CFC vs. CPAS: Which Maryland Program Is Right for Your Family?

Maryland has two Medicaid programs that pay for personal care at home and let families choose who provides it: Community First Choice (CFC) and Community Personal Assistance Services (CPAS). They sound similar, they're both run by the Maryland Department of Health, and many families aren't sure which one applies to their loved one. The difference mostly comes down to how much help the person needs. This guide compares CFC and CPAS side by side so you can see which Maryland program is right for your family, and how a family member can get paid in either one.

Program Overview: CFC and CPAS at a Glance

Both CFC and CPAS are Maryland Medicaid programs that pay for personal assistance services so people can stay in their own homes instead of a nursing home. Both require full Maryland Medicaid. Both let the participant choose their caregiver, including family members, and both pay that caregiver through a licensed agency. And both serve people of any age who meet the eligibility requirements.

The main differences:

• Level of need: CFC requires a nursing facility level of care. CPAS requires help with at least one activity of daily living, without that higher bar.
• Services: CFC covers a broader range of support services. CPAS focuses on personal assistance.

What Is the Community First Choice (CFC) Program in Maryland?

Community First Choice CFC (opens in new tab) is a Maryland Medicaid program for people who meet a nursing facility level of care but want to live at home. According to the Maryland Department of Health (opens in new tab), participants need full Maryland Medicaid, must meet the nursing facility level of care, and must live in a community setting.

CFC services can include:

• Personal assistance with daily living, such as bathing, dressing, eating, and preparing meals.
• Supports planning to build the plan of service.
• Nurse monitoring of the personal care services.
• Home delivered meals.
• Accessibility adaptations (home modifications) and assistive technology.
• Transition services for people moving out of a nursing facility, which can help with things like household furnishings and personal effects.
• Consumer training, environmental assessments, and personal emergency response systems.

What Is Community Personal Assistance Services (CPAS)?

Community Personal Assistance Services CPAS (opens in new tab) is a Maryland Medicaid program for people who need help with at least one activity of daily living but don't need a nursing facility level of care. According to the Maryland Department of Health (opens in new tab), participants need full Maryland Medicaid and must live in the community. CPAS covers personal assistance services, nurse monitoring, and supports planning.

CPAS is a good fit for someone who needs real, daily help, for example with bathing or getting dressed, but is still fairly independent otherwise.

CFC vs. CPAS Side by Side

• Medicaid: both require full Maryland Medicaid.
• Care need: CFC requires a nursing facility level of care. CPAS requires help with at least one activity of daily living.
• Age: Both serve people of any age who qualify.
• Services: CFC offers personal assistance plus home delivered meals, home modifications, assistive technology, and more. CPAS offers personal assistance, nurse monitoring, and supports planning.
• Waiting list: Neither has a waiting list. Anne Arundel County notes there are no caps on the number of eligible individuals (opens in new tab) in these programs.
• Family caregivers: Both let the participant choose a family member, including a spouse, as the paid caregiver.

Who Qualifies for Each Program?

Medicaid eligibility

Both programs require full Maryland Medicaid. For older adults and people with disabilities, the 2026 asset limit is $2,500 for one person and $3,000 for a married couple, according to the Maryland Department of Aging (opens in new tab). Financial eligibility depends on the Medicaid category. For married couples where one spouse needs a nursing facility level of care, spousal impoverishment protections can let the non applicant spouse keep more assets and income.

The state assessment

Eligibility for both programs is decided through a state assessment. A nurse from the local health department visits and completes an assessment of the person's daily needs. That assessment shows whether the person meets a nursing facility level of care (CFC) or needs help with at least one activity (CPAS), and it is the basis for the plan of service and approved hours.

Which Program Is Right for Your Family?

