Maryland Community First Choice (CFC): Getting Paid to Care for a Family Member

What Community First Choice (CFC) is in Maryland

Community First Choice is Maryland's main Medicaid pathway for paid in-home personal care. It's a Medicaid state plan option, not a capped waiver — so unlike most waiver programs, there's generally no waitlist or registry to sit on once someone qualifies.

CFC pays for help with everyday personal care at home: bathing, dressing, grooming, mobility, meal support, medication reminders, and similar day-to-day assistance. Under the self-directed model, the person receiving care chooses, hires, schedules, and supervises their own personal assistant — and that assistant can be a family member.

You don't get a check from the state directly. A Financial Management Services (FMS) agency handles payroll, tax withholding, and paperwork, while the participant directs the work.

Does Maryland pay family caregivers?

Yes — indirectly, and through the person receiving care. Maryland doesn't pay caregivers a "caregiver benefit." Instead, the care recipient qualifies for Medicaid long-term care, enrolls in CFC, chooses self-direction, and then employs a caregiver of their choosing. Many families use this route to pay an adult child, sibling, other relative, or trusted friend.

Could your family member qualify?

• Enrolled in Maryland Medicaid (Medical Assistance)
• Needs help with two or more Activities of Daily Living (ADLs)
• CFC is an entitlement program, so there is generally no waitlist once someone qualifies
• Meets a nursing-facility level of care, determined through a state assessment
• Meets CFC income and asset limits (commonly cited as roughly $350/month income and $2,500 in countable assets for a single applicant, with different rules for married couples). Limits change yearly — confirm current figures before you apply.

Can you be the paid caregiver?

• Adult children, siblings, other relatives, and qualifying friends can generally be hired under self-direction
• Parents of a child under 18 cannot be paid for that child's care
• Spouses: Maryland is one of the few states where a spouse can be paid — but only under the self-directed model. Spouses are excluded under the standard agency-directed model, so which model you enroll in decides the answer. Confirm your specific case with Maryland Access Point or your CFC case manager.
• The caregiver must be employed through a Medicaid Personal Assistance Agency or a Financial Management Service — not paid directly by the family
• Caregivers must pass a background check and complete enrollment before any paid hours begin

How much does CFC pay in Maryland?

Maryland doesn't publish one flat statewide caregiver wage. Rates are set within the participant's approved plan of service, and commonly cited figures fall in the $15–20 per hour range depending on the plan and assessed level of care. Maryland has also been expanding supplemental payment support for CFC direct-care workers. Approved weekly hours matter as much as the hourly rate — the assessment determines how many hours are funded.

Ask your case manager for two numbers: the current hourly rate, and the number of hours authorized per week.

Ready to apply? Here's where to start — step by step

1. Confirm Medicaid. The person receiving care must be enrolled in Maryland Medical Assistance (or apply through Maryland Health Connection first).
2. Call Maryland Access Point (MAP). MAP is the front door for long-term services and supports and can start a CFC referral.
3. Complete the in-home assessment. A state assessment establishes ADL needs and level of care, and produces a plan of service with authorized hours.
4. Choose self-direction. Tell the case manager you want the self-directed model so the participant can hire their own personal assistant.
5. Name your caregiver and enroll them. Background check, employment paperwork, and payroll setup go through the Financial Management Services agency.
6. Start logging hours. Paid hours only count from enrollment forward — not retroactively.

Plan for several weeks between the first call and the first paycheck, mostly driven by Medicaid eligibility and assessment scheduling.

Other Maryland pathways worth checking

• Community Personal Assistance Services (CPAS) — a related Medicaid personal-assistance option; some families are routed here rather than CFC, depending on eligibility
• Community Options Waiver — for people who need a broader set of home and community-based services
• Increased Community Services (ICS) — supports people moving out of a nursing facility back into the community
• VA programs — if the person you care for is a veteran, VA's Program of Comprehensive Assistance for Family Caregivers, Veteran-Directed Care, and Aid and Attendance run on separate rules and can pay a spouse
• Maryland's National Family Caregiver Support Program — respite and support services through your Area Agency on Aging (support, not wages)

Common reasons Maryland applications stall

• Medicaid financial eligibility isn't in place yet, so the CFC referral can't move
• The assessment records fewer ADLs than the family actually helps with, because nobody described a typical bad day
• The caregiver starts helping before enrollment is complete, so those hours are unpaid
• Renewal paperwork arrives and the household can't find the documentation it asks for

What you'll need to keep track of once approved

• Care hours worked and submitted timesheets
• Enrollment, background check, and payroll records
• Assessment notes and plan-of-service documents
• Medical appointments and changes in condition that support the next renewal
• Ongoing eligibility documentation for renewals and audits

Keeping this organized

Once approved, tracking hours and holding onto documentation for renewals and audits becomes a recurring job on top of the caregiving itself. FeatherKeep organizes this as you go — appointments, hours, receipts, and records in one place, ready when a renewal or audit asks for them.

• Check our Medicaid Structured Family Caregiving checklist
• Check what else you may qualify for

Related guides

• US state-by-state pillar page
• Medicaid checklist tool

Disclaimer: General information to help you get started — not legal or financial advice. Maryland's Medicaid programs, spousal eligibility rules, income limits, and pay rates change, so the Maryland Department of Health, Maryland Access Point, or your local Area Agency on Aging can confirm current details before you apply.