How the Maryland Medicaid Waiver Works for In-Home Care
If someone you love needs ongoing help at home — bathing, dressing, medication reminders, or just getting through the day safely — and money is tight, the Maryland Medicaid waiver may be one of the most important programs you've never heard of. It can pay for real, meaningful in-home care that keeps your family member out of a nursing facility and in the place they love most: home.
This guide focuses narrowly on the two waiver programs Maryland families use most for home care — CFC (Community First Choice) and the Community Options Waiver — and the role a Supports Planner plays in making them work for you. If you're in Silver Spring, Rockville, Gaithersburg, Germantown, Takoma Park, or anywhere else in Montgomery County, this is written for you.
What Is a Medicaid Waiver — and Why Does It Matter?
Standard Medicaid covers doctor visits, hospital stays, and some medical equipment. What it does not automatically cover is long-term, ongoing personal care at home. That gap is where Medicaid waiver programs come in.
A waiver is essentially federal permission for a state to spend Medicaid dollars in a flexible way — specifically, to pay for home and community-based services instead of nursing home care. Maryland has several waivers, but for most families seeking in-home care, two matter most.
CFC: Community First Choice
Community First Choice (CFC) is not technically a waiver — it is a Medicaid State Plan option, which means it does not have a waiting list. If your loved one meets the eligibility criteria, they are entitled to services.
What CFC Covers
CFC pays for personal care services: help with activities of daily living like bathing, dressing, grooming, eating, toileting, and mobility. It also covers assistance with instrumental activities — things like meal preparation, light housekeeping related to the person's care, and medication management.
The care is delivered by a licensed home care agency or, in some cases, through a consumer-directed model where the individual manages their own care workers.
Who Qualifies for CFC
To qualify, your loved one must:
- Be enrolled in Maryland Medicaid (full Medicaid, not just a Medicare Savings Program)
- Require a nursing-facility level of care — meaning they need significant help with daily activities
- Want to live in the community rather than a facility
The level-of-care determination is made through a functional assessment, not a medical diagnosis. Age alone is not a factor; adults of any age can qualify.
How to Apply
Applications for CFC go through Maryland's Local Health Departments or the Department of Social Services, depending on your county. In Montgomery County, you can also connect through the Aging and Disability Resource Unit (ADRU). A social worker or case manager will conduct the functional assessment and help determine if CFC is the right fit.
The Community Options Waiver
The Community Options Waiver (COW) is a separate program that covers a broader range of services than CFC, but it does operate with limited enrollment slots — meaning there can be a waiting list.
What the Community Options Waiver Covers
In addition to personal care, the Community Options Waiver can fund:
- Companion services for supervision and social engagement
- Adult day services
- Assistive technology and home modifications (ramps, grab bars, etc.)
- Residential habilitation for individuals with disabilities
- Respite care to give family caregivers a break
- Supported employment for eligible individuals
The COW is often the better fit for adults under 65 who have physical disabilities or complex care needs that go beyond what CFC alone can address.
Who Qualifies for the Community Options Waiver
Eligibility requirements are similar to CFC — full Medicaid and a nursing-facility level of care — but the waiver also targets individuals who would otherwise require institutional placement. Priority is often given to people transitioning out of nursing facilities or hospitals.
Because slots are limited, your family may be placed on a waitlist. If that happens, it is worth applying for CFC in the meantime, since CFC has no waitlist and can fill the gap while you wait for a waiver slot to open.
The Role of a Supports Planner
This is where many families get lost — and where having the right guidance makes all the difference.
A Supports Planner (sometimes called a Case Manager or Support Broker) is a professional assigned to help individuals enrolled in a Maryland Medicaid waiver program navigate their services. Think of them as a coordinator who sits between you, the state, and the providers.
What a Supports Planner Actually Does
- Helps develop a Person-Centered Plan that reflects your loved one's goals, preferences, and daily needs
- Identifies which services your family member is eligible for under the waiver
- Connects you with approved providers, including home care agencies
- Monitors that services are being delivered as planned
- Helps troubleshoot problems, request service changes, or appeal decisions
- Conducts regular check-ins (often quarterly) to make sure the plan still fits
How to Get a Supports Planner
When your loved one is enrolled in a waiver program, the state or local care management office will help assign a Supports Planner. You can also ask directly — families have the right to request a specific planner or change planners if the relationship is not working.
In Montgomery County, the Office on Aging and Independence and its ADRU unit are key entry points. If your loved one is transitioning from a hospital or rehab facility, a hospital social worker may already be coordinating a referral.
Choosing a Home Care Agency Under a Waiver
Not every home care agency in Maryland is approved to accept Medicaid waiver clients. When you're ready to choose a provider, make sure the agency:
- Holds a current Maryland home care agency license from the OHCQ
- Is listed as an approved waiver provider with the Maryland Department of Health
- Has experience coordinating with Supports Planners and navigating waiver documentation
- Can clearly explain what services they will provide, how scheduling works, and how they communicate with your family
Ask directly. A good agency will walk you through what the waiver covers, what it does not, and what your family might need to arrange separately.
Common Questions Maryland Families Ask
Can I use a waiver and pay privately for additional hours?
Yes, in many cases. The waiver pays for the services authorized in your loved one's care plan. If your family wants additional hours beyond what the waiver covers, you can often supplement privately — but confirm the arrangement with your Supports Planner and agency first.
What if my loved one is already in a nursing facility?
Both CFC and the Community Options Waiver support transitions out of nursing facilities. Maryland has specific programs designed to help people move back into the community when they want to. Your Supports Planner, or a hospital/facility social worker, can help coordinate this.
My loved one is on a waiting list. What do we do now?
Apply for CFC right away if you haven't — it has no waiting list and covers personal care. Reach out to your local Area Agency on Aging for any bridge resources. And document everything: dates, assessments, correspondence. It will matter when a waiver slot opens.
Getting Started in Montgomery County and Surrounding Areas
If your family is in Silver Spring, Rockville, Gaithersburg, Germantown, Takoma Park, or elsewhere in Montgomery County, your first call should be to the Montgomery County Office on Aging and Independence at (240) 777-3000, or the Maryland Access Point line at 1-844-627-5465. These programs exist specifically to help families like yours find a path forward.
Vitalis HealthCare works with families across Maryland — including those navigating the Maryland Medicaid waiver process — and we're happy to help you understand what in-home care can look like once your loved one's services are in place.
Related Articles
- A Guide to Medicaid and Medicare Coverage for Home Care in Maryland
- Signs It's Time to Hire a Caregiver
- How to Avoid Caregiver Burnout
Related Services
Call us at 240.716.6874 or request a free consultation online.
Vitalis HealthCare is a family-owned, Maryland-licensed home care agency based in Silver Spring, MD. We are licensed by the Maryland Department of Health Office of Health Care Quality (OHCQ License #3879R), CareScout Approved, and a 3× Best of Home Care Employer of Choice recipient. We serve Silver Spring, Rockville, Gaithersburg, Germantown, Takoma Park, Towson, Pikesville, Owings Mills, Annapolis, and surrounding communities.