.
This page is general information, not legal or benefits advice. Program rules change, so confirm the details with Maryland Medicaid or Maryland Access Point before you act.