Medicaid Long-Term Care Guide in Maryland
Long-term care eligibility, benefits, and how to apply through the Maryland Department of Health.
What makes Maryland Medicaid different
In Maryland, Medicaid is also called Medical Assistance (MA). The program providing long-term care for the aged, blind, and disabled is called Long Term Services and Supports (LTSS). While jointly funded by the state and federal government, it is state-administered within federally set guidelines. In addition to nursing home care, MD Medicaid pays for care services in adult foster care homes, assisted living residences, and non-medical support services to help frail seniors live at home.
Administered by the Maryland Department of Health.
Program Types
Institutional / Nursing Home Medicaid
An entitlement; anyone who is eligible will receive assistance. Benefits are provided in Medicaid-certified nursing homes.
Level of care: Nursing Home
Medicaid Waivers / Home and Community Based Services (HCBS)
Not an entitlement; there are a limited number of participants and waiting lists may exist. Intended to prevent and delay nursing home admissions, benefits are provided at home, adult day care, adult foster care, or in assisted living.
Level of care: Nursing Home
Regular Medicaid / Aged Blind and Disabled (ABD)
An entitlement; meeting the eligibility requirements ensures one will receive benefits. While Regular Medicaid is not Long-Term Care Medicaid, some long-term care services, such as personal care assistance or adult day care, may be available.
Level of care: Help with ADLs
2026 Maryland Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid*
Medicaid Waivers / Home and Community Based Services†
Regular Medicaid / Aged Blind and Disabled‡
*With the exception of a Personal Needs Allowance of $106 / month (eff. 7/1/25), Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, all of a beneficiary's monthly income must go towards nursing home costs. This is called a Patient Liability.
†Based on one's living setting, a beneficiary may not be able to keep monthly income up to this level.
‡Persons eligible for SSI are automatically Medicaid-eligible, including long-term services and supports via Regular Medicaid given functional criteria are met. In 2026, the SSI pathway allows a single applicant income up to $994 / month and a couple up to $1,491 / month. The asset limit is $2,000 for a single applicant and $3,000 for a couple.
Explore Maryland Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Maryland.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — Maryland
How the main LTC programs available in Maryland compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $16–19/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in Maryland | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Maryland Medicaid programs
MD HCBS Waiver
Community First Choice (CFC)
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Maryland
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in MarylandHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: MDH · mmcp.health.maryland.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Maryland
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Maryland. The process typically takes 45–90 days from application to first paycheck.
Apply in Maryland: MDH · mmcp.health.maryland.gov
Medicaid Eligibility Screener — Maryland
Answer 7 quick questions — we'll check the financial and care requirements for Maryland and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Almost any income from any source is counted, including employment wages, alimony, pension payments, SSDI, SSI, and stock dividends.
- Nationally, Holocaust restitution payments are not counted as income.
- Unlike many states, Maryland considers VA Aid & Attendance benefits as countable income.
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,643 (eff. 7/1/25 – 6/30/26). If a non-applicant's income falls under 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 (eff. 7/1/25 – 6/30/26), but the total cannot exceed the Maximum MMMNA of $4,066.50 / month.
- For Regular Medicaid, both spouses' income is counted. There is no MMMNA for a non-applicant spouse.
- SSI recipients are automatically Medicaid-eligible in Maryland.
- Countable assets 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 the couple's assets, up to $162,660 (2026). If the non-applicant's share is under $32,532, up to $32,532 can be retained.
- There is no CSRA for Regular Medicaid.
- The 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 this is not the case, there is a home equity interest limit of $730,000 (in 2026).
- Home equity is the value of the home minus any 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 have Intent to Return.
- There is no home equity interest limit for Regular Medicaid.
- The home is NOT exempt from Medicaid's Estate Recovery Program. After a beneficiary's death, Maryland's Medicaid agency attempts reimbursement of care costs through the deceased's estate.
- Maryland has a 60-month Look-Back Period for Nursing Home Medicaid and Waiver applications.
- During the look-back, Medicaid checks to ensure no assets were gifted or sold for under fair market value.
- Violations result in a Penalty Period of Medicaid ineligibility.
- There is no Look-Back Period for Regular Medicaid.
- The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule still violates the Look-Back Period.
- MMMNA: $2,643 · CSRA: $162,660 · CSRA Min: $32,532
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,643 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
- A non-applicant can increase their Spousal Income Allowance if housing/utility costs exceed the shelter standard of $793 / month, up to a maximum of $4,066.50 / month.
- The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
- For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.
- Medically Needy Pathway — 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 (individual) and $392 / month (couple). The spenddown is calculated for a 6-month period. The medically needy asset limit is $2,500 (individual) and $3,000 (couple).
- Asset Spend-Down — Spend excess assets on non-countable items such as home modifications (wheelchair ramps, stair lifts, pedestal sinks, wheelchair-friendly flooring), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof the Look-Back Rule was not violated.
- Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.
Maryland does not use Qualified Income Trusts (Miller Trusts). The Medically Needy Pathway / ABD Spenddown Program is available for persons over the income limit.
Maryland Medicaid 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 list).
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 as part of Regular State Plan Medicaid.
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.
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.
How to Apply
- Apply online at Maryland Benefits (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
Before submitting a Medicaid application, it is extremely important that seniors are confident all eligibility requirements are met. Medicaid Planning is strongly suggested for those unsure of eligibility.
More Maryland Long-Term Care Resources
Take the Next Step for Maryland Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- Maryland Department of Health — Maryland Medicaid — Official site