Maryland Medicaid Nursing Home Coverage 2026

Maryland Medicaid pays for nursing home care once Medicare's short rehabilitation window runs out. If a parent has just moved into a facility where a semi-private room costs a median $12,927 a month, this is the program that covers the long-term custodial care their savings cannot.1

This guide walks through how Maryland Medicaid nursing home coverage works in 2026: who qualifies medically and financially, how Maryland's medically needy spend-down works without a Miller Trust, what you keep versus what goes to the facility each month, how the at-home spouse is protected, and how estate recovery affects the family home.

Does Maryland Medicaid Pay for Nursing Home Care?

It does. Medicaid is the only public program that pays for long-term custodial nursing home care in any meaningful way, and in Maryland that program is Medical Assistance, run by the Maryland Department of Health (MDH), with eligibility processed by the local department of social services or health department.2 Medicare covers up to 100 days of skilled nursing care after a qualifying hospital stay, and then it stops. The custodial care that most nursing home residents need long-term, the daily help with bathing, dressing, eating, and moving, is not something Medicare pays for. That is the gap Maryland Medicaid fills.

For a resident who qualifies, Medical Assistance pays the nursing facility directly for covered care under Maryland's Medicaid Long Term Services and Supports program. The resident contributes most of their own income (the share of cost, explained below), and Medicaid covers the difference up to the facility's Medicaid rate.

What Maryland Medicaid pays for inside the facility:

• Room and board.
• Nursing care and help with daily activities.
• Prescription drugs and medical supplies under the daily rate.
• Physician services and therapies covered by the facility benefit.

To get there, an applicant has to clear two separate tests: a medical one and a financial one.

Maryland Medicaid Nursing Home Medical Eligibility (Level of Care)

Before Maryland Medicaid pays for a nursing home, the resident has to need that level of care. The state uses a level-of-care determination to confirm the person requires the kind of skilled or custodial care a nursing facility provides, rather than care that could safely be delivered at home or in assisted living.

In practice, this means the resident needs ongoing nursing supervision or hands-on help with several activities of daily living, things like transferring in and out of bed, toileting, eating, and managing medications. A physician documents the need, and the facility's admission process and the resident's medical records support it. Most older adults entering a nursing home directly from a hospital, after a stroke, a serious fall, or advancing dementia, clear this bar without difficulty.2

If the person's needs are real but could be met at home, the better fit may be Maryland's Community Options waiver or another home- and community-based program rather than institutional care. Those programs apply the same spousal protections discussed below, which is worth knowing before you assume a nursing home is the only path.

Financial Eligibility: Assets and Income

This is where most families get stuck, and where Maryland's rules differ from the federal default.

The asset limit

Effective February 1, 2026, the countable-asset limit for an aged, blind, or disabled individual, including long-term care, is $2,500, and $3,000 for a couple.2 That is higher than the $2,000 figure most states use. Some assets don't count toward that limit:2

• The primary residence, exempt up to a 2026 home-equity limit of $752,000.2
• One vehicle.
• Household goods and personal effects.
• A prepaid burial plan.

Maryland applies a 60-month (five-year) look-back to uncompensated asset transfers, so gifts or below-market transfers made in the five years before applying can create a penalty period. That makes early planning worthwhile.

The income test and Maryland's spend-down

Here is where Maryland differs from income-cap states like Indiana and Colorado. Maryland is a medically needy state and does not require a Miller Trust. There is no hard income ceiling that bars you from nursing-home coverage. Instead, an applicant whose income runs above the medically needy income level (which is low, $350 a month for an individual in 2026) qualifies by spending down the excess on incurred medical bills, including the cost of the nursing facility itself.2 In a nursing home, that spend-down effectively becomes the resident's monthly contribution toward care, described in the next section. The practical result is that high income does not lock you out; it just means more of that income goes toward the facility.

For a full walk-through of the income standards and exempt assets, see Maryland Medicaid eligibility and income limits.

What You Pay: Share of Cost / Patient Liability

Once a resident is approved, the question becomes how much of their income goes to the facility each month. Maryland calls the resident's contribution the share of cost, and the math runs in a fixed order.

Start with the resident's gross monthly income. Subtract, in order:

1. The personal needs allowance, $106 per month in Maryland, which the resident keeps for personal expenses like haircuts, clothing, and toiletries. Maryland's allowance runs well above the federal floor of $30 a month, which is the statutory minimum most states only modestly exceed.2,3
2. Health insurance premiums, including the Medicare Part B premium and any Medigap premium.
3. A monthly maintenance allowance for an at-home spouse, if there is one (covered in the next section).

Whatever remains is the share of cost the resident pays the facility each month. Medical Assistance covers the rest of the facility's Medicaid rate. The resident is never left without the $106 set aside for personal needs, which is one of the more generous allowances in the country.2

A quick illustration shows the mechanic. Suppose a widow in a Baltimore nursing home has no at-home spouse, and her Medicare Part B premium is already paid by a Medicare Savings Program. After Maryland sets aside her $106 personal needs allowance, essentially all of her remaining monthly income, whatever the amount, goes to the facility as her share of cost, and Medical Assistance covers the gap up to the facility's Medicaid rate.2

Protecting the At-Home Spouse

When one spouse enters a nursing home and the other stays in the community, federal spousal-impoverishment rules keep the at-home spouse from being left without enough to live on. Maryland applies these protections.2

Two protections do the heavy lifting:

• The Community Spouse Resource Allowance (CSRA) lets the at-home spouse keep up to half the couple's countable assets, up to a 2026 maximum of $162,660 (minimum $32,532). This is separate from the institutionalized spouse's $2,500 limit.2
• The Minimum Monthly Maintenance Needs Allowance (MMMNA) lets income shift from the nursing-home spouse to the at-home spouse, bringing the at-home spouse's income up to a floor that ranges from $2,705.00 to $4,066.50 per month in 2026, depending on housing costs.2

Because the asset snapshot and the housing-cost calculation get technical fast, and because the difference can run into six figures, this is one area where it pays to get the numbers right. See Maryland spousal impoverishment protections for the full framework.

Estate Recovery After Nursing Home Care

After a Medicaid recipient who received long-term care dies, federal law requires the state to try to recover what it spent from the person's estate. Maryland pursues this recovery for recipients who were 55 or older when they received long-term-care services.2

A few protections limit how and when recovery happens:

• There is no recovery while a surviving spouse is living.
• Recovery is barred while a surviving child under 21, or a child of any age who is blind or permanently disabled, is living.
• An undue-hardship waiver is available where recovery would create real hardship for survivors.

The home is an exempt asset while the resident is alive, but it can be subject to a claim from the estate after death. Because the rules around the home, probate, and hardship waivers get detailed, this is a planning conversation worth having with an elder-law attorney before a parent enters a facility. For the full mechanics, see Maryland Medicaid estate recovery.

How to Find a Maryland Medicaid Nursing Home

Most nursing homes in Maryland are certified to accept Medical Assistance, but quality varies widely, and that is the choice that matters most. Three free resources should drive it: Medicare Care Compare for the national five-star ratings, the Maryland Office of Health Care Quality (OHCQ) for the state's own inspection and complaint record, and the Maryland Long-Term Care Ombudsman for on-the-ground advocacy before you commit to a home.4

Questions worth asking any facility you're considering:

• How many Medicaid beds do you currently have open?
• What is your current five-star rating, and have you had deficiencies in the past year?
• What is your staffing ratio on day, evening, and overnight shifts?
• Will you accept a "Medicaid pending" admission, and how do you bill during the application period?

Learn More

Find personalized help mapping a Maryland Medicaid nursing home application 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.