If you hope to bring a parent home from a Maryland nursing facility and be paid for their care, start with Maryland's Increased Community Services (ICS) program. ICS helps a Medicaid nursing-home resident move home, and its rules let the participant choose their own attendant. Current ICS materials don't say whether that option is in use today, so confirm with the Maryland Department of Health before you count on a paycheck. The rules bar a spouse, a parent of a dependent child and a full guardian unless exempted. They don't name adult children, but they don't say whose dependent child is meant, so a son or daughter with children of their own should ask the Department too.,

In This Guide

Who Can Be Paid Through Maryland's Increased Community Services Program

If you're hoping to bring a parent home and be paid for the care you give, start with who the ICS rules allow. Increased Community Services (ICS) is governed by the Code of Maryland Regulations (COMAR) 10.09.81, and the Maryland Department of Health decides who is eligible. The ICS regulation provides for a participant-employed attendant: someone who doesn't work for an agency and whom your relative chooses and may train, supervise and fire. It also lists who may not be an attendant.

Family member Can they be the paid attendant?
Adult son or daughter Not named among those barred, unless a full guardian; unclear if they have a dependent child of their own
Other relative, including one who lives there Not named among those barred, unless a full guardian; unclear if they have a dependent child of their own
Spouse No, unless exempted
Parent of a dependent child (the rule doesn't say whose child) No, unless exempted
Guardian with full, unrestricted powers No, unless exempted

The regulation bars "a parent of a dependent child" without saying whose child it means, so it doesn't settle whether an adult son or daughter who has a dependent child of their own can be the attendant; ask the Maryland Department of Health before you plan around it. If you'd be your relative's participant-employed attendant but don't meet the ICS age, English-language or CPR and first-aid qualifications, your relative can ask the Maryland Department of Health to exempt you. The Department may grant exemptions and revoke them for cause, and an exempted attendant may serve only the person who asked for the exemption. The regulation doesn't say in words whether the spouse bar itself can be exempted.,

Before you plan around a paycheck, know that the Department's ICS page lists personal assistance as a service without saying how it's delivered, and the Centers for Medicare & Medicaid Services (CMS) says ICS provides the same home and community services as the Community Options Waiver.

That matters because the Community Options Waiver itself covers no personal assistance benefit. Maryland's waiver regulation places personal assistance under Community First Choice or Community Personal Assistance Services instead. Not knowing which program would actually pay you is frustrating when you're planning a parent's move home, and these two questions are how to get a straight answer from the Department:

CFC requires an institutional level of care, a community setting and full Medicaid, with no age limit, and its transition services matter to someone leaving an institution; whether your relative can use it alongside ICS is a question for the Department. In CFC's self-directed model, the participant decides what to pay within state and federal compensation rules, and a Financial Management and Counseling Services (FMCS) contractor helps with payroll and employment taxes. Hires must meet CFC's own requirements, including first aid and CPR certification and a background check; see how a family caregiver gets paid through Maryland Community First Choice.

How an ICS Attendant Would Get Paid

Being paid to care for a parent through ICS would mean becoming your relative's employee on paper, with a fiscal intermediary handling payroll and taxes. Here is how that would work if the Maryland Department of Health confirms your relative can use the participant-employed model.

A participant-employed ICS attendant must be an enrolled Medicaid provider, and your relative uses a fiscal intermediary under contract with the Department. You'd send payment requests to the fiscal intermediary, which bills the Department, withholds taxes and Social Security, and pays you.

For comparison, the median home care aide wage in Maryland is about $18.29 an hour (BLS, May 2025). That Bureau of Labor Statistics median is a wage estimate for the occupation, not a rate any program pays a family caregiver.

Your relative's ICS plan of service must also be one the Maryland Department of Health finds will cost Medicaid less than staying in the nursing facility. For taxes, see whether family caregiver pay is taxable in Maryland.

For a spouse, see getting paid to care for your spouse in Maryland.

