Maryland Medicaid income limits are some of the lowest in the country: the medically needy income level is just $350 a month for one person in 2026. That doesn't mean you're shut out if you earn more. Maryland lets you spend down the excess on medical bills to qualify, and it lets you keep a bit more in the bank than most states do.
This guide walks through the 2026 income and asset rules for Maryland Medicaid (the state calls it Medical Assistance) for seniors and people who are aged, blind, or disabled. It covers the $2,500 asset limit, how the spend-down actually works, what a nursing-home resident keeps, what an at-home spouse is protected from, the five-year look-back, and how to apply.
The $2,500 asset limit: a little more room than most states
Maryland Medicaid is administered by the Maryland Department of Health (MDH). For an aged, blind, or disabled applicant, including someone applying for long-term care, the countable-asset limit effective February 1, 2026 is $2,500 for an individual and $3,000 for a couple.
That $2,500 figure is worth pausing on. The federal default, unchanged since the 1980s, is $2,000, and most states still use it. Maryland sits a little above that floor. It's not the dramatic break that states like Illinois made when they raised the limit into five figures, but the extra $500 is real money for an applicant counting every dollar.
"Countable" is the word that does the work. Maryland, like every state, exempts a long list of assets from the count: your home (subject to an equity cap, covered below), one vehicle, household goods and personal effects, and prepaid burial arrangements. So the $2,500 applies to things like bank accounts, a second car, and investments, not the roof over your head.
How the income test actually works: spend-down
Here's where Maryland surprises people. The medically needy income level for 2026 is $350/month for one person and $392/month for a couple. Almost no one's income is that low. A single Social Security check alone usually clears it several times over.
Being over that number does not disqualify you. Maryland is a medically needy state, which means it offers a spend-down: the amount your income exceeds the $350 level becomes your monthly spend-down. Once you've incurred that much in medical or care costs in a given period, Medicaid covers the rest. The excess can be reduced by what you pay for health insurance, like a Medicare Part B premium or a Medigap policy, before the spend-down is calculated.
Because the spend-down exists, Maryland does not require a Qualified Income Trust (also called a Miller Trust). In strict income-cap states, an applicant even a dollar over the limit is shut out unless they route the excess through a special trust. Maryland has no such cliff. If your income is high, you spend down; you're never simply "too rich" for long-term-care Medicaid.
One number to know for home-based care: the home and community-based services (HCBS) waivers use a higher special income limit of $2,982/month, set at 300% of the 2026 SSI Federal Benefit Rate of $994. An applicant under that ceiling can qualify for waiver services without running the full medically needy spend-down.
Long-term care: what a nursing-home resident keeps
When Maryland Medicaid pays for nursing-facility care, the resident contributes nearly all of their monthly income toward the cost of care. What they hold back is the Personal Needs Allowance (PNA), money reserved for the resident's own small expenses like clothing, a haircut, or a phone. Maryland sets its PNA at $106/month, one of the highest in the country (many states keep it near the $30 to $60 range).
The same asset limit applies to nursing-home applicants. And because Maryland uses spend-down rather than an income cap, even a resident with substantial monthly income can qualify; they simply contribute more of it toward care, after the PNA and certain other deductions like a community-spouse allowance and health-insurance premiums. For the national picture on how the PNA is set and calculated, see our explainer on the Medicaid personal needs allowance.
Protecting the spouse who stays home
When one spouse needs long-term care and the other stays in the community, federal spousal-impoverishment rules keep the at-home spouse from being left destitute. Maryland applies the federal framework for 2026:
| Protection | 2026 Amount | What it does |
|---|---|---|
| Community Spouse Resource Allowance (CSRA) | Half the couple's countable assets, up to $162,660; minimum $32,532 | The most in countable assets the at-home spouse may keep, on top of the applicant's own limit. |
| Minimum Monthly Maintenance Needs Allowance (MMMNA) | Federal range from $2,643.75 (eff. 7/1/2025) to $4,066.50 (eff. 1/1/2026) | The monthly income the at-home spouse may keep; income can be shifted from the applicant to reach it. |
| Home-equity limit | $752,000 | Equity in the primary residence above this amount is countable for long-term-care eligibility. |
So a married couple is in a very different position from a single applicant. Unlike the flat $2,500 individual limit, the community spouse can hold up to $162,660 in countable assets, half the couple's total, and keep a monthly income allowance while the other spouse receives Medicaid-funded care.
