Maryland Community First Choice (CFC) lets your parent hire a family member as a paid caregiver if they have full Maryland Medicaid, need an institutional level of care and live in the community. That hiring happens in CFC's self-directed model, where your parent becomes your employer and sets qualifications you must meet on top of the state's provider requirements, and a Financial Management and Counseling Services (FMCS) contractor helps with payroll and taxes. Whoever acts as your parent's CFC representative can't also be the paid caregiver.,,

In This Guide

Who Can Be a Paid Family Caregiver Under Maryland Community First Choice

If you already help your parent bathe, dress and get through the day, this is the route that can turn that care into a paid job. Maryland CFC is a Medicaid state plan home and community-based services benefit, run by the Maryland Department of Health Medicaid Administration. It has no age limit, and your parent has the full Medicaid it requires if they have a red and white Medicaid card.

In the self-directed model Maryland added to CFC effective July 1, 2023, the state plan lets your parent permit "family members, or any other individuals" to provide their planned services, if they meet the qualifications your parent sets, including extra training. The other way to get CFC personal assistance is through a Residential Service Agency licensed by the Office of Health Care Quality.

Family caregivers in self-direction still need first aid and CPR certification and a background check your parent completes before hiring you, plus the Maryland Department of Health's general Medicaid and CFC provider requirements. Your parent may waive further action on the background check unless it shows a history of behavior that could harm someone.

Two people need a closer look:

  • A spouse. Maryland's CFC state plan says "family members" without mentioning spouses, and its CFC regulation names spouses neither way, so whether a spouse may be a paid CFC provider isn't stated. See getting paid to care for your spouse in Maryland.
  • A representative or guardian. This rule can sting if you're the one already doing the work. Federal Community First Choice rules say a CFC representative "may not also be a paid caregiver," and Maryland's CFC regulation defines "representative" to include a legal guardian and anyone who signs the plan of service for your parent or makes decisions about the plan on their behalf. The bar falls on the person acting as representative, not on relatives as a group, so another family member or trusted person can be the representative while you're the paid caregiver. A guardian counts as a representative under Maryland's definition, so if you're the guardian, plan on someone else, such as another relative or an agency worker, being paid, and ask the CFC Program before anyone is hired.,,

Who Hires, Pays and Approves?

Becoming your parent's employee can feel strange, and the paperwork can look like a lot. Your parent doesn't carry it alone: an FMCS contractor helps with payroll and employment taxes.

Who What they do
Your parent Hires, supervises, schedules and can dismiss you; sets your pay within state and federal compensation rules; approves payment requests
Supports planner Writes the person-centered plan with your parent or their authorized representative
FMCS contractor Reviews and confirms the plan; helps with hiring, pay rate, budget, employment taxes, insurance and payroll; trains your parent and staff
Maryland Department of Health Approves, denies or asks questions about the plan

For who issues your tax form, see who sends your W-2 or 1099.

How a Family Caregiver Gets Paid Through Maryland Community First Choice

1
Step 1

Get referred

Most Maryland CFC referrals come through Maryland Access Point (MAP). Family can refer too, or your parent can contact the Department.,

2
Step 2

Get assessed

The interRAI or another assessment sets a recommended budget for your parent's CFC personal assistance.

3
Step 3

Choose self-direction and a supports planner

Your parent picks the supports planner, for example an independent case manager, who writes the CFC plan with them. The FMCS contractor reviews it, and the Maryland Department of Health approves, denies or asks for clarification.

4
Step 4

Clear the hiring requirements above

5
Step 5

Track your hours

Self-directed CFC caregivers don't use the Department's Electronic Visit Verification (EVV) system; your parent, with FMCS support, uses the contractor's system.

How Many Hours Can You Be Paid For?

If you're trying to picture how many hours a week this could cover, the answer starts with a budget, not a fixed number. Maryland's CFC state plan doesn't set a fixed cap on hours. The Maryland Department of Health sets a CFC personal assistance budget from your parent's assessed need, and services must be preauthorized in the plan of service.

That budget follows your parent's Resource Utilization Group (RUG) or other case mix from the interRAI or another assessment. As of 2026, the highest RUG carries a recommended initial Maryland CFC personal assistance budget of $43,680 a year, which the state plan says is not the maximum amount of services or hours; it can be exceeded for medical necessity after prior authorization. That $43,680 budgets your parent's personal assistance; it isn't a wage rate, since your parent decides, within state and federal compensation rules, what each self-directed CFC service pays and approves your payment requests.

Besides personal assistance, Maryland CFC can cover services such as home-delivered meals, nurse monitoring and transition services.