Who Qualifies for Maryland Increased Community Services

If Medicaid turned down your relative's Community Options Waiver application because their income was too high, it can feel like the way home just closed. ICS may still open it: a person denied the waiver because of income may be eligible for ICS. To qualify for Maryland Increased Community Services, your relative must meet every one of these rules:

  • Your relative needs nursing facility level of care and is 18 or older.
  • Your relative is living in a nursing facility when applying, has lived there for at least the six months before applying, and has been eligible for Medicaid for at least 30 days in a row before enrolling in ICS. The federal terms behind ICS also describe a 90-day route; see the FAQ on stays under six months below.
  • Your relative isn't eligible for a home and community-based waiver or the Programs of All-Inclusive Care for the Elderly (PACE).
  • Your relative's monthly income is above 300% of Supplemental Security Income (SSI) benefits, and as an ICS participant they pay the amount above that toward the cost of care as a monthly fee.
  • Your relative's countable assets are no more than $2,500 (Maryland Department of Health, February 2026).
  • Your relative can live safely at home with ICS services, at a cost no more than institutional care.

For a sense of scale, 300% of the federal SSI benefit for one person is $2,982 a month for 2026, three times the $994 federal rate set by the Social Security Administration. Maryland's ICS materials state the test as 300% of SSI benefits, so confirm the exact monthly limit with the Department.,

Seeing part of a parent's income go to a monthly fee is hard to accept. Under ICS, that fee goes toward the cost of your relative's care at home. Only your relative's own income and assets count for ICS, not a spouse's.

ICS vs. the Community Options Waiver

CMS says ICS provides home and community-based services identical to the Community Options Waiver, so what sets ICS apart is who it serves. If the waiver said no because of income, ICS is the program to ask about.,

Increased Community Services (ICS) Community Options Waiver
Monthly income Above 300% of SSI benefits; the amount above that is paid as a monthly fee No more than 300% of SSI benefits
Countable assets No more than $2,500 No more than $2,000 or $2,500, depending on eligibility category
Whose income and assets count Your relative's only, not a spouse's Based on the household's
Where your relative lives In a nursing facility, for at least six months before applying At home or in the community; a nursing facility resident whose Medicaid has paid for at least 30 days may apply with no wait
Waitlist Capped at 100 participants, then a registry The Community Options Waiver Registry, through Maryland Access Point

What ICS Covers

An ICS participant gets all Medicaid covered services and benefits. If you'll be the one giving care, three listed ICS program services are the ones to raise first:

  • Personal assistance: the service a paid family attendant would provide, so ask how your relative's would be delivered (see the two questions above).
  • Respite: worth asking about if you'll need time away from caregiving.
  • Family training: worth asking about if you'll be learning to handle your relative's care at home.

Other listed ICS services include assisted living, home-delivered meals, medical day care, and transition and supplemental services with the Money Follows the Person Program.

How to Start

1
Step 1

Ask for a referral

Your relative can't apply to ICS directly; the referral comes from Medicaid's Eligibility Determination Division. Call Maryland Access Point at 844-627-5465 or the Office of Long Term Services and Supports at 410-767-1739, ask how the ICS referral works, and mention any Community Options Waiver denial for income.

2
Step 2

Expect a possible wait

ICS is capped at 100 participants at a time, so the move home may have to wait for a slot. Maryland enrolls eligible people first-come, first-served up to the cap, so getting the referral started early matters. Once ICS is full, eligible people go on a registry in the order they showed interest; when a slot opens, they have 15 days to answer, then a second letter gives 7 more days before the slot goes to the next person. Watch the mail closely so a letter doesn't go unanswered.

3
Step 3

Ask who can provide care

Before the plan is set, call the Office of Long Term Services and Supports at 410-767-1739 and ask whether your relative's ICS personal assistance can be self-directed, with you as the participant-employed attendant. To ask about Community First Choice instead, call Maryland Access Point at 844-627-5465, which refers most people to CFC, or the CFC program at 410-767-1739.,,

Frequently Asked Questions

What happens if my relative doesn't answer the ICS registry letter?

