Long-Term Care Medicaid in Maryland: 2026 Guide

In Maryland, Medicaid is run by the Maryland Department of Health (MDH), and eligibility for long-term care is decided by your local Department of Social Services (LDSS). Long-Term Care Medicaid can pay for nursing home care and for care at home through the Home and Community-Based Options Waiver, Community First Choice and other programs. Maryland uses a medically needy route rather than an income cap for nursing home care. This guide explains the 2026 rules in plain language.

At a glance: Maryland 2026 figures

Item	2026 figure
Income limit (nursing home applicant)	No fixed cap for nursing home care: medically needy route (income goes toward care)
Asset limit (single applicant)	$2,500 (medically needy, used for nursing home care); $2,000 categorically needy
Home equity limit	$752,000
Spouse at home: resource allowance (CSRA)	Minimum $32,532 / maximum $162,660
Spouse at home: monthly income allowance (MMMNA)	Minimum $2,705 (from July 1, 2026) / maximum $4,066.50
Personal needs allowance (nursing home)	$106 a month
Look-back period	60 months (5 years)
Penalty divisor	$12,501 a month ($411 a day), from July 1, 2025

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Maryland Department of Health before relying on them.

What Long-Term Care Medicaid covers in Maryland

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

Home and Community-Based Options Waiver (Community Options Waiver). This waiver is for adults 18 and older who need a nursing facility level of care and meet the financial rules. It can pay for services such as assisted living, case management, home-delivered meals and help moving out of a nursing home. Most people join the Services Registry through Maryland Access Point and are invited as openings come up, with priority based on risk of needing a nursing home.

Community First Choice (CFC). A state plan program for people who already have full Medicaid, live in the community and need an institutional level of care. It pays for personal assistance and related supports. CFC does not have its own waiting list.

Other programs. Maryland also has the Medical Day Care Services Waiver, a separate waiver for adults 16 and older who need a nursing facility level of care (it cannot be combined with another Medicaid HCBS waiver or PACE), and PACE (Program of All-Inclusive Care for the Elderly) in some areas.

Assisted living. Medicaid does not pay room and board in assisted living. The Community Options Waiver can pay for assisted living services in approved settings.

Who qualifies

A person generally must:

be 65 or older, or blind or disabled (18 or older for the Community Options Waiver);
live in Maryland and be a U.S. citizen or qualified non-citizen;
need a nursing facility level of care. The assessment for home care is arranged through Maryland Access Point and your local health department;
meet the income and asset rules below, as decided by the local Department of Social Services.

Income rules

For nursing home care, Maryland does not use a fixed income cap. People qualify through a medically needy route: the state compares your income with the cost of your care, and you spend down by paying toward that cost. Maryland’s medically needy income standard is $350 a month for one person, so most nursing home residents pay most of their income to the facility.

For the Community Options Waiver, a different income limit applies.

Once you are on Medicaid in a nursing home, you keep a personal needs allowance, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

For nursing home care through the medically needy route, a single applicant can have up to $2,500 in countable assets in 2026. The categorically needy limit is $2,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
One vehicle
Household goods and personal belongings
Burial plots and limited burial funds, within MDH rules

Spousal protections

Assets: The spouse at home can keep a Community Spouse Resource Allowance of at least $32,532 and up to $162,660 in 2026, plus the home, one car and belongings.
Income: The spouse at home keeps their own income. If it is low, part of the applicant’s income can be set aside for them. Maryland’s published schedule had not yet been updated for the July 1, 2026 federal change when this guide was written.

Look-back and penalties

When you apply, Maryland looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
Selling a house or car to a relative for much less than it is worth.
Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($12,501 a month ($411 a day), from July 1, 2025).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $12,501 is about 4 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Maryland

Maryland’s estate recovery program is run by MDH.

What is recovered: Medicaid paid for services received at age 55 or older, and for some people of any age in a nursing facility.
When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
Hardship waivers: MDH can waive or put off recovery in some situations. Ask MDH for the current rules.
Family members and personal representatives can contact MDH Estate Recovery with questions.

How to apply

For nursing home Medicaid: apply through your local Department of Social Services, online through myMDTHINK or on paper.
For the Community Options Waiver: contact Maryland Access Point (MAP) to join the Services Registry. MAP’s contact details are on the MDH Community Options Waiver page.
For Community First Choice: if you already have Medicaid, contact MAP or your local health department to request an assessment.

After you apply. Your local DSS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive.

Gather what you can before you apply. The caseworker may ask for:

Photo ID, Social Security card and Medicare card
Proof of age and of U.S. citizenship or immigration status
Proof that you live in the state (for example, a utility bill or lease)
Proof of all income: Social Security award letter, pension statements, annuity statements
Bank, credit union and investment statements (often for the full 60-month look-back period)
Deeds, property tax bills and the value of any real estate
Life insurance policies (showing cash value) and prepaid funeral or burial contracts
Vehicle titles
Health insurance cards and long-term care insurance policies
Power of attorney or guardianship papers, if someone is applying for you
For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Maryland

MDH and your local Department of Social Services: Medicaid applications and eligibility.
Maryland Access Point (MAP) and Area Agencies on Aging: local information on long-term care options and the Services Registry.
SHIP (Senior Health Insurance Assistance Program): Maryland’s free Medicare counseling program, through the Maryland Department of Aging.
Maryland Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and assisted living.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Maryland:

Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Maryland’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Maryland’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

Frequently asked questions

Is there an income limit for nursing home Medicaid in Maryland? Not a fixed cap. Maryland uses a medically needy route, so you pay most of your income toward your care and Medicaid pays the rest.

Is there a wait for the Community Options Waiver? Usually, yes. Most people join the Services Registry through Maryland Access Point and are invited as openings come up.

What is Community First Choice? A Medicaid program for people who already have full Medicaid and need help with daily activities at home. It does not have its own waiting list.

How much can my spouse keep? In 2026, at least $32,532 and up to $162,660 in assets, plus the home, a car and belongings. Ask your local DSS about the monthly income allowance.

How long is the penalty for a gift? Maryland divides the gift by its average monthly nursing home cost.

Will the state take my home after I die? MDH can seek repayment for Medicaid paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Maryland Department of Health before relying on them.

Sources

MDH, Medicaid Manual appendix schedules (2026)
MDH, Community Options Waiver
MDH, Community First Choice
MDH, Community First Choice overview
myMDTHINK
CMS, 2026 SSI and spousal impoverishment standards
Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.