What Community First Choice is
CFC is a Maryland Medicaid entitlement program (not a capped waiver) that helps people stay in their own homes by paying for personal care assistance. Under self-direction, participants can choose their own caregiver, including family members.
Who qualifies — the care recipient
- Must be enrolled in Maryland Medicaid (Medical Assistance)
- Must require assistance with at least two Activities of Daily Living (ADLs)
- Must meet income and asset limits (individual income limit around $350/month for CFC specifically, with more complex rules if married)
Who qualifies — the caregiver
- Adult children, siblings, and qualifying friends can generally be enrolled as paid caregivers under self-direction
- Parents of children under 18 are excluded in all cases
- On spouses specifically: this is genuinely unclear from available sources — some describe Maryland as explicitly allowing spouses as paid caregivers under self-directed CFC, while others state spouses are generally excluded. Confirm this directly with the Maryland Department of Health or a CFC caseworker.
- Must pass a background check and complete enrollment before starting
How pay works
The state sets caregiver wages within a given range, with payment rates periodically reviewed. Maryland received approval in 2025 to expand supplemental payment support for CFC direct care workers.
How to apply
- Confirm the care recipient's Maryland Medicaid eligibility
- Confirm they need assistance with at least two ADLs
- Contact Maryland Medicaid to apply for CFC (no waitlist)
- Choose self-direction and identify the family caregiver
- Complete required background checks and enrollment/payroll setup
What you'll need to keep track of once approved
- Care hours and claims documentation
- Enrollment and payroll records
- Ongoing eligibility documentation for renewals and audits
Keeping this organized
Once approved, tracking hours and maintaining documentation for renewals and audits is an ongoing task. FeatherKeep organizes this automatically as you go.
Related guides
Disclaimer: General information only, not legal or financial advice. Maryland's Medicaid programs, spousal eligibility rules, and pay rates are subject to change and vary by specific program — confirm current details directly with the Maryland Department of Health before applying, particularly on the spouse question where available information is inconsistent.