One of the hardest questions families face is how to pay for care at home. In Maryland, two Medicaid programs are built to help people stay in their own homes instead of moving to a nursing facility: Community First Choice and the Community Options Waiver. They sound alike, and they even work together, but they are not the same. Here is a plain-language guide to what each one covers, who qualifies, and how to get started.
Two programs, one goal
Both programs are run by the Maryland Department of Health, and both exist for the same reason: to bring care to you at home instead of paying for care in an institution. The real differences come down to how you qualify and what each one covers, and many families end up using them together.
Community First Choice
Community First Choice, usually called CFC, is a Medicaid state plan benefit. Because it is part of the regular Medicaid benefit and not a waiver, it generally does not have a waiting list. If you meet the rules, you can receive services.
To qualify for CFC, you need to already have full Maryland Medicaid, which is the red and white card, you need an institutional level of care, and you must live in a community setting rather than a facility. There is no age limit.
CFC can cover personal assistance with everyday activities, nurse monitoring, supports planning to help coordinate your care, a personal emergency response system, home-delivered meals, home accessibility adaptations, assistive technology, and services to help someone transition from a facility back home.
The Community Options Waiver
The Community Options Waiver, also called the Home and Community-Based Options Waiver, is a Medicaid waiver. It includes everything Community First Choice offers, and then adds services such as case management, assisted living, medical day care, family training, and nutrition support.
Eligibility is a little different here. You must need a nursing facility level of care, be 18 or older, and be able to live safely at home with the waiver's help. Financially, monthly income generally may not exceed 300 percent of the SSI benefit amount, and countable assets must stay under roughly 2,000 to 2,500 dollars, depending on your category.
There is one important catch: the Community Options Waiver has a waitlist. You add your name to the registry by calling Maryland Access Point, and you receive an invitation to apply when your turn comes. One exception, if your loved one is already in a nursing facility and Medicaid has paid for at least 30 days, they may be able to apply with no wait.
Which one fits your family
If your loved one already has full Medicaid and mainly needs help with daily personal care at home, Community First Choice is often the most direct path, and there is no line to wait in. If they need a broader set of services, or supports like case management and assisted living, the Community Options Waiver may be the better fit, but because of the waitlist, the smartest move is to get on the registry early, even before you are certain you will need it.
How to start
The single best first step for either program is to call Maryland Access Point at 844-627-5465. They can help you understand your options, add your name to the Community Options Waiver registry, and connect you with a supports planner who guides you through the process. You can also reach the state's Office of Long Term Services and Supports at 410-767-1739.
One piece of advice we give families often: do not wait to make that call. Because the waiver has a waitlist, adding your name sooner rather than later protects your options down the road, even if care is not needed yet.
Where My Home Cares fits in
We are a licensed Maryland home care agency, not a Medicaid office, so we cannot approve benefits. But we work with families using these waiver programs every week. We help you understand what may cover your care, and we provide the actual personal care and in-home support once you are approved. For a wider look at all the ways families pay for care, see our guide to paying for home care in Maryland, and if your loved one already has Medicaid, read our reminder on keeping that coverage active at renewal.
Have questions about whether Medicaid could help cover care for your loved one? Call us at (410) 231-3076 or reach out for a free consultation, and we will help you find the right starting point.
This article is general information, not legal or benefits advice. Programs, income limits, and asset limits can change over time. For guidance on your specific situation, contact Maryland Access Point at 844-627-5465 or the Maryland Department of Health's Office of Long Term Services and Supports at 410-767-1739.