Maryland Medicaid Long Term Services and Supports (LTSS) Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Maryland, Medicaid is also called Medical Assistance. This article focuses on Maryland Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different from regular Medicaid, which is for financially limited people of all ages.

 

Maryland Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Maryland Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Maryland seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Maryland Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $93/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Maryland Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Maryland Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Maryland’s Money Follows the Person (MFP) program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.

Home and Community Based Services (HCBS) Waivers

Maryland’s Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports for financially limited Maryland seniors who show a medical need for that care and live in the community. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services that will help Maryland residents remain living in their home, the home of a loved one, adult foster care or an assisted living residence instead of moving to a nursing home. While Maryland’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.

The HCBS Waivers that provide long-term care services and supports to Maryland seniors are the Community Options Waiver and the Medical Daycare Services Waiver. Both programs are described below.

1. Community Options (CO) Waiver
Maryland’s Community Options (CO) Waiver provides long term-care benefits to Maryland seniors who need assistance with their Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and live in their own home, the home of a loved one or an assisted living residence. The CO Waiver will also help seniors living in nursing homes relocate to their own home, the home of a loved one or an assisted living residence. While the CO Waiver will help cover the cost of relocation and long-term care services and supports in those settings, it will not cover room and board.

CO Waiver long-term care benefits include adult day care, meal delivery, case management, short-term respite care and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. Instead, there are a limited number of enrollment spots for each waiver program, and once those spots are full, additional eligible applicants are placed on a waitlist. The CO Waiver had about 6,300 enrollment spots per year as of 2023.

2. Medical Day Care Services Waiver (MDCSW)
Maryland’s Medical Day Care Services Waiver (MDCSW) is an HCBS Waiver that will cover the cost of daytime care and supervision in a community-based facility for the elderly and disabled. Program participants can live in their own home, the home of a loved one, an adult foster care home or an assisted living residence and qualify for MDCSW benefits, which can be thought of as adult day care. While the MDSCW will cover the cost of long-term care services and supports in those settings, it will not cover room and board.

MDCSW beneficiaries can choose the facility where they attend day care and receive services, and this Maryland Long Term Services and Supports webpage has a list of facility locations.

Maryland’s Medical Day Care Services Waiver (MDCSW) facilities operate 5-7 days per week and 4-12 hours per day. In addition to supervision, most of the facilities also provide benefits such as medication management, nursing services, social work services, activities, therapies (physical, occupational, behavioral), meals & snacks, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

 

Aged, Blind, and Disabled Medicaid

Maryland’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Maryland residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

Maryland ABD Medicaid beneficiaries who show a medical need for long-term benefits can receive some of them through the following programs:

  1. Community Personal Assistance Services (CPAS) – covers long-term care in the community for individuals who need help with one Activity of Daily Living (mobility, bathing, dressing, eating, toileting)
  2. Community First Choice (CFC) Program – covers long-term care in the community for individuals who require a Nursing Facility Level of Care
  3. Program of All-Inclusive Care for the Elderly (PACE) – coordinates Medicaid and Medicare benefits into a single plan for dual-eligible applicants

1. Community Personal Assistance Services (CPAS)
Maryland’s Community Personal Assistance Services (CPAS) program covers a variety of long-term care services and supports for Maryland ABD Medicaid beneficiaries who live in their own home, the home of a loved one or an adult foster care home. While CPAS will pay for services in those settings, it will not cover room and board. To be eligible for the program, CPAS applicants must require help with one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

Benefits of the CPAS program include personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), oversight of the personal care provider and support with accessing health care services, including those that are non-Medicaid. The personal care assistance can be provided by a licensed agency worker, but the CPAS program participants also have the ability to self-direct their care. This means they can hire a caregiver of their choosing, like a friend or relative, including spouses. The self-directed caregiver cannot be the program participant’s guardian or legal decision-maker (a Power of Attorney, for example) and they must be 18-years-old or older. After the self-directed caregiver has been approved by Medicaid, they become an employee of a Maryland Medicaid Personal Assistance Agency.

Like ABD Medicaid itself, the CPAS program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

2. Community First Choice (CFC) Program
Maryland’s Community First Choice (CFC) Program provides a range of long term care services and supports to Maryland ABD Medicaid beneficiaries who require a Nursing Facility Level of Care and live in their own home or the home a loved one.

CFC Program benefits include home modifications, assistive technology, meal delivery, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). To be clear, the CFC Program will not provide these benefits to individuals who live in adult foster care homes or assisted living residences.

Like ABD Medicaid itself, the CFC Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

3. Program of All-Inclusive Care for the Elderly (PACE)
Maryland residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. PACE can be used by people who are “dual eligible” for Medicaid and Medicare and will help them coordinate the care from those two programs. This Maryland Department of Health webpage has information on Maryland’s PACE programs, and the Hopkins ElderPlus Medical Center in Baltimore is the PACE center for the state. To learn more about PACE, click here.