Under CMS's terms for Maryland's ICS program, a person who doesn't answer the second registry letter within 7 days is removed from the ICS registry, and the slot goes to the next person in line.

What if Maryland Medicaid denies my relative's ICS application?

A denial can feel like the way home just closed again, but it isn't the final word: if your relative believes a decision to deny their Medicaid eligibility or services is wrong, they can ask for a fair hearing. For most decisions, the request must be made within 90 days of the date on the notice, through the Maryland Department of Health's online Medicaid Request for Fair Hearing form, by mail or by fax. The Maryland Office of Administrative Hearings conducts the hearing. If the decision came from a HealthChoice managed care organization, your relative must first use the plan's own appeal process, filed within 60 days of the denial notice.

My relative has been in a nursing facility less than six months. Can they still get ICS?

Possibly. The federal approval behind ICS, which runs through December 31, 2026, also authorizes ICS for someone who is living in a nursing facility, has been there for at least 90 consecutive days and receives Medicaid nursing home benefits, not counting short-term rehab days limited under Medicare. For the ICS nursing facility stay requirement, Maryland's program page, fact sheet and regulation still say six months, so if your relative has been in a facility between 90 days and six months, ask the Department which rule applies. The same federal terms also authorize ICS for someone currently receiving Home and Community-Based Options waiver services whose income is above that waiver's income limit by no more than 5% and who still needs nursing facility level of care. Maryland's program page, fact sheet and regulation don't mention either federal route, so if either one describes your relative, ask the Department whether it applies.

Will Maryland Medicaid recover ICS costs from my parent's estate?

Thinking about your parent's estate while you're trying to bring them home is uncomfortable, but knowing the spouse and child protections up front helps you plan. Maryland Medicaid seeks recovery of correctly paid Medical Assistance from the estate of anyone who was 55 or older when they received benefits. Under COMAR 10.09.24.15, that recovery waits until after the death of a surviving spouse, and it doesn't happen when there's a surviving child as the regulation defines it or a surviving son or daughter who is blind or disabled. For questions, start with your caseworker at the local department of social services, whom the Department's 2006 estate recovery fact sheet names first. That fact sheet also lists the Recoveries and Financial Services Division at 410-767-6613, so confirm the number is still current when you call.

What if I can't be paid through ICS?

You can still get help as an unpaid caregiver. The Maryland Department of Aging's Family Caregiver Support Program serves adult family caregivers age 18 and older caring for someone 60 or older, or for someone of any age with Alzheimer's disease or a related disorder. Its services include respite care, individual counseling, support groups and caregiver training, delivered through your local Area Agency on Aging. To find it, call Maryland Access Point at 1-844-627-5465.,

Can I be the paid ICS attendant if I live with my relative?

Maryland's ICS regulation, COMAR 10.09.81, doesn't list a relative who lives with the participant among those barred from being an attendant, but it doesn't otherwise address live-in relatives either, so confirm with the Maryland Department of Health. Maryland Community First Choice is clearer: its self-directed model with a service budget lets family members who meet the participant's qualifications be paid providers, subject to the CFC hiring requirements above. A CFC personal assistance provider who lives with the participant may be exempted from electronic visit verification.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in MarylandGet 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. CaregiverMaryland Community First Choice: How a Family Caregiver Gets PaidMaryland CFC self-direction lets a parent on full Medicaid hire a family member as a paid caregiver. Who can be hired, payroll help, and how CPAS differs. 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. CaregiverMaryland Caregiver ProgramsThe Maryland programs that support family caregivers, how Medicaid self-direction works, how to get a respite break, and where to get help in Maryland. MedicaidMaryland Medicaid HCBS WaiversMaryland 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.

Get personalized help planning your relative's move home from a Maryland nursing facility 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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