The five-year look-back
Maryland reviews asset transfers made in the 60 months before a long-term-care application. Giving away money or property for less than fair market value during that window, such as gifting a grandchild a down payment or signing a house over to a child for a dollar, can trigger a penalty period during which Medicaid won't pay for long-term-care services, even though you're otherwise eligible.
There are legitimate exceptions (transfers between spouses, transfers to a disabled child, certain caregiver-child home transfers) and legitimate planning approaches, but anything done inside the five-year window deserves an elder-law attorney's review first. If long-term care is on the horizon for someone in your family, talk to a professional before moving assets. For the broader toolkit, see our guide to Medicaid planning strategies.
After death: estate recovery
Like every state, Maryland runs a Medicaid estate-recovery program. After a recipient who was 55 or older and received long-term-care services dies, the state may seek repayment from the estate, unless the recipient is survived by a spouse or a minor, blind, or disabled child. An undue-hardship waiver also exists for cases where recovery would force a survivor off the property or into hardship. For how estate recovery works and where families have room to plan, see our Medicaid estate recovery explainer.
How to apply in Maryland
Maryland Medicaid is run by the Maryland Department of Health, with eligibility processed locally. You have a couple of ways to apply:
- Online through Maryland Health Connection, the state's official marketplace, which handles Medical Assistance applications.
- Through your local department of social services or health department, which handle the long-term-care eligibility determinations, including the asset review, spend-down calculation, and spousal-impoverishment math.
Long-term-care applicants also go through a level-of-care assessment to confirm they need nursing-facility-level services. Apply even if you think your income is too high. Between the spend-down rules and the higher waiver income limit, many people who assume they're disqualified are not.
Frequently Asked Questions
$2,500 in countable assets for one person and $3,000 for a couple, effective February 1, 2026. That's a bit above the $2,000 most states use. The home (subject to an equity cap), one vehicle, household goods, and prepaid burial arrangements are exempt from the count.
The medically needy income level for 2026 is just $350/month for one person and $392/month for a couple. But income above that does not disqualify you. Maryland lets you spend down the excess on medical and care costs to qualify, so most applicants qualify through spend-down rather than by meeting the number.
Your spend-down is the amount your monthly income (reduced by health-insurance premiums like Medicare Part B or Medigap) exceeds the $350 medically needy level. Once you've incurred at least that much in medical or care bills in a given period, Medical Assistance covers the rest. There's no income cap and no Miller Trust requirement.
No. Maryland is a medically needy spend-down state, not an income-cap state, so there's no hard income ceiling for long-term-care Medicaid and no need for a Qualified Income Trust. That's a key difference from income-cap states like Florida, where over-income applicants must route excess income through such a trust.
For 2026, the at-home (community) spouse can keep up to $162,660 in countable assets, half the couple's total, with a minimum of $32,532. The spouse also keeps a monthly income allowance set within the federal range ($2,643.75 to $4,066.50). The home is generally protected up to $752,000 of equity.
A Personal Needs Allowance of $106/month, among the highest in the country. The rest of the resident's monthly income goes toward the cost of care, after deductions for a community spouse and certain health-insurance premiums.
Learn More
- Medicaid Planning Strategies
- How Medicaid Estate Recovery Works
- The Medicaid Personal Needs Allowance, Explained
Find personalized help working through Maryland Medicaid eligibility and spend-down for your family 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.