You don't have to pick a program on your own. The assessment determines which one your loved one qualifies for. As a general guide:

• CFC is usually the fit when your loved one needs help with many daily tasks, has advanced dementia or Alzheimer's disease, is at risk of moving to a nursing home, or would benefit from home modifications or assistive technology.
• CPAS is usually the fit when your loved one needs moderate care, such as help with bathing or dressing, but can manage most other things on their own.

If your loved one's needs increase, they can be reassessed. Someone who starts in CPAS may later qualify for CFC.

Two Examples

These examples are illustrations, not guarantees. The state assessment always decides.

A mother who needs help with a few things. Linda is 78 and lives alone in Baltimore County. She can cook simple meals, get around her apartment with a walker, and dress herself, but she can no longer get in and out of the shower safely. Her daughter stops by every day to help. Linda has full Maryland Medicaid and needs hands-on help with only one activity of daily living, bathing, but she doesn't need a nursing facility level of care. CPAS is the likely fit, and her daughter could be hired as her paid caregiver.

A father with advanced dementia. Robert is 82 and has Alzheimer's disease. He needs help with bathing, dressing, eating, and toileting, and he can't be left alone for long. His wife and son share the care. Robert has full Maryland Medicaid and meets a nursing facility level of care, so CFC is the likely fit. Because CFC can cover more than personal assistance, the family could also ask about a personal emergency response system and grab bars in the bathroom. Either his wife or his son could be the paid caregiver.

Questions to Ask Before the Assessment

• Which daily activities does my loved one need hands-on help with, and how often?
• Have they had falls, hospital stays, or a recent change in memory?
• Would home modifications or assistive technology make the home safer?
• Who in the family, or which friend, will be the paid caregiver?

Writing these down before the nurse visits helps make sure the assessment reflects your loved one's real needs.

How Can I Get Paid to Care for a Family Member in Maryland?

In both CFC and CPAS, the participant chooses their caregiver. That can be an adult child, a spouse, another relative, or a friend or neighbor. In Maryland, spouses CAN be paid. The only exceptions: a parent can never be paid to care for their own minor child in any program, and the caregiver can't be the participant's authorized representative. Once the child turns 18, a parent can be paid as their caregiver.

Paid caregivers are employed by an approved provider, a licensed Residential Service Agency like Family Love Care, which handles tax withholding and payroll. Caregivers must be at least 18, pass a criminal background check, and complete state-required training. Family Love Care provides that training for free, along with RN clinical oversight.

Through Family Love Care, Maryland caregivers earn $15 to $18 per hour, depending on the program, location, and care needs. Total pay depends on approved hours. For the full process, see our guide to signing up for Medicaid home care in Maryland (opens in new tab).

Where Maryland Home Care Comes From

One thing that surprises many families: in Maryland, home care is a carve-out. It comes directly from Medicaid, not through your loved one's Medicaid health plan (MCO). So even if your loved one is enrolled in a HealthChoice plan, CFC and CPAS are arranged separately. A good place to start is Maryland Access Point (opens in new tab) at 1-844-627-5465, or Family Love Care.

What Is the Best Medicaid Plan in Maryland?

For families looking for home care, the right "plan" is less about the health plan and more about the home care program. Your loved one's MCO covers doctor visits, hospital care, and prescriptions. CFC or CPAS covers personal care at home and paid family caregiving. Most families need both.

Frequently Asked Questions

Can someone have CFC and CPAS at the same time?

No. The assessment places the person in the program that matches their level of need.

Is there a waiting list for CFC or CPAS?

No. Eligible participants can receive services without a waiting list. The Community Options Waiver, a separate program, does have a waiting list.

Does my family caregiver need nursing experience?

No. Personal care doesn't require a nursing license. Caregivers pass a background check and complete required training, and a nurse provides oversight.

Let Family Love Care Help You Choose

Family Love Care is a home care agency that helps Maryland families with enrollment in CFC and CPAS, then employs and pays the family caregiver. We provide RN clinical oversight and free caregiver training. Contact Family Love Care (opens in new tab) to get started.