How to Apply for Maryland Medicaid 2026: Step-by-Step

Maryland lets you apply for Maryland Medicaid online, by phone, or in person, and unlike most states, you can qualify through spend-down bills alone, no Miller Trust needed. Medicaid is run here by the Maryland Department of Health through Maryland Health Connection for standard coverage and your local DSS for long-term care. This guide walks through each channel, how the spend-down works in practice, what documents to gather, and how to appeal a denial.

How Maryland's Spend-Down Works When Applying for Medicaid

Maryland's spend-down is the detail that catches applicants off guard. Most states that impose an income cap above the medically needy level require a Qualified Income Trust (Miller Trust) to route excess income before Medicaid will pay. Maryland does not. Instead, Maryland uses the medically needy pathway: if your monthly income exceeds the medically needy income level of $350 for a single applicant (effective February 1, 2026), you can still qualify by accumulating incurred medical expenses equal to the difference.

Here is how the mechanics work in practice. Say your monthly income is $1,800 from Social Security. Your spend-down obligation is $1,800 minus $350, or $1,450 per month. You submit unpaid medical bills (hospital invoices, doctor bills, pharmacy receipts, Medicare Part B premiums, Medigap premiums) totaling at least $1,450. Once those bills are verified, Maryland Medicaid covers the remaining costs for that month. The next month, the process repeats.

Bills do not have to be new. Maryland allows incurred but unpaid bills from prior periods to count toward the spend-down, which can accelerate coverage for applicants who have been accumulating medical debt. Your local DSS worker will tell you exactly which bills count and how to submit them.

For HCBS waiver applicants, the income standard is entirely different: $2,982/month (300% of the 2026 SSI Federal Benefit Rate). If your income falls under that figure, no spend-down calculation is needed for the waiver programs.

How to Apply for Maryland Medicaid

Maryland offers two application channels. Which one you use depends primarily on the program you're applying for.

Apply Online Through Maryland Health Connection

Maryland Health Connection is the state's health insurance marketplace and Medicaid enrollment portal. For most Medicaid categories, including standard coverage for seniors with income below the medically needy level, this is the fastest route.

Go to marylandhealthconnection.gov and select "Apply for Coverage." You can create an account (which lets you save progress, check status, and upload documents) or apply without one. The portal accepts applications for most Maryland Medicaid categories and automatically routes long-term-care determinations to the appropriate office.

The online application asks for household income, assets, and insurance information. Have your documents ready before you start. Incomplete applications stall at the verification step, which is the most common reason for delayed decisions.

Apply at Your Local DSS or Health Department

For long-term-care determinations, including nursing facility Medicaid, HCBS waivers, and spend-down cases, Maryland routes applications through the local Department of Social Services or health department. This channel gives you a case worker who handles the spend-down calculation, collects your medical bills, and coordinates with the nursing facility or home-care provider.

To find your local office, visit health.maryland.gov or call the Maryland Department of Health at their main line (listed on their website). Many counties also allow you to call 211 to be connected to your local DSS.

If a family member or an elder law attorney is handling the application on your behalf, they can appear at the local office with written authorization. For applicants who cannot sign due to incapacity, the person holding durable power of attorney or legal guardianship can sign and act as the authorized representative.

What Happens After You Apply

For standard Medicaid categories, Maryland must make an eligibility determination within 45 days of the application date. For applications that require a disability determination, the window extends to 90 days.

Long-term-care applications, particularly spend-down cases, typically involve a more involved process. The local DSS worker will schedule an interview, request supporting documentation, and verify your asset and income claims. The 60-month look-back on asset transfers is reviewed at this stage. If you transferred assets for less than fair market value during the prior five years, a penalty period may be assessed. An elder law attorney familiar with Maryland's rules can help you evaluate whether any transfers are problematic before you submit.

Once approved, nursing-home residents contribute nearly all monthly income toward the cost of care. The state allows a Personal Needs Allowance of $106/month, which the resident keeps for personal expenses. Married applicants should ask about the spousal impoverishment protections, which allow the community spouse to retain income and assets within federal limits.

Documents to Gather Before You Apply

Missing paperwork is the single biggest reason applications stall. Collect these before you start:

Identity and citizenship:

• Social Security card or benefit statement
• U.S. birth certificate, passport, or Certificate of Naturalization
• State-issued photo ID or driver's license
• Already on Medicare? Medicare ID cards serve as proof of citizenship in most cases

Income:

• Social Security award letter or most recent SSA-1099
• Pension and retirement income statements
• Documentation of any rental income, annuity payments, or other monthly income sources

Financial accounts:

• Bank statements for all checking and savings accounts (current month plus at least three prior months)
• Statements for CDs, IRAs, brokerage accounts, and any trusts
• Long-term-care applicants should prepare up to 60 months of financial statements to support the look-back review

Property and insurance:

• Property deeds and current tax bills for real estate
• Life insurance policies (face value and current cash surrender value)
• Prepaid burial contracts and cemetery plot deeds
• Vehicle title

Medical bills and insurance:

• Unpaid medical bills (for spend-down applicants, these are central to the application)
• Medicare Part B and Medigap premium invoices
• Explanation of benefits from any private insurance

What to Do if You're Denied

Maryland Medicaid applicants have the right to appeal a denial through the Office of Administrative Hearings. You must request a hearing within 90 days of the date on your denial notice.

Request a hearing in writing and send it to:

Office of Administrative Hearings 11101 Gilroy Road, Hunt Valley, MD 21031

You can also request a hearing by calling your local DSS office. If you request a hearing before your Medicaid coverage ends, you generally have the right to continue receiving services while the appeal is pending, a protection worth invoking quickly.

Hearings can be held in person, by telephone, or (in some cases) by video. An administrative law judge will issue a written decision. If you disagree with the outcome, you can seek judicial review in circuit court.

Free legal help with appeals is available through Maryland Legal Aid (statewide, 410-539-5340) and the Maryland Disability Law Center (for applicants with disabilities).

Where to Get Help With Your Application

You don't have to navigate this alone:

Maryland Legal Aid. Free civil legal services for low-income Marylanders, including Medicaid application and appeal assistance. Call 410-539-5340 or find the nearest office at mdlab.org.

State Health Insurance Assistance Program (SHIP) / SHIP Maryland. Free one-on-one counseling on Medicare and Medicaid interactions. Especially useful for dual-eligible situations and spend-down cases where Medicare premiums factor into the calculation. Call their main line (listed on their website) to connect with a counselor.

Area Agencies on Aging (AAA). Maryland has 19 local AAAs that provide free benefits counseling for adults 60 and older. Find yours through the Maryland Department of Aging at their main line (listed on their website) or aging.maryland.gov.

Elder law attorneys. For spend-down strategy, look-back analysis, and spousal impoverishment protection, a Maryland-licensed elder law attorney can significantly improve your outcome. The Maryland State Bar Association offers a referral service at 410-539-3300.

Learn More

• Maryland Medicaid Eligibility and Income Limits
• Medicaid Planning Strategies
• How Medicaid Estate Recovery Works Find personalized help applying for Maryland Medicaid 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.