What the Job Pays

If you're weighing cutting work hours, plan around the rate your parent sets with FMCS help. As a benchmark, the Bureau of Labor Statistics put Maryland's May 2025 median for home health and personal care aides at about $18.29 an hour, a market estimate, not a CFC rate.,

What If the Plan Is Denied or the Budget Is Too Low?

A denial or a budget that falls short isn't the last word. If your parent needs services costing more than the recommended CFC budget, the plan needs prior authorization with a medical necessity review.

If Maryland Medicaid denies, ends or reduces your parent's services, your parent can ask for a fair hearing, for most decisions within 90 days of the date on the notice. To keep existing coverage during the appeal, file within 10 calendar days of the notice date, the postmark or the effective date of the action, whichever is later; coverage may then continue until the hearing decision, though your parent may have to pay back that cost if the decision is upheld. A decision made by a HealthChoice managed care plan goes through the plan's own appeal first, filed within 60 days.

Could Maryland CPAS Pay You Instead?

Community Personal Assistance Services (CPAS) is another Maryland Medicaid personal care benefit, with different rules on who your parent can hire.,,

Maryland CFC Maryland CPAS
Who qualifies Full Medicaid, institutional level of care, lives in the community Medicaid-eligible under a qualifying coverage group, needs help with at least one activity of daily living, lives at home, active plan of service
How care is delivered Licensed Residential Service Agency, or self-direction Licensed residential service agency, or self-direction since July 1, 2023
Family member as paid caregiver in self-direction Allowed if they meet your parent's qualifications and the state's provider requirements and aren't the representative Can't be a "legally liable relative"; other relatives aren't addressed

The Department re-evaluates CPAS eligibility every 12 months, or sooner after a significant change in your parent's condition or needs. CPAS covers help with activities of daily living, delegated nursing tasks and physician-ordered medications, and instrumental activities of daily living only alongside that care. It excludes housekeeping unrelated to your parent's daily activities, such as laundry not incidental to their care.

Self-direction in CPAS comes with a supports planner and an FMCS contractor, but Maryland doesn't let a self-directing CPAS participant hire a "legally liable relative." Federal rules define a legally liable relative as someone with a state-law duty of care, which may include a spouse. Neither Maryland's CPAS amendment nor that federal rule names adult children, so confirm before counting on CPAS pay.,

Is There a Waitlist for Maryland CFC?

Maryland CFC is a state plan benefit, and you apply by calling Maryland Access Point at 844-627-5465 or the CFC Program at 410-767-1739. The CFC sources we checked don't state a CFC waiting list, so ask how long referral, assessment and plan approval are taking when you call.,

A Maryland waitlist you may have heard about belongs to the Community Options Waiver, the Community Options Waiver Registry, joined through MAP. That waiver has no personal assistance benefit of its own, so a family member paid to give a waiver participant personal care is paid through CFC or CPAS.,

Frequently Asked Questions

Can I be paid through Maryland CFC if I live with my parent?

Yes, if you meet the qualifications your parent sets and the state's provider requirements and aren't acting as your parent's CFC representative: Maryland's CFC state plan lets your parent hire family members in the self-directed model, and says providers who live with the person they serve may be exempted from the electronic visit verification requirement.,

Does the state send my paycheck?

Not directly. In CFC's self-directed model your parent reviews and approves your payment requests, and the Financial Management and Counseling Services contractor the state contracts with assists with payroll processing and employment taxes.,

My parent is in a nursing facility. Can Maryland CFC help them come home?

Maryland CFC's services include transition services. Someone in a nursing facility whose care Medicaid has paid for at least 30 days can also apply to the Community Options Waiver with no wait.,

Learn More

CaregiverMaryland Paid Family Caregiver Programs: How to Get Paid to Care for a Loved OneGet paid to care for a family member in Maryland: self-directed Community First Choice, the VA caregiver programs, and when a spouse can be hired. CaregiverHow to Get Paid to Care for Your Spouse in MarylandCan a spouse be paid as a caregiver in Maryland? How self-directed Community First Choice, CPAS, ICS, PCAFC and Veteran-Directed Care treat a husband or wife. MedicaidHow to Get Home Care Through a Maryland Medicaid HCBS WaiverMaryland Medicaid HCBS waivers pay for home and community care through the Community Options Waiver for adults who need a nursing-facility level of care. CaregiverIs Family Caregiver Pay Taxable in Maryland?Family caregiver pay in Maryland may be taxable: it depends on which program pays you. CFC and CPAS vs IRS Notice 2014-7, the VA stipend, and county tax. CaregiverMaryland Increased Community Services (ICS): Can a Family Member Be Paid?Maryland's ICS program helps nursing-home residents go home on Medicaid: which relatives it bars as paid attendant unless exempted, and its 100-slot cap.

Find personalized help getting hired as your parent's Community First Choice caregiver at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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