Does Medicaid Pay for Assisted Living in Maryland? 2026 Guide

Yes—Maryland Medicaid can help pay for assisted living services for some people, but it does not simply pay the full assisted living bill.

The main program families should know is Maryland’s Community Options Waiver, also called the Home and Community-Based Options Waiver. For people who meet medical, technical, and financial requirements, the waiver can cover approved assisted living services in a participating setting.

Two limitations matter: the waiver does not cover room and board, and qualifying for Medicaid does not automatically mean someone has a waiver slot or that every assisted living community participates.

What does Maryland Medicaid cover in assisted living?

Maryland lists assisted living services among the Community Options Waiver’s covered services. Under state regulations, covered services can include a supportive environment, help with activities of daily living, housekeeping and laundry, meal planning and preparation, basic hygiene supplies, 24-hour supervision, medication assistance, social activities, appointment reminders, transportation arrangements, and coordination with a case manager.

The participant’s services must be authorized through Medicaid and included in the approved plan of service.

Does Medicaid pay room and board?

No. Maryland’s waiver payment for assisted living services does not include room and board. State regulations define room and board separately and require the participant to pay that charge directly to the provider.

For Community Options Waiver participants in assisted living, the regulation currently uses a room-and-board charge of no more than $420 per month in the post-eligibility calculation. A participant may also owe an assessed contribution toward care based on available income.

When a community says it “accepts Medicaid,” ask what Medicaid pays, what the resident pays, and whether other charges remain outside the waiver.

Who may qualify for the Community Options Waiver?

Maryland requires applicants to satisfy medical, technical, and financial rules.

Medical requirement

The applicant must need a nursing-facility level of care. The waiver is not simply an assisted living discount based on income.

Technical requirements

Maryland currently lists requirements that include being age 18 or older, living at home or in the community, not being enrolled in another waiver or PACE at the same time, meeting cost-neutrality requirements, and being able to live safely in the community with waiver services.

2026 financial framework

Maryland currently states that financial eligibility is based on household income and assets. Monthly income may not exceed 300% of the federal SSI benefit, and countable assets may not exceed $2,000 or $2,500, depending on eligibility category.

The federal SSI benefit rate for an individual is $994 per month in 2026. Three hundred percent equals $2,982 per month.

These are screening benchmarks, not a final eligibility determination. What income and assets count, household circumstances, spousal protections, transfers of assets, and other Medicaid rules can affect the result. Maryland advises people to apply rather than deciding eligibility from the limits alone.

Is there a waitlist?

Yes. Maryland currently states that the Community Options Waiver has a waitlist.

For someone applying from the community, call Maryland Access Point at 1-844-627-5465 to ask to be placed on the Community Options Waiver Registry. Maryland says an invitation to apply is sent when it is the person’s turn.

Joining the registry is not the same as being approved. The applicant must still complete the application and meet the program requirements.

What if the person is already in a nursing facility?

Maryland provides a different route for certain nursing-facility residents. The Department of Health states that if a person is in a nursing facility and Medicaid has paid for services for at least 30 days, the person may apply for the waiver without waiting on the community registry. Families can speak with the facility’s social worker and request an options counselor.

If your family is navigating a rehabilitation transition, also see What Happens When Medicare Stops Paying for Rehab?

What if income is too high?

Maryland also operates the Increased Community Services (ICS) Program, but it is not a general alternative for everyone over the waiver income limit.

Maryland says ICS is intended for certain people transitioning from nursing facilities. Current requirements include needing nursing-facility level of care, being at least 18, having lived in a nursing facility for at least six months, having been eligible for Medicaid for at least 30 consecutive days, and meeting other program rules.

The state says people with income above 300% of SSI may have to contribute income above that amount toward their cost of care under ICS. Applicants cannot apply directly; a referral from Medicaid’s Eligibility Determination Division is required.

Does every Maryland assisted living community accept the waiver?

No. Assisted living licensure does not automatically mean a community participates in the Community Options Waiver.

To receive waiver payment, a provider must meet Maryland Medicaid participation requirements. State regulations also allow an approved provider to limit waiver participation to designated units under specified conditions.

