Maryland Medicaid pays for care in your own home and community through the Community Options Waiver, its main home- and community-based services (HCBS) waiver.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 The Community Options Waiver is built for older adults and people with disabilities who need a nursing-facility level of care, meaning the kind of daily help you would otherwise receive in a nursing home. Maryland Medicaid HCBS waivers exist so that a person who qualifies for that level of care can stay at home instead, with support brought to them. The Community Options Waiver is the program most families are looking for, and it works alongside a companion benefit called Community First Choice (CFC) that provides the hands-on personal care.
In This Guide
- What Are Maryland Medicaid HCBS Waivers?
- The Community Options Waiver and Community First Choice
- Who Qualifies for Maryland Medicaid HCBS Waivers?
- What the Waiver Covers
- The Waitlist and How Enrollment Works
- How to Apply
What Are Maryland Medicaid HCBS Waivers?
Home- and community-based services, usually shortened to HCBS, are the long-term care supports Medicaid pays for outside of an institution: in your own home, a family member's home, or a community setting rather than a nursing facility. The federal authority behind them is Section 1915(c) of the Social Security Act, which lets a state ask the federal government for permission to "waive" some normal Medicaid rules so it can serve people in the community who would otherwise need institutional care.
Here is the key idea to hold onto. A waiver does not lower the level of care you have to need. You still have to need a nursing-facility level of care to qualify. What the waiver changes is where you can receive that care, so a person who meets the institutional standard can get services at home instead.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
Maryland's Community Options Waiver is a federally approved 1915(c) program, listed on the federal waiver record as the MD Home and Community Based Options Waiver, approved through December 31, 2027.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 The waiver itself is governed by the Code of Maryland Regulations (COMAR) chapter 10.09.54.
The Community Options Waiver and Community First Choice
Two Maryland programs work together to keep a person at home, and it helps to see how they fit.
The Community Options Waiver, also called the Home and Community-Based Options Waiver (HCBOW), is the 1915(c) waiver. It helps you get services and support in your home and community instead of in an institution, and it is where the extra, waiver-specific services live.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
Community First Choice (CFC) is the companion benefit. When you are approved for the waiver, you receive all of your regular Medicaid state-plan services and Community First Choice, and then the waiver adds services on top of that base.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 In practice, CFC is where much of the everyday personal care comes from, while the waiver layers on the additional supports described below. Both programs are administered by the Maryland Department of Health.
Who Qualifies for Maryland Medicaid HCBS Waivers?
Eligibility comes down to two tests you have to pass at the same time: a functional test about your level of care, and a financial test about income and assets.
The functional test. You must need a nursing-facility level of care.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 This is a clinical judgment about how much help you need with daily activities and health needs, and it is the same institutional standard whether you would use it in a nursing home or, through the waiver, at home. If you would qualify for nursing-home care, you generally meet this part of the test.
The financial test. The Community Options Waiver uses Maryland's long-term care Medicaid financial rules:Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
- Income. For Maryland's Community Options Waiver, your monthly income may not exceed 300% of the Supplemental Security Income (SSI) benefit rate.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
- Assets. For Maryland's Community Options Waiver, your countable assets may not exceed $2,000 or $2,500, depending on your Maryland Medicaid eligibility category.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
Only your countable assets are tested, not everything you own. Under Maryland's long-term care Medicaid rules, an exempt primary home (up to a home-equity limit), one vehicle, household goods, and a prepaid burial do not count toward that limit, so it is worth confirming your own numbers with the state before you assume you are over.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf Our Maryland Medicaid income and asset limits guide walks through how these figures are counted.
What the Waiver Covers
Start from the base and build up. Once you are on the Community Options Waiver, you keep all of your covered Medicaid benefits, including Community First Choice. On top of that, the waiver may add services that include:Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
- Assisted living services
- Behavior consultation
- Case management
- Dietitian and nutritionist services
- Family training
- Medical day care
- Senior Center Plus
The mix that ends up in your plan is built around your assessed needs rather than handed out as a fixed package, so two people on the same waiver can have quite different service plans. Case management is worth calling out, because a case manager is the person who helps assemble and adjust that plan over time.
The Waitlist and How Enrollment Works
Here is the part that surprises people, so it is worth explaining plainly. There is a waitlist for the Community Options Waiver.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 Meeting every eligibility rule does not by itself put services in place; for most people, the first step is getting a place in line.
You join the line by getting your name on the Community Options Waiver Registry. You do that by calling Maryland Access Point (MAP) at 844-627-5465, and then you apply when you receive an invitation telling you it is your turn.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
There is one important exception to the wait. If you are already in a nursing facility and Medicaid has paid for your services there for at least 30 days, you may apply with no wait.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 That path exists to help people who are already in an institution move back into the community, so if that describes your situation, say so when you call.
How to Apply
Applying involves two tracks that run together: getting into the waiver line, and establishing Medicaid eligibility itself.
Get on the registry. Call Maryland Access Point at 844-627-5465 to add your name to the Community Options Waiver Registry, unless you qualify for the no-wait nursing-facility path above.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
Apply for Medicaid. The waiver runs on Medicaid, so you also need to be financially eligible for Maryland Medicaid through the Maryland Department of Health. Federal rules require the state to accept your application online, by phone, by mail, or in person, so you can use whichever channel is easiest for you.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Our how to apply for Maryland Medicaid guide covers the documents and steps in detail.
Know the decision clock. Once you apply, federal rules cap how long the state may take to decide. The determination may not exceed 45 calendar days for most applicants, or 90 calendar days if you are applying on the basis of a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf Those are the outer limits, not a promise of how fast a specific case moves, but they give you a benchmark for when to follow up.
Frequently Asked Questions
Do I have to move into a nursing home to get these services?
No. That is the whole point of a home- and community-based services (HCBS) waiver. The Community Options Waiver helps you get services and support in your home and community instead of in an institution, as long as you meet the nursing-facility level of care that would otherwise send you to one.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
Is there a waitlist, and how do I get on it?
Yes, there is a waitlist for the Community Options Waiver. You get in line by calling Maryland Access Point at 844-627-5465 to add your name to the Community Options Waiver Registry, and you then apply when you are invited.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956
My parent is already in a nursing home. Do we still have to wait?
Not necessarily. If your parent is in a nursing facility and Medicaid has paid for their services there for at least 30 days, they may apply for the Community Options Waiver with no wait.Centers for Medicare & Medicaid Services. (n.d.). MD Home and Community Based Options Waiver (0265.R06.00) — Medicaid.gov. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81956 This is designed to help people already in an institution transition back to the community.
How do I apply, and how long does a decision take?
You get on the registry through Maryland Access Point and establish Medicaid eligibility through the Maryland Department of Health, which must accept your application online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Federal rules then cap the eligibility decision at 45 calendar days for most applicants, or 90 calendar days if you apply on the basis of a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf
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