Long-Term Care Planning in Maryland: Costs, Medicaid & Your Options (2026 Guide)

Maryland's long-term care costs are substantially above the national average — nursing home care averages $12,927 per month, approximately 35% above the national average of $9,581, while assisted living averages $7,173 per month, approximately 16% above the national average of $6,200. Home care averages $6,673 per month, closely aligned with the national rate. Maryland Medicaid — also called Medical Assistance (MA) — is administered by the Maryland Department of Health. Maryland's Nursing Home Medicaid has no set income limit — income cannot exceed the cost of nursing home care, with all income going toward care minus a $106/month Personal Needs Allowance. The asset limit is $2,500 for individuals. Maryland does not use Miller Trusts — instead, it offers a Medically Needy spenddown (ABD Spenddown Program). This guide covers what care costs in Maryland, how to qualify for Medicaid, and what options exist for veterans and family caregivers in Baltimore, Silver Spring, Bethesda, Annapolis, and across the Old Line State.

Maryland's Aging Population: The Numbers Behind the Need

Maryland is home to more than 1.1 million residents aged 60 or older. The senior population is concentrated in the Baltimore metropolitan area (Baltimore City and Baltimore County), the Washington D.C. suburbs (Montgomery County — Bethesda, Silver Spring, Rockville, Germantown; Prince George's County — Bowie, College Park), and Annapolis (Anne Arundel County). Other significant aging communities include Columbia, Frederick, Towson, Hagerstown, Salisbury, and Dundalk.

Maryland's geography — from the urban corridor between Baltimore and Washington D.C. to the rural Eastern Shore and Western Maryland mountains — creates varying long-term care landscapes. The D.C. suburbs and Baltimore metro area have extensive facility options but higher costs, while rural counties like Allegany, Garrett, Dorchester, and Somerset have fewer providers and limited home care availability.

Unpaid Caregivers in Maryland: Scale and Impact

An estimated 770,000 unpaid family caregivers in Maryland provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

Maryland offers strong support for family caregivers through its Community Personal Assistance Services (CPAS) and Community First Choice (CFC) programs — both available through Regular State Plan Medicaid with no waiting lists. CPAS allows participants to self-direct care, hiring the caregiver of their choosing, including a spouse or adult child. CFC similarly allows participants to hire, train, and supervise their care provider. These programs provide personal care assistance, meal delivery, home modifications, and assistive technology.

What Long-Term Care Costs in Maryland

Maryland's care costs vary by type of care:

• Assisted Living: $7,173 per month — approximately 16% above the national average of $6,200
• Nursing Home (semi-private room): $12,927 per month — approximately 35% above the national average of $9,581
• Home Care (home health aide): $6,673 per month — closely aligned with the national average of $6,673
• Adult Day Care: $2,526 per month — approximately 23% above the national average of $2,058

At these rates, a three-year nursing home stay in Maryland costs approximately $466,000 — while home care totals roughly $240,000 over the same period. Assisted living, at $7,173/month, totals approximately $258,000 over three years. For a detailed breakdown of care costs by type and how Maryland compares to other states, visit our Maryland Care Costs page.

How to Qualify for Maryland Medicaid: Eligibility Rules for 2026

Maryland Medicaid is administered by the Maryland Department of Health. The program providing long-term care for the aged, blind, and disabled is called Long Term Services and Supports (LTSS). In addition to nursing home care, Maryland Medicaid pays for care in adult foster care homes, assisted living residences, and non-medical support services to help frail seniors live at home. Consulting with a Maryland elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income cannot exceed the cost of nursing home care. All of a beneficiary's monthly income, with the exception of a $106/month Personal Needs Allowance (eff. 7/1/25), Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability). Asset limit of $2,500 (single) or $3,000 (married couple, both applying — after 6 months, $2,500 per spouse). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement — anyone who qualifies receives benefits.
• HCBS Waivers / Home and Community Based Services: Income limit of $2,982/month. Asset limit of $2,500 (single) or $3,000 (couple). This is not an entitlement — the number of participant slots is limited and waiting lists may exist. Services are intended to prevent and delay nursing home admissions. Benefits are provided at home, adult day care, adult foster care, or in assisted living.
• Regular Medicaid / Aged, Blind, and Disabled (ABD): Income limit of $350/month (single) or $392/month (couple). Asset limit of $2,500 (single) or $3,000 (couple). This is an entitlement. SSI recipients are automatically Medicaid-eligible in Maryland — the SSI pathway allows income up to $994/month (single) or $1,491/month (couple) with asset limits of $2,000/$3,000.

