Maryland Medicaid for seniors and long-term care

Last verified: June 2026

Maryland Medicaid long-term care eligibility

Maryland Medical Assistance covers long-term care services for eligible seniors and adults with disabilities. Eligibility for long-term care Medicaid in Maryland requires both financial and clinical qualification — the individual must need nursing facility level of care, and must meet income and asset limits under the non-MAGI (non-Modified Adjusted Gross Income) rules that apply to this population.

Maryland's long-term care Medicaid is administered by the Maryland Department of Health's Medical Care Programs Administration (MCPA). Applications for seniors and individuals with disabilities are processed through local health departments, which conduct Level of Care (LOC) assessments.

Individuals who receive SSI (Supplemental Security Income) automatically qualify for Maryland Medical Assistance without a separate application.

Asset limits for long-term care in Maryland

Source: Maryland MCPA long-term care eligibility rules; federal spousal impoverishment protections under 42 U.S.C. § 1396r-5. Asset limits for the non-MAGI population are distinct from MAGI eligibility rules (which have no asset test).

Community Options waiver and HCBS services

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. Key programs include:

• Community Options Waiver: personal care, case management, adult day care, home modification, assistive technology
• Medical Day Care Services: structured day programs for medically complex adults
• Community Personal Assistance Services: for adults who need physical assistance with ADLs (Activities of Daily Living)
• Rare and Expensive Case Management (REM): for individuals with complex, high-cost diagnoses

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.

PACE sites in Maryland

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. PACE provides 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.

Medicaid estate recovery in Maryland

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.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Maryland's share of that population is administered through Maryland Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

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 varies by state but is often $30–$50 per month). Medicaid covers the gap.

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. Not all states allow this; verify whether Maryland uses this approach with Maryland Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Maryland Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Maryland Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Maryland Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Maryland's current CSRA is set by Maryland Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments