Maryland Medicaid Guide 2026: Medical Assistance Programs

Maryland Medicaid (Medical Assistance) pays for long-term care through a medically needy spend-down, with a 2026 medically needy countable-asset limit of $2,500 and no Miller Trust required.

Maryland Medicaid is administered by the Maryland Department of Health (MDH), which sets policy while local departments of social services process eligibility for older adults and people with disabilities. This guide maps every key question about Maryland Medicaid to the dedicated article that answers it.1

What Maryland Medicaid Covers

Medicaid in Maryland is called Medical Assistance. It covers the mandatory federal Medicaid benefit categories plus a set of state-elected optional services:

• Hospital inpatient and outpatient care
• Physician, clinic, and specialist services
• Prescription drugs through managed care formularies
• Behavioral health and substance use disorder services
• Home health and private duty nursing
• Nursing facility care for eligible long-term care residents
• Home- and community-based services (HCBS) through MDH's long-term services and supports (LTSS) waivers
• Community Options Waiver for adults who qualify for nursing facility care but choose to remain at home
• Community First Choice (CFC) attendant services, a statewide entitlement
• Medicare Savings Programs for low-income Medicare beneficiaries

For older adults and people with disabilities, long-term care coverage is the most financially significant benefit. In Maryland, a semi-private nursing home room runs about $155,125 per year and a private room about $173,375 per year, according to the CareScout 2025 Cost of Care Survey. Medicaid covers the full cost once a resident meets financial and clinical eligibility standards.2

Who Qualifies for Maryland Medicaid

Maryland Medicaid long-term care eligibility uses both financial and clinical criteria. The rules below apply to the nursing facility and HCBS-waiver track.1

• Asset limit: Effective February 1, 2026, Maryland's medically needy (non-MAGI) countable-asset limit (the standard that governs aged, blind, and disabled and long-term-care eligibility) is $2,500 for an individual and $3,000 for a couple. Maryland's separate categorically needy (non-MAGI) standard is $2,000 for an individual and $3,000 for a couple.1 Exempt assets include the primary home (subject to an equity cap), one vehicle, household goods, and prepaid burial.
• Income, medically needy spend-down: Maryland is a medically needy state and does NOT require a Qualified Income Trust (Miller Trust). The medically needy income level is $350/month for an individual and $392/month for a couple (effective 2/1/2026). An applicant with income above that threshold qualifies by spending down the excess on incurred medical bills, reduced by health-insurance premiums such as Medicare Part B or Medigap.
• Home equity limit: Maryland Medicaid Manual Schedule MA-10 sets the excess home equity limit at $752,000, the 2026 federal minimum. The primary residence is exempt while a spouse or dependent lives there.3,1

Maryland applies a 60-month (five-year) lookback to uncompensated asset transfers, following the federal rule under 42 U.S.C. § 1396p(c). Transfers for less than fair market value during that window generate a penalty period of Medicaid ineligibility.3

For the complete eligibility picture, including transfer rules, penalty divisors, and how MAGI-based categories work for working-age adults, see Maryland Medicaid Eligibility and Income Limits 2026.

Maryland Medicaid and Long-Term Care

Maryland Medicaid covers two long-term care settings: nursing facilities and HCBS through MDH's waiver programs.

Nursing facility coverage requires both clinical eligibility (nursing facility level of care) and financial eligibility ($2,500 medically needy asset limit for a single applicant, spend-down for income). Once enrolled, the resident contributes nearly all monthly income toward the cost of care, keeping the $106 Personal Needs Allowance plus allowances for a community spouse and health-insurance premiums. Maryland's $106 PNA is notably higher than the $30 a month federal minimum for a nursing facility resident, a floor states may set higher.4

Community Options Waiver covers home- and community-based services for adults who meet nursing facility level of care but choose to remain in the community. Services include personal care assistance, case management, adult day services, respite care, assistive technology, and environmental accessibility adaptations.1

Community First Choice (CFC) provides attendant services (personal care, habilitation) statewide as an entitlement to Medicaid members who meet an institutional level of care. CFC is available regardless of whether a member is on an HCBS waiver.

