Maryland Medicaid for Seniors & Long-Term Care

Asset limits for the non-MAGI population are distinct from MAGI eligibility rules, which have no asset test. Federal spousal impoverishment protections under 42 U.S.C. § 1396r-5 apply to married applicants.

Maryland operates several Section 1915(c) HCBS waivers allowing eligible individuals to receive long-term care services at home or in community settings rather than nursing facilities. HCBS waivers have enrollment caps and may have waiting lists. Contact your local health department or the Maryland Access Point for seniors (1-844-627-5465) for current availability and to request a Level of Care assessment.

The Community Options Waiver has a substantial waitlist for people living in the community — a statewide "Service Registry" — and enrollment is capped. As of early 2026, tens of thousands of people were on the registry, with a limited number invited to apply each month. Medicaid-funded nursing home residents who have received at least 30 days of care are prioritized and can apply for the waiver directly without joining the registry; call the MDH Office of Long Term Services and Supports at 410-767-1739. Community members should call Maryland Access Point at 1-844-627-5465 to be added to the registry.

Maryland has multiple PACE (Program of All-Inclusive Care for the Elderly) sites operating in the Baltimore metro area and the Chesapeake region. PACE serves adults age 55 and older who need nursing facility level of care but can safely live in the community, providing comprehensive medical, social, and personal care services through a single provider.

For Medicaid-eligible PACE participants, there is no out-of-pocket cost for PACE services. Medicare-eligible participants use Medicare as primary coverage with Medicaid as secondary. Contact the Maryland Department of Health or the National PACE Association at npaonline.org for current PACE site locations in Maryland.

Maryland Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance, which is $106/month in Maryland (tied to the cost-of-living allowance). If income exceeds the institutional Medicaid limit, Maryland may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Maryland operates a Medicaid estate recovery program under 42 U.S.C. § 1396p. Recovery is permitted from the estates of recipients age 55 and older who received long-term care services. Recovery is deferred while a surviving spouse or minor/disabled/blind child survives. Maryland limits recovery to probate assets — the state does not pursue non-probate transfers like jointly held property or designated beneficiary accounts. Families should consult an elder law attorney for estate planning guidance specific to their situation.