 

Eligibility Criteria For Maryland Medicaid’s Long Term Care Programs

To be eligible for Maryland Medicaid, applicants have to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

  Just For You: The easiest way to find the most current Maryland Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Maryland Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Maryland residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Maryland Medicaid. For a single applicant in 2024, the asset limit is $2,500, which means they must have $2,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income for a single applicant in Maryland in 2024 cannot exceed the cost of nursing home care. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, stock dividends, alimony, wages, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments. The average cost of nursing home care in Maryland is roughly $8,500/month. However, Maryland Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the cost of nursing home care. They are only allowed to keep $93/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Maryland Medicaid is $3,000 per spouse to start, but the asset totals must fall to $2,500 per spouse after six months. The income for a married couple with both spouses applying can not exceed the cost of nursing home care, but the applicants must give almost all of their income to the state to offset the cost of care (they can keep $93/month per spouse and make Medicare premium payments).

For a married applicant with just one spouse applying, the 2024 asset limit is $2,500 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income of the applicant cannot exceed the cost of nursing home care, but they must give most of their income to the state to offset the cost of care. The income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Maryland Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Maryland has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Maryland Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine if the NFLOC requirement is met for Medicaid purposes, Maryland uses the interRAI Home Care assessment tool. This tool takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as their cognitive ability.

 

Maryland Medicaid Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Maryland residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for the HCBS Waiver in Maryland is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Maryland for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Maryland is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Maryland HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Maryland has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through Maryland Medicaid is showing a medical need for the long-term care services and supports the Waiver will provide. The state will conduct an in-person assessment of each applicant and communicate with their care providers to determine if the level of care needs are met.

 

Maryland Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Maryland residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,500, which means they must have $2,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for ABD Medicaid in Maryland for a single applicant is $350/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for Maryland’s ABD Medicaid is $3,000 combined and the income limit is a $392/month combined.

These are low income limits, but Maryland residents who receive Supplemental Security Income (SSI) can keep all of that income (up to $943/month for a single applicant and up to $1,415/month for married applicants, as of 2024) and still remain eligible for Maryland Medicaid. Maryland seniors who do receive SSI are automatically eligible for ABD Medicaid.

  Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Maryland has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirements for receiving healthcare coverage through Maryland’s ABD Medicaid are being disabled, blind or aged (65 or over). For ABD Medicaid beneficiaries and applicants who require long-term care services and supports, Maryland Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of services the applicant needs and the state will cover.

 

How Maryland Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Maryland Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Maryland and how you can protect your home from it, click here.

 

Applying For Maryland Medicaid Long Term Care Programs

The first step in applying for Maryland Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Maryland Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Maryland Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Maryland residents can apply for Medicaid online at myDHR. They can also apply in person at their local Department of Human Resources Social Services Office, or they can download an application, complete it, and send it to their local Social Services Office.

To apply for the Community Options Medicaid Waiver if you are living in a Medicaid-approved nursing home and want to relocate to the community, contact the Maryland Medicaid Office of Long Term Services and Supports at 410-767-1739 or 877-463-3464. To be put on a waiting list to receive Community Options Medicaid Waiver benefits, or to apply for the Medical Day Services Waiver, contact the Maryland Access Point (MAP) at 844-627-5465.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

  Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

 

Choosing a Maryland Medicaid Nursing Home

After being approved for nursing home coverage through Maryland Medicaid, seniors need to choose which Medicaid-accepting nursing home best fits their circumstances. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available spaces. Finding the right nursing home can be a task, especially if you’re looking in a specific locale.

Maryland has about 200 nursing homes that accept Medicaid. There are roughly 60 in Greater Baltimore, and about 10 more around Annapolis. The area just outside of Washington, D.C., including Silver Spring, Rockville and Gaithersburg, has approximately nursing homes. There are around 30 more facilities within 25 miles of Frederick, which includes Hagerstown and Westminster to the north. The choices narrow in the Maryland panhandle, with just nine nursing homes within 25 miles of Cumberland that are in Maryland.

Residents in some Maryland communities regularly cross the state border for personal or business reasons, including healthcare. Medicaid coverage, however, can not cross state lines. So, a Maryland Medicaid beneficiary would not be covered for a nursing home in Washington, D.C., or Virginia, even if facilities in those places are convenient or well-suited for the Maryland resident.

 TOOLS: To find and compare nursing homes, Maryland residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging for more information about Maryland nursing homes.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? How does it handle dental and vision care? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data reveals that nursing homes in Maryland nursing homes were well below national standards when it came to health inspections. Maryland nursing homes averaged 41.5 health deficiencies that led to citations during a three-year span from 2019-2022, which was well above the national average of 25.7 per nursing home in that same time frame. The data also shows that 11.9% of residents in Maryland nursing homes have depressive symptoms, which is higher than the national average of 8.1%. And the ability to move independently worsened for 24.5% of residents in Maryland nursing homes, which is worse than the national average of 15.1%.

This is not to say that all Maryland nursing homes have health deficiencies, or depressed and immobile residents. Instead, you should research and ask about these specific areas before choosing a Maryland nursing home.