Maryland provides long-term care resources to seniors through the Maryland HealthCare Commission, Consumer Guide to Long Term Care. The resources available throughout the state include specific services for Medicare recipients and County-specific resources. Additionally, Maryland’s Department on Aging oversees the different local programs available through local Area Agencies on Aging (AAA) available throughout the state’s 23 regions. Each of the local agencies on aging provides a variety of adult services, incorporating assisted living; protective services; and temporary disability programs. Transportation services for seniors and people with disabilities are also provided at the county level through either a division of the aging department or a separate transportation department.

In addition to the support through the local AAA offices, the Department on Aging oversees the Continuing Care Division and the Long-Term Care Services and Supports Division. These Divisions regulate care received in a long-term retirement community setting or in an in-home environment.

Maryland’s Department of Health and Mental Hygiene, Long Term Services and Supports (LTSS) programs target individuals over 65 and individuals eligible for both Medicaid and Medicare (“dual eligibles”), among other discrete populations. One of the LTSS and support programs available is the Program for All-Inclusive Care for the Elderly (PACE), which provides services to seniors 55 and over who meet certain financial and medical criteria, including income and asset limits for Medicaid eligibility and require a nursing home level of care. In Maryland, the PACE program is only available in select zip codes, primarily in Baltimore.

Maryland Medicaid also covers certain services available to these participants based on medical necessity and technical and financial eligibility through home-and-community-based (HCBS) waivers. Home and community-based services vary by program and may include, but are not limited to, personal assistance, nursing, nurse monitoring, medical day care, case management, transportation, medical supplies and medical equipment.

Maryland maintains six HCBS waivers targeting specific populations. and provides seniors over the age of 65 an alternative to nursing home facilities through

Medicaid Waiver Programs for Assisted Living and In-Home Care

Maryland Home and Community-Based Options Waiver (HCBS Medicaid Waiver)


Services included in the Home and Community Based Options Waiver: Assisted living services (not including room and board); Behavior consultation services; Case management; Dietitian and nutritionist services; Medical day care; Senior Center Plus; and all other standard Medicaid Services, including Community First Choice if living at home.


  1. Health: Applicants for the waiver must meet a nursing home level of care.
  2. Financial: An applicant is subject to certain income and asset limits. Single people can have no more than $2,000 in resources. Maryland is a Special Income Limit (SIL) state, and the income limit for a single individual is $2,523. Married couples can have up to $137,400 in resources as long as one spouse at home DOES NOT receive long-term care services. Furthermore, the community spouse may receive a monthly income of up to $3,435 (the maximum monthly maintenance needs allowance, or MMMNA) to pay for living costs.

In Maryland, the “medically needy” provision applies to applicants for the waiver. A “Waiver Spend-down” option allows your eligibility to be considered even if your income exceeds the limit. In order to qualify, you must spend your income on medical or other remedial costs such that the amount spent reduces your monthly income to below the SIL of $2,523. A Miller Trust, also known as a Qualified Income Trust, is not permitted as a strategy to divert income to meet the SIL.

Practical Considerations

There is a limit on the total number of participants who can be served in each waiver. When the waiver is at maximum capacity, the waiver will be closed to community applicants. In the event that a waiver has reached maximum capacity, interested persons can place themselves on the Waiver Services Registry by calling Maryland Access Point at 1-844-627-5465 for the Home and Based Community Options Waiver.


Maryland is a state that has a strict income limit in order to qualify for Medicaid for long-term care, making it difficult for seniors who would otherwise be eligible (due to the need for a nursing home level of medical care) to qualify for the waiver program if they have too much income. In addition, the unavailability of a Miller Trust vehicle to divert income so that the countable income for Medicaid purposes is at or below the limit means that the applicant would have to spend money on care. This “medically needy” provision is complicated and requires detailed recordkeeping. A Medicaid Planning specialist is essential to ensuring the best outcome. Using a Medicaid Planning specialist such as FamilyAssets may help you or your loved one qualify for the Home and Community-Based Options Waiver in Maryland.

Access all state Medicaid Waiver pages.