Maryland applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. There is no Look-Back Period for Regular Medicaid. For the full Maryland Medicaid eligibility breakdown, see our Maryland Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or an HCBS Waiver in Maryland, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660. The minimum CSRA is $32,532 — if the non-applicant's share is under $32,532, up to $32,532 can be retained.

Maryland sets the Monthly Maintenance Needs Allowance (MMMNA) at $2,643 per month (eff. 7/1/25 – 6/30/26). If the non-applicant spouse's income falls below this amount, income can be transferred from the applicant spouse. A non-applicant spouse can increase their Spousal Income Allowance if housing/utility costs exceed a shelter standard of $793/month, but the total cannot exceed $4,066.50/month. For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.

Maryland Medicaid Programs: Community Options Waiver, CPAS, CFC, and More

Maryland offers several Medicaid-funded long-term care programs:

• Community Options (CO) Medicaid Waiver: Also called the Home and Community Based Options Waiver (HCBOW), this program provides services to help persons live independently at home or in assisted living. Applications from nursing home residents wishing to transition to the community are prioritized; community residents can join a registry. Waiting lists exist for this program.
• Community Personal Assistance Services (CPAS): Personal care assistance and nurse monitoring via Regular State Plan Medicaid — no waiting lists. Participants can self-direct care, hiring the caregiver of their choosing, including a spouse or adult child.
• Community First Choice Program (CFC): A state plan option providing personal assistance, meal delivery, home modifications, assistive technology, and personal emergency response systems. Participants can self-direct care, hiring, training, and supervising the care provider of their choice. No waiting lists.
• Medical Day Care Services Waiver (MDCSW): Medical day care, such as skilled nursing services and physical therapy, in adult day centers for seniors and adults with disabilities who require a nursing home level of care. Waiting lists may exist.
• Increased Community Services (ICS): Transitional services for institutionalized adults with physical disabilities and frail seniors wishing to return home or to assisted living. Benefits include home modifications, personal care assistance, meal delivery, and assistive technology. Limited to 100 participant slots.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid (including long-term care) and Medicare benefits into one program. Additional benefits such as dental and eye care may be available.
• Money Follows the Person: A federal program that helps institutionalized Medicaid-eligible persons transition back home or into the community.

Qualifying When Over the Limits: Medically Needy Spenddown and Asset Strategies

Maryland does not use Miller Trusts (Qualified Income Trusts). Instead, the state offers the following pathways for applicants who exceed income or asset limits:

• Medically Needy / ABD Spenddown: Maryland's ABD Spenddown Program allows seniors over the income limit to become eligible by spending income on medical expenses. The MNIL is $350/month for an individual and $392/month for a couple. The spenddown is calculated for a 6-month period. The Medically Needy asset limit is $2,500 for an individual and $3,000 for a couple. Applicants with income above these limits "spend down" by applying medical expenses to the difference. Once met, Medicaid benefits begin for the remainder of the coverage period.
• Asset Spend-Down: Spend excess assets on non-countable items — home modifications (wheelchair ramps, stair lifts, pedestal sinks, wheelchair-friendly flooring), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Medicaid Planning Professional to employ legal strategies for eligibility and protect your home from Medicaid's Estate Recovery Program.

