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, 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. Medicare covers skilled nursing facility care only on a short-term basis after a qualifying hospital stay: up to 100 days per benefit period, with a $217 daily coinsurance from day 21, and nothing after day 100.4 The custodial care that most nursing home residents need long-term, help with the basic personal tasks of everyday life, is not something Medicare pays for, and Medicare itself points families who need that care to Medicaid.4 In Maryland that program is Medical Assistance, run by the Maryland Department of Health (MDH).2

For a resident who qualifies, Medical Assistance pays the nursing facility under Maryland's Medicaid Long Term Services and Supports program, but it reduces that payment by the resident's own income left after certain allowances, the share of cost explained below.2

Nursing home care itself typically includes nursing care, 24-hour supervision, three meals a day, and help with everyday activities, with physical, occupational, and speech therapy also available.5

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, rather than care that could safely be delivered at home or in assisted living. Ask the hospital discharge planner or the facility's admissions staff early what medical documentation the facility and the state will need, so the medical side doesn't hold up the financial application.

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. The waiver's income test works differently: MDH says monthly income may not exceed 300% of SSI benefits, which is $2,982 a month in 2026, and countable assets may not be more than $2,000 or $2,500 depending on eligibility category.2

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, Maryland's medically needy (non-MAGI) countable-asset limit, the figure MDH posts for anyone aged 65+, blind or disabled, or in a home and community-based program, is $2,500 for an individual and $3,000 for a couple.2 Maryland's separate categorically needy (non-MAGI) standard is $2,000 for an individual and $3,000 for a couple.2 MDH also tells applicants they may still be eligible if their income or assets are higher than the posted limits, and to call the Department of Human Services for help with their own limit.2

Home equity has its own cap. Maryland's Schedule MA-10 sets an excess home-equity limit of $752,000, and equity above it rules out long-term-care coverage.2 Some property doesn't count toward the asset limit at all, and what is excluded depends on whether the resident intends to return home. For a resident who does, Maryland's resource regulation excludes, among other things, the home (with a narrow exception for a life estate interest), any automobile regardless of value, household goods necessary for the home, a wedding and engagement ring, burial spaces, up to $1,500 per person set aside for burial, and an irrevocable burial fund of any amount.2 For a resident who does not intend to return home, the list is narrower: the home is excluded only if a spouse or certain medically or financially dependent relatives live there, and the automobile exclusion is not repeated.2 The full lists, including how life insurance is treated, are covered in Maryland Medicaid eligibility and income limits.

Maryland looks back 60 months (five years) from the date a person is both in a nursing home and has applied for Medical Assistance. A gift or below-market transfer in that window, by the applicant or a spouse, creates a penalty period during which Medicaid won't pay for nursing-home or waiver care, though it doesn't end all Medical Assistance coverage. The penalty runs one month for each month of the state's average private-pay nursing-home cost that was given away, and transfers to a spouse are exempt.2 That makes early planning worthwhile.

The income test and Maryland's spend-down

Maryland is a medically needy state. Its medically needy income level is low, $350 a month for one person and $392 for two in 2026, but income above it doesn't end the application. Through spend-down, an applicant who is ineligible because of excess income becomes eligible by deducting incurred medical expenses from that excess.2 Nursing-home bills are large, so ask your caseworker how the facility's charges count toward spend-down. Once a resident is approved, their income left after the allowed deductions goes toward the facility each month, as the next section explains. The practical result is that high income alone does not lock you out; it means more of that income goes toward care.

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. The resident's contribution is often called the share of cost or patient liability, and federal rules set the order of the math.

Start with the resident's total monthly income. The state deducts, in order:

1. The personal needs allowance, $106 per month in Maryland ($212 for a couple), which the resident keeps for clothing and other personal needs. Maryland's allowance runs well above the federal floor of $30 a month, which is the statutory minimum every state must at least meet.2,3
2. A monthly maintenance allowance for an at-home spouse, if there is one (covered in the next section).
3. A maintenance allowance for other family members at home, if there are any.
4. Medical expenses no one else pays, including health insurance premiums such as the Medicare Part B premium and any Medigap premium, plus deductibles and coinsurance.3

Federal rules also allow an extra home-maintenance allowance for up to six months when a physician certifies the resident is likely to return home.3

Whatever remains is the share of cost the resident pays the facility each month, and Medical Assistance reduces what it pays the facility by that amount.2 The $106 set aside for personal needs stays with the resident.

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 and any other allowed deduction, such as unpaid medical bills, the rest of her monthly income goes to the facility as her share of cost, and Medical Assistance pays the facility the remainder.2,3

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 through its Schedule MA-8.6,2

Two protections do the heavy lifting:

• The Community Spouse Resource Allowance (CSRA) protects assets for the at-home spouse. Maryland's Schedule MA-8 sets a maximum spousal share of $162,660 and a minimum of $32,532 for 2026, matching the federal standards.2,6 Those figures are not an absolute ceiling: federal law lets a fair hearing or a court order protect more when it is needed to bring the at-home spouse's income up to the minimum maintenance allowance, though the state first counts the nursing-home spouse's available income as going to the at-home spouse.6 This is separate from the institutionalized spouse's $2,500 medically needy limit.2
• The Minimum Monthly Maintenance Needs Allowance (MMMNA) lets income shift from the nursing-home spouse to the at-home spouse. Maryland's own Schedule MA-8 publishes a basic maintenance and shelter allowance of $2,643 (effective 7/1/2025), an excess shelter standard of $793, and a maximum of $4,066 (effective 1/1/2026).2 The federal minimum rose to $2,705.00 a month on July 1, 2026, and the federal maximum is $4,066.50, but Maryland's published schedule still shows $2,643, so confirm the current figure with your caseworker.6,2 A fair hearing can raise the allowance when exceptional circumstances cause significant financial duress.6

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 Medical Assistance recipient dies, Maryland's estate recovery regulation directs the Department to seek repayment from the estate of anyone who was 55 or older when they received benefits. That reaches more than nursing-home costs, though Maryland does not recover what it paid for Medicare premiums, copayments, or deductibles.2

Family circumstances delay recovery rather than cancel it:

• Recovery waits until after the death of a surviving spouse.
• Recovery waits while there is a surviving unmarried child under 21, or a surviving son or daughter of any age who is blind or disabled.
• If a lien was placed on the home, recovery on it also waits while a sibling who lived there at least a year before admission, or a son or daughter who lived there at least two years and provided the care that kept the parent at home, still lives there.

Separately, the Department may not seek recovery at all where, in its judgment, substantial hardship exists.2

A home that was protected while the resident was alive can still be reached by recovery after death: Maryland's rules say excluding the home does not prevent a lien being attached to or executed on it, apart from a limited exception the regulation cross-references.2 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

Quality varies from home to home, and choosing well matters as much as qualifying. Three free resources should drive the choice: Medicare Care Compare for the five-star ratings, the Maryland Office of Health Care Quality (OHCQ), which licenses and inspects Maryland's nursing homes and takes complaints, and the Maryland Long-Term Care Ombudsman for resident advocacy.7

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.