Maryland Medicaid HCBS Waivers: Home Care Options

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.1 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
• Increased Community Services: If Income Is Too High for the Waiver
• 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.1

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, 2027.1 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.1

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.1 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?

Maryland says you must meet all of the waiver's medical, technical and financial rules at the same time.1 Think of them as three tests: one about the level of care you need, one about your circumstances, and one about income and assets.

The functional test. You must need a nursing-facility level of care.1 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 technical test. You must be age 18 or older and live at home or in the community. You can't be in another waiver program or the Programs of All-Inclusive Care for the Elderly (PACE) at the same time. Your community-based service costs can't be more than institutional care would cost, and you must be able to live safely at home and in the community with the waiver's services.1

The financial test. The Community Options Waiver uses Maryland's long-term care Medicaid financial rules:1

• Income. For Maryland's Community Options Waiver, your monthly income may not exceed 300% of the Supplemental Security Income (SSI) benefit rate.1 At the 2026 SSI federal benefit rate, that cap is $2,982 a month.2 If Medicaid denies your application because your income is too high, the Maryland Department of Health says you may be eligible for the Increased Community Services Program instead.1
• 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.2

Only your countable assets are tested, not everything you own. One rule about the home is worth knowing: Maryland's Medicaid manual sets an excess home-equity limit of $752,000 for long-term care coverage, so home equity above that amount can stand in the way of coverage.2 The Maryland Department of Health also tells applicants they may still be eligible even if their income or assets are higher than its listed limits, and to call the Department of Human Services for help with their own limit amount, so confirm your numbers with the state before you assume you are over.2 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:1

• 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.1 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.1

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.1 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.

Increased Community Services: If Income Is Too High for the Waiver

If Maryland Medicaid turns down a Community Options Waiver application because income is over the limit, the Increased Community Services (ICS) Program is the route the state points to. ICS is a home and community-based services demonstration governed by COMAR chapter 10.09.81, and it helps a person who has been living in a nursing facility get services at home and in the community instead.3

Maryland says you must meet all of the program's medical, technical and financial rules:3

• Age and care need. Age 18 or older, and needing a nursing-facility level of care.3
• Time in a nursing facility. Living in a nursing facility for at least six months, and eligible for Medicaid for at least 30 days in a row.3
• Income. Monthly income above 300% of the SSI benefit rate. You pay any monthly income above that amount toward your cost of care, as a required monthly fee based on your income.3
• Assets. Countable assets of no more than $2,500. Eligibility is based on the income and assets of the applicant only.3
• Other limits. You must not be eligible for a home and community-based waiver or for PACE, and the cost of your community-based services must not be more than institutional care.3

Maryland's six-month nursing-facility rule is narrower than the federal terms the program runs under. CMS's current terms for Maryland's HealthChoice demonstration allow ICS for someone who has lived in a nursing facility for at least 90 consecutive days with Medicaid paying for that care, or for a Community Options Waiver participant whose income is no more than 5 percent over the waiver's limit, though another section of the same document still states the six-month rule. Maryland's own program page, fact sheet and regulation mention neither of those federal routes, so if either one describes your situation, ask the program which rule it applies to you. Those terms also cap ICS at 100 participants enrolled at any one time.3

You cannot apply directly. In Maryland's words, "You cannot apply directly to this program. You must receive a referral from Medicaid's Eligibility Determination Division."3 So if a waiver denial for high income arrives, ask that division about an ICS referral.

Who can be the paid attendant. Under COMAR 10.09.81.13, an ICS attendant is employed either by the participant or by an agency. Unless the Department grants an exemption, an attendant may not be a spouse, a parent of a dependent child, or someone with full and unrestricted powers of guardianship. The regulation lets the Department grant exemptions but does not say whether the spouse bar is one it can lift, so a husband or wife should ask before counting on being paid. Adult children and relatives who live with the participant are not named among those barred. The regulation does not say whose child the "parent of a dependent child" bar refers to, though, so it leaves open whether a son or daughter who has a dependent child of their own can be the paid attendant. If that describes you, confirm with the program first.4 For how each Maryland program treats family caregivers, see how to get paid to care for a family member in Maryland and getting paid to care for your spouse in Maryland.

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.1

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.5 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 days for most applicants, or 90 days for applicants who apply for Medicaid on the basis of disability.6 Those are the outer limits on the agency, not a promise of how fast a specific case moves, but they give you a benchmark for when to follow up. Note that the window turns on the basis you applied under, not on whether a disability question comes up in your case: an older adult applying on the basis of age falls under the 45-day limit even when the file includes a level-of-care assessment, so a wait past day 45 is late rather than routine unless an unusual circumstance applies, such as a delay by the applicant or an examining physician.6

Learn More

Find personalized help understanding Maryland Medicaid HCBS waivers 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.