How the Maryland Community Options Waiver and Community First Choice work for Montgomery and Prince George's families, and who to call to start.
By DC Senior Advisor Care Team · October 9, 2026
Families in Silver Spring, Wheaton, Hyattsville and College Park often tell us the same thing after a hospital stay: Mom wants to stay home, but private-duty aides at $30 to $40 an hour will drain her savings in a year. The Maryland Community Options Waiver and Community First Choice are the state's two main answers. Both are run through Maryland Medical Assistance, both are meant for people who would otherwise qualify for a nursing home (what Maryland calls a comprehensive care facility), and both pay for help at home or in a small group setting instead of an institution. They are not the same program, though, and picking the wrong door first can cost months.
Community First Choice, usually shortened to CFC, is a Medicaid state plan benefit. It covers personal assistance with bathing, dressing, toileting and meals, along with nurse monitoring and some supports for emergencies and home safety. The Community Options Waiver covers a broader menu, which can include assisted living services, adult day care, home-delivered meals, and case management, and it historically has had a limited number of slots and a registry when demand outran funding. Ask any intake worker today whether a registry is active, because that status changes. If you only need hands-on personal care at home, CFC is often the faster route. If your parent needs a licensed assisted living setting or day services, the waiver is the one to pursue.
Maryland looks at two separate tests. The first is medical: a nurse from the local health department conducts an assessment to decide whether the applicant needs the level of care a nursing facility provides. That does not mean the person must be bedbound. Needing help with several activities of daily living, such as transferring from a bed, bathing, or managing medications because of dementia, can be enough. The assessment visit usually happens at home or in the hospital before discharge, so ask the hospital social worker at Holy Cross in Silver Spring, Suburban in Bethesda, or Adventist HealthCare in Takoma Park or Rockville to flag the case early.
The second test is financial. For long-term care Medicaid, Maryland applies an individual asset limit of about $2,500, with the primary home and one vehicle generally not counted, and an income cap tied to a multiple of the federal SSI benefit, which works out to just under $3,000 a month for a single applicant in 2026. People over those limits are not automatically out of luck. Maryland has medically needy rules and spend-down pathways, and a married couple is treated differently, because the spouse still living at home is allowed to keep a protected share of income and assets. Gifts made in the five years before applying can trigger a penalty period, so do not move money around before talking to someone who knows the look-back rules.
The front door is Maryland Access Point, reached at 1-844-MAP-LINK, which routes you to the local point of contact. In Montgomery County that is Aging and Disability Services, reachable at 240-777-3000, and in Prince George's County it is the Aging and Disabilities Services Division. A counselor there will screen for CFC, the Community Options Waiver, and other programs, and can explain where your family sits on any waiting list. Ask them directly: what is the current status of the registry, how long are people waiting, and what can we use in the meantime.
Expect paperwork. You will need proof of identity, Medicare and Medicaid cards if any, bank statements, and documentation of income such as Social Security and pension letters. Bring a list of diagnoses and medications, because the nurse assessor will ask. Many families find it useful to designate one family member as the paperwork lead, and to keep copies of everything submitted with the date. Processing times vary, so file the Medicaid financial application as soon as you have the documents instead of waiting for the medical assessment to finish. If the family has a durable power of attorney, bring it, since it allows someone to sign on a parent who can no longer manage the forms.
Once approved, a participant can often choose their own provider agency, and under some self-directed options hire and manage a personal care worker, including in some cases a relative, subject to program rules. For a parent in Wheaton or Hyattsville, that can mean a few hours of aide help every day instead of a move. The waiver can also help fund adult day services, which give caregivers a break and give seniors meals, activities and supervised company. Both programs pay for care, not rent. Medicaid does not cover room and board in an assisted living community, so a resident still pays that part from Social Security or other income unless a subsidy fills the gap.
That is where Maryland's Senior Assisted Living Group Home Subsidy comes in. It helps low-income residents of eligible small assisted living homes with the cost of living there, and it can be combined with waiver services that pay for the care. Not every Montgomery or Prince George's home accepts Medicaid or the subsidy, and some limit the number of subsidized residents, so ask the provider outright before you tour. Assisted living programs in Maryland are licensed by the Office of Health Care Quality under COMAR 10.07.14 at Level 1, 2 or 3, and the licensed level determines how much hands-on care a home may legally provide.
The first mistake is waiting for a crisis. A fall at home in Rockville or a stroke at Suburban pushes families into rushed decisions, and a hospital discharge date will not wait for a Medicaid determination. Start the conversation with Maryland Access Point as soon as help is needed, even if you think your parent has too much money, because the counselor can screen for other help such as respite, home modification grants or senior nutrition programs. The second mistake is assuming a denial is final. Appeal rights exist, and many first denials result from missing documents, not true ineligibility.
The third mistake is paying a provider privately and expecting reimbursement later. Medicaid generally pays only for services authorized in advance through an approved plan of care. If you hire an agency before you know your status, you may be paying out of pocket for weeks. Keep a bridge plan: private-pay hours at the lowest level of help that keeps your parent safe, Veterans benefits if your parent served, and area agency services while approval is pending. A free consultation with an elder law attorney, often offered by local bar programs, is worth the hour if the asset picture is complicated.
Free, no pressure, and no one rushing you. We answer to families, not to facilities.
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