To apply for long-term care Medicaid, contact the local department of social services or health department for a long-term care determination. See How to Apply for Maryland Medicaid for the step-by-step process.

Maryland Medicare Savings Programs

Maryland Medicaid administers the federal Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries. These programs reduce out-of-pocket Medicare costs:5

QMB enrollees are automatically deemed eligible for Part D Extra Help (Low-Income Subsidy). Federal law also bars providers from billing a QMB enrollee for any Medicare cost-sharing.5

For current income and asset limits in Maryland, see Maryland Medicare Savings Programs.

Spousal Protections in Maryland Medicaid

When one spouse enters a nursing facility or HCBS waiver and the other remains in the community, federal spousal impoverishment protections keep the community spouse from losing all of the couple's shared resources.6

Key 2026 figures:

• Community Spouse Resource Allowance (CSRA): The community spouse may retain up to the federal maximum of $162,660 in countable assets, with a floor of $32,532.6
• Minimum Monthly Maintenance Needs Allowance (MMMNA): The federal floor is $2,705.00 (effective 7/1/2026) and the federal ceiling is $4,066.50 (effective 1/1/2026).6 Maryland's own Schedule MA-8 publishes a basic maintenance and shelter allowance of $2,643 (effective 7/1/2025) and a maximum of $4,066 (effective 1/1/2026).1 Where the community spouse's income falls below the allowance, income from the institutionalized spouse can be diverted to cover the gap.
• Home: Exempt from the eligibility calculation while the community spouse lives there.

For the snapshot mechanics, CSRA calculation, and income diversion process in Maryland, see Maryland Medicaid Spousal Impoverishment Protections.

Maryland Medicaid Estate Recovery

After the death of a recipient who was age 55 or older and received long-term care services, MDH pursues federally mandated estate recovery. In Maryland, recovery is made from the probate estate.1

Maryland's estate recovery applies to nursing facility care, HCBS waiver services, and related hospital and prescription drug services received on or after age 55. The federal mandatory exemptions apply: recovery is deferred while a surviving spouse is alive, a surviving child is under age 21, or a surviving child of any age is blind or permanently disabled. An undue hardship waiver process is available.

For the full scope of recoverable services, exemptions, and how to respond to a claim in Maryland, see Maryland Medicaid Estate Recovery.

How to Apply for Maryland Medicaid

Applying for Maryland long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through the agency pathway that fits your situation.

If Maryland Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road, but the deadline that keeps your current coverage running is far shorter than the one to appeal.

Maryland's deadline is 90 days, counted from the date on your notice rather than the day it reached you.7 Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.8 That 90 is the ceiling 42 CFR 431.221(d) puts on what a state may allow, not a floor you are owed; Maryland uses it in full, and other states set shorter windows that bind just as firmly.7

The second deadline is 10 calendar days, and it is the one people miss. If you already have Maryland Medicaid and want coverage to continue until the fair hearing decision, you must appeal within 10 calendar days of the notice date, the postmark, or the effective date of the action, whichever is later.7 The federal protection turns on filing before the action takes effect, and a denied applicant has no benefits to continue, so this window guards coverage you already have.9

A managed care denial goes to the plan first. If you get your care through a HealthChoice managed care organization, file the plan's internal appeal within 60 days of the date on the denial notice and exhaust it before asking for a State fair hearing.7 That 60-day plan window is not the eligibility-denial deadline.

So when an adverse notice arrives: find the effective date, request the hearing before it, and ask in writing that your benefits continue. See Maryland Medicaid Appeals and Fair Hearings for how to file, what the hearing itself involves, and what happens after a decision.

Keeping Maryland Medicaid Coverage Once You Have It

Coverage is not permanent once approved. Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

Maryland Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.10 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Maryland may offer the same windows but is not required to, so ask Maryland Medicaid what applies to you.10

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).10 So a MAGI-based renewal missed by a few weeks is usually recoverable, provided you act.

Keep your mailing address current, open anything from Maryland Medicaid, and return the form by the deadline printed on it. See Maryland Medicaid Recertification and Renewal for the full cycle and how to recover closed coverage.

Where to Get Help

Maryland Medicaid FAQ

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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.