Asset Rules: What Counts and What Doesn't

Countable assets in Maryland include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside. In Maryland, IRAs are counted as assets. Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, burial spaces, and generally one's primary home. All assets of a married couple are considered jointly owned regardless of the Medicaid program.

The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (minimum $32,532). There is no CSRA for Regular Medicaid. Unlike many states, Maryland considers VA Aid & Attendance benefits as countable income. Nationally, Holocaust restitution payments are not counted as income. SSI recipients are automatically Medicaid-eligible in Maryland.

Veterans and Long-Term Care in Maryland

Maryland has a significant veteran population, with facilities including the VA Maryland Health Care System (Baltimore VA Medical Center, Perry Point VA Medical Center), the Charlotte Hall Veterans Home in Southern Maryland, and community-based outpatient clinics across the state. The VA Aid & Attendance benefit provides additional monthly income to veterans and surviving spouses who require assistance with activities of daily living.

Note that Maryland counts VA Aid & Attendance as income for Medicaid eligibility purposes — unlike some other states that exempt this benefit. Veterans should factor this into their Medicaid planning strategy. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Maryland

Understanding how to pay for nursing home care in Maryland — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $12,927/month (35% above the national average), a 60-month look-back period, and a $2,500 asset limit, advance planning is essential. Maryland long-term care insurance policies, personal savings, veterans benefits, and Medicaid each play a role. Key steps include:

• Understanding your current financial position relative to Maryland Medicaid eligibility thresholds
• Knowing that Maryland's Nursing Home Medicaid has no set income limit — income cannot exceed the cost of care, with a $106/month PNA
• Recognizing Maryland's $2,500 individual asset limit and that IRAs are counted as assets
• Exploring CPAS and CFC programs for home-based care with no waiting lists — both allow hiring a spouse or adult child as caregiver
• Taking advantage of Maryland's MMMNA ($2,643) to protect the non-applicant spouse's income
• Factoring in that Maryland counts VA Aid & Attendance as income for Medicaid purposes
• Researching Maryland long-term care insurance options while still healthy enough to qualify
• Consulting with a Maryland elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Maryland

Maryland operates a Medicaid Estate Recovery Program, which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $730,000 (in 2026). Home equity is the value of the home after subtracting outstanding debt. Equity interest is the amount of equity owned by the applicant. If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. There is no home equity interest limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a Maryland elder law attorney to explore legal protections.

Regional Cost Variations Across Maryland

Long-term care costs in Maryland vary significantly by region. The Washington D.C. suburbs (Montgomery County — Bethesda, Rockville, Silver Spring, Germantown; Prince George's County — Bowie, College Park) typically see the highest costs. Baltimore City and Baltimore County (Towson, Dundalk, Catonsville) represent a mid-to-high cost market. Annapolis and Anne Arundel County are also above-average markets. In contrast, Western Maryland (Allegany, Garrett Counties — Cumberland, Frostburg) and the Eastern Shore (Dorchester, Somerset, Worcester Counties — Salisbury, Ocean City, Cambridge) generally have lower costs, though availability of providers may be more limited.

Application Timeline and Process

Maryland Medicaid applications can be submitted through several channels:

• Apply online at Maryland Benefits (mymdthink.maryland.gov)
• Apply in person at a local Social Services Office
• Submit a completed Application for Assistance (Regular Medicaid) or Long-Term Care / Waiver Medical Assistance Application to a local Social Services Office
• Contact a local Area Agency on Aging (AAA) for questions and application assistance
• Call the Maryland Medicaid helpline at 1-800-332-6347

It is extremely important that applicants are confident they meet all eligibility criteria before submitting a Medicaid application. For seniors who don't meet the requirements, Medicaid Planning is strongly recommended. Processing times vary but typically take 45–90 days.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including Maryland's Community Options Waiver, CPAS, CFC, and PACE — are likely targets for cuts. This law is still facing legal challenges. Families relying on or planning to use HCBS should monitor developments and consider applying early.

Last updated: September 2026. Data sources: Maryland Department of Health, CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.