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This is one of the most searched and most poorly answered money questions in Maryland senior care. Families deserve a straight answer, even when part of that answer is “no.” Here it is, in plain language, with the current rules and the practical steps that actually help.
The Community Options Waiver (formerly the Home and Community-Based Options Waiver) is Maryland’s main Medicaid waiver for older adults and adults with disabilities who need a nursing-facility level of care but want to live in the community including in an assisted living home. “Medicaid” in Maryland is officially called Medical Assistance.
The waiver pays for care services like personal assistance, case management, and assisted living services that Medicaid would otherwise only cover in a nursing home. What it does not pay is your room and board. Waiver participants contribute their own income toward rent and meals, keeping only a small personal-needs allowance. To qualify, an applicant must meet three tests:
Here’s where honesty matters most. For someone living in the community, waiver access typically means joining a registry, waiting to be invited to apply, and then completing both a financial and a functional assessment. That wait is long: as of early 2026, more than 20,000 people were on Maryland’s Community Options Waiver registry, and only around 700 are invited to apply each month so the wait commonly runs many months to several years. You add your name by calling Maryland Access Point at 844-627-5465.
The practical implication: if there’s any chance your family will need waiver support within the next couple of years, get on the registry now even if you’re currently paying privately. There’s no cost to being on the list and no obligation if your plans change. Families who wait until the money runs out have the worst outcomes.
The registry wait doesn’t mean sitting idle. The families who navigate this best run several tracks in parallel:
Not for room and board. Maryland Medicaid does not cover the rent-and-meals portion of assisted living. However, the Community Options Waiver can pay for the care-services portion for people who qualify, while the resident covers room and board from their own income. So Medicaid can help with assisted living in Maryland but it does not cover the full cost.
The Community Options Waiver (formerly the Home and Community-Based Options Waiver) is Maryland’s main Medicaid waiver for adults who need a nursing-facility level of care but want to live in the community, including in assisted living. It pays for care services not room and board and requires meeting functional and financial eligibility tests, plus joining a waitlist.
In 2026, a single applicant’s monthly income may not exceed $2,982 (300% of the SSI federal benefit rate), and countable assets must be $2,500 or less ($3,000 for a couple with both spouses applying). A home and one vehicle are typically exempt. These limits change each year, so verify the current figures with the state before applying.
It can be long often many months to several years. In early 2026, more than 20,000 people were on the registry, with roughly 700 invited to apply each month. You join by calling Maryland Access Point at 844-627-5465. One exception: if your loved one is in a nursing home and Medicaid has paid for 30+ days, they may apply with no wait.
It works the same as assisted living. Maryland Medicaid does not pay room and board for memory care, but the Community Options Waiver can cover the care-services portion for those who qualify and are in a waiver-enrolled community. Room and board is still paid from the resident’s income. Confirm waiver participation with any specific memory care provider.
Maryland’s Medicaid look-back period is five years (60 months). Assets given away or sold below fair market value within five years of applying can trigger a penalty period of Medicaid ineligibility. Because the rules are complex, talk to an elder-law attorney before making any gifts or transfers if Medicaid may be needed.
