Medicaid for Senior Care in Maryland
What Medicaid Actually Covers for Senior Care
Navigating Medicaid for senior care in Maryland can feel like learning a new language, but think of it as a set of programs designed to help your loved one stay safe and cared for. Maryland Medicaid, often called Medical Assistance, offers several avenues for long-term care. For those needing significant support, Nursing Home Medicaid covers the full cost of care in a certified facility, including the often-burdensome room and board, skilled nursing, doctor visits, and personal care.
If staying at home or in an assisted living community is the goal, Maryland offers Home and Community-Based Services (HCBS) Waivers. The most prominent is the Community Options (CO) Waiver, also known as the Home and Community Based Options Waiver (HCBOW). This program provides services like assisted living support (though it won't cover room and board itself), case management, medical day care, respite care, and behavioral consultation, helping individuals remain independent. Another key program is Community Personal Assistance Services (CPAS), which offers personal care assistance and nurse monitoring. Similarly, the Community First Choice (CFC) program provides self-directed personal care assistance. Both CPAS and CFC are part of the state's Regular Medicaid plan. While these programs are a lifeline, remember that for assisted living, Medicaid helps with the services but generally does not pay for room and board.
Do You Qualify?
Eligibility for Maryland Medicaid in 2026 depends on several factors, including income, assets, and the type of care needed. For most Home and Community-Based Waivers, a single applicant's monthly income limit is typically $2,982. If your parent needs Nursing Home Medicaid, they'll generally need to contribute almost all their income towards care costs, keeping only a small personal needs allowance of $106 per month.
The asset limit for a single applicant across many long-term care programs, including Nursing Home Medicaid and HCBS Waivers, is generally $2,500. For married couples where both are applying, the combined asset limit is typically $3,000 initially, adjusting to $2,500 per spouse after six months for nursing home care. If only one spouse is applying, the applicant spouse is limited to $2,500 in assets, but the non-applicant spouse (often called the "community spouse") can keep significantly more, up to $162,660, under what's known as the Community Spouse Resource Allowance.
Maryland has a "spend-down" rule for income, known as the Medically Needy Pathway, where excess income can be used for medical expenses to qualify. For assets, you can "spend down" by paying off debts, prepaying funeral expenses, or making home modifications. If your parent owns a house, their primary residence is usually not counted as an asset, especially if a spouse, minor child, or disabled child lives there. However, pension payments are generally counted as income. Be aware that Maryland also has a 60-month (five-year) look-back period for asset transfers, meaning any significant gifts or sales for less than fair market value in the past five years could affect eligibility.
Waitlists & How to Apply
The reality of waitlists in Maryland varies by program. Good news: Nursing Home Medicaid, Community Personal Assistance Services (CPAS), and Community First Choice (CFC) are considered "entitlement" programs, meaning if your loved one qualifies, they are guaranteed services without a waitlist.
However, many Home and Community-Based Services (HCBS) Waivers, like the Community Options Waiver, are not entitlements and do have limited enrollment slots, which can lead to waitlists. As of a few years ago, Maryland had over 21,000 residents on waiver waitlists, and the state even stopped accepting new additions to some lists. If you're looking for the Community Options Waiver and your parent is in the community, you'll need to add their name to the Waiver Services Registry by calling 1-866-417-3480. For information on the Medical Day Services Waiver or to get on the CO Waiver waitlist, contact Maryland Access Point (MAP) at 844-627-5465.
To apply for most Medicaid long-term care programs, you can do so online at marylandbenefits.gov, in person at your local Social Services Office, or by mailing a completed application. The Office of Long Term Care in Catonsville handles applications for Baltimore City and Counties, Anne Arundel, and Prince George's. Be prepared with documentation for citizenship, identification, health insurance, all income sources, and a detailed list of assets, as they will review your financial history for the past 60 months. While processing times vary, state law aims for a decision on waiver applications within 30 days. For general assistance, the Maryland Department of Health can be reached at 410-767-6500 or 1-877-463-3464.
Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.