Ask each community:

• Do you currently participate in Maryland’s Community Options Waiver?
• Is participation limited to designated units?
• Do you currently have a waiver-participating opening?
• What amount would the resident be responsible for each month?
• What charges are not covered?
• What happens if the contribution to care changes?
• What level of assisted living care are you licensed to provide?

Three questions have to line up

1. Does the person qualify for the Community Options Waiver?
2. Does the assisted living provider participate in the waiver?
3. Can that community safely meet the person’s assessed care needs?

All three matter. For help evaluating care fit and Maryland licensing, see How to Choose Assisted Living in Baltimore, MD.

How much might the resident still pay?

There is no single correct out-of-pocket amount for every waiver participant. Responsibility can depend on income, Medicaid’s contribution-to-care calculation, room and board, the provider’s participation arrangement, and noncovered charges.

For Baltimore private-market planning benchmarks, see our Baltimore assisted living cost guide.

Ask a participating community for a written breakdown showing the Medicaid-covered service component, room-and-board responsibility, any contribution to care, noncovered optional charges, and the estimated total the resident would personally pay.

How to start the Maryland waiver process

For someone living in the community, the most direct first step is Maryland Access Point (MAP). MAP helps older adults, people with disabilities, and caregivers navigate long-term care resources, screening, application assistance, and options counseling.

• Statewide MAP: 1-844-627-5465
• Baltimore City MAP: 410-396-2273
• Baltimore County MAP: 410-887-2594

Tell MAP whether the person is currently at home, in assisted living, in a hospital or rehabilitation setting, or already in a nursing facility because the appropriate pathway can differ.

What to gather before calling

• age and Maryland residence;
• current living situation;
• help needed with daily activities, medications, mobility, and supervision;
• diagnoses and recent hospital or rehabilitation stays;
• monthly income sources;
• bank accounts and other potentially countable assets;
• marital status and spouse’s living situation;
• current Medicaid status, if any; and
• any assisted living community already under consideration.

Do not transfer or give away assets solely to try to qualify for Medicaid without appropriate professional guidance. Long-term-care Medicaid has financial rules under which asset transfers can matter.

Finding assisted living in Baltimore while planning for Medicaid

Nursing Home Placement’s Baltimore directory can help families build an initial shortlist. Directory inclusion does not mean a community accepts Medicaid, participates in the waiver, has a current opening, or is appropriate for a particular resident. Verify those points directly.

Frequently asked questions

Does Medicaid pay for assisted living in Maryland?

Maryland Medicaid can pay for approved assisted living services for eligible Community Options Waiver participants. The waiver does not pay the full private assisted living bill, and its assisted living service payment excludes room and board.

What is the 2026 income limit?

Maryland currently states that monthly income may not exceed 300% of the federal SSI benefit. The 2026 individual SSI rate is $994, making 300% equal to $2,982 per month. Other Medicaid eligibility rules still apply.

What is the asset limit?

Maryland currently states that countable assets may not exceed $2,000 or $2,500 depending on eligibility category. Formal Medicaid review determines what counts and which limit applies.

Is there a waiting list?

Yes. Maryland currently reports a waitlist for community applicants. Call Maryland Access Point at 1-844-627-5465 for the current registry process.

Can someone in a nursing facility apply without waiting?

Maryland states that a nursing-facility resident for whom Medicaid has paid for services for at least 30 days may apply without waiting on the community registry.

Does every assisted living facility accept Maryland Medicaid?

No. Assisted living licensure and Medicaid waiver participation are separate. Verify current participation and whether it is limited to designated units.

For a broader Baltimore overview across assisted living, memory care, nursing homes, skilled rehabilitation, costs, and payment questions, see Senior Care in Baltimore, MD: A Complete Guide for Families.

Sources and further reading

• Maryland Department of Health — Community Options Waiver
• COMAR 10.09.54 — Home and Community-Based Options Waiver
• COMAR 10.09.54.13 — Covered Assisted Living Services
• Maryland Department of Health — Increased Community Services Program
• Maryland Department of Aging — Maryland Access Point
• Social Security Administration — 2026 SSI Federal Payment Amounts
• Medicaid.gov — Maryland Waiver Factsheet

Last reviewed September 2026. This article is general information, not legal, financial, Medicaid eligibility, or benefits advice. Program rules, financial standards, waitlists, provider participation, and individual eligibility can change. Confirm current information with Maryland Medicaid or Maryland Access Point.