Maryland Home and Community-Based Options Waiver (Community Options Waiver)

The Home and Community-Based Options Waiver, usually called the Community Options Waiver, is Maryland Medicaid’s waiver for adults who need a nursing facility level of care. It pays for services such as assisted living, case management, home-delivered meals and help moving out of a nursing home. Medical day care is not part of it: Maryland pays for medical day care through its own waiver, the Medical Day Care Services Waiver. It sits alongside our Maryland Long-Term Care Medicaid guide, which covers the nursing home rules.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

The Community Options Waiver in brief

To sum up, Maryland Department of Health (MDH) oversees the Community Options Waiver. Its target group is 18 and older; on care need, the rule is: Needs a nursing facility level of care. Waiting list status in 2026: Yes. The Services Registry. The sections below repeat these points with more detail, and our state guide covers the Maryland rules that apply to every long-term care program. Families weighing the Community Options Waiver against other Maryland options can use the related pages at the end to compare programs side by side.

What the program is

MDH runs the waiver. 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. Once invited, a supports planner helps with the application and plan of service. Personal assistance for waiver participants is generally provided through Community First Choice.

Under federal law, Maryland can run home and community-based waivers like the Community Options Waiver, which bend some ordinary Medicaid rules so care can happen outside a facility. Slots are limited each year, every participant has an individual care plan, and a case manager or coordinator puts services in place. They do not replace regular Medicaid: a person on a waiver still has ordinary Medicaid coverage for doctor visits, hospital care and prescriptions, with Medicare paying first for people who have it. See our overview of HCBS waivers.

Who qualifies in 2026

In Maryland, the basic requirements for the Community Options Waiver are that the person:

• Is 18 or older
• Needs a nursing facility level of care
• Qualifies for full Medicaid under Maryland’s long-term care financial rules (see the money test below)
• Lives in Maryland and is a U.S. citizen or qualified non-citizen
• Has been invited off the Services Registry (or enters through a nursing facility route)

Income and assets. The person must qualify for full Medicaid under Maryland’s rules for long-term care. The income and asset figures in the table above are Maryland’s 2026 Long-Term Care Medicaid figures from our state guide. Maryland Medicaid’s countable assets do not usually include the home (within the equity limit, if the applicant or a spouse lives there or intends to return), one car, personal belongings and a small burial fund. Married couples get extra protection in Maryland: the spouse at home keeps a share of assets and may get some of the applicant’s income. See Spousal impoverishment rules.

About the level-of-care assessment. For the Community Options Waiver, an assessor checks how much help the person needs with bathing, dressing, eating, toileting, mobility and medications, and whether memory loss calls for supervision. For the Community Options Waiver, an assessor, usually a nurse or social worker, visits the person at home, in the hospital or in the facility. Before a the Community Options Waiver assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.

What services it can pay for

What a participant receives under the Community Options Waiver follows the care plan. Possible services include:

• Assisted living services (resident pays room and board)
• Case management and supports planning
• Home-delivered meals
• Behavioral consultation
• Family training
• Senior Center Plus
• Help moving out of a nursing home

Not every participant gets every service; the plan reflects assessed need and the help family already gives. A change in health is a reason to request a reassessment.

How to apply

Getting the Community Options Waiver means passing a money test and a care test. Step by step:

1. Contact Maryland Access Point to join the Services Registry.
2. When invited, complete the Medicaid application and level of care assessment.
3. Work with a supports planner on the plan of service.

For the paperwork, use our documents checklist before applying for the Community Options Waiver; Applying for a waiver explains the general process.

Waiting lists

Most applicants wait on the Services Registry. Invitations are prioritized by risk of nursing home placement. People in a nursing facility may have a separate route.

More on how lists work: Waiver waiting lists.

How it relates to nursing home Medicaid

The waiver uses the nursing facility level of care. Maryland’s nursing home Medicaid uses a medically needy route with no fixed income cap; the waiver uses the special income rule. If a waiver application is denied because income is too high, the Increased Community Services program may help.

Rules shared with nursing home Medicaid. Maryland’s financial rules for the Community Options Waiver track the nursing home rules closely. The five-year look-back for gifts generally applies, so a gift or transfer for less than fair value can cause a period when Medicaid will not pay for long-term care services. Maryland Medicaid can also use estate recovery to seek repayment for long-term care services received after 55. Some participants pay a monthly share of income toward services.

Personal needs allowance. If the person does move to a nursing home, Maryland’s 2026 personal needs allowance is $106 a month. Most of the rest of their income goes toward the cost of care. Our state guide covers the nursing home rules in detail.

Tips for families

• Do not wait for a crisis. Lists and assessments for the Community Options Waiver take time, and the start date is usually when you first request help.
• Keep copies of every the Community Options Waiver form, notice and letter, and write down the name of each person you speak with and the date.
• Watch the deadlines on notices. A denial or cut can be appealed through a fair hearing, and a timely request can keep services going meanwhile.
• Report changes promptly, including income, assets, a move or a new living arrangement.
• Mark renewal dates. Eligibility and the care plan are usually reviewed annually; see Renewals.
• Get help with complex the Community Options Waiver cases, such as a spouse at home or past gifts. A certified Medicaid planner or a legal aid office can review how Maryland’s rules fit a family’s situation.

Common questions

Does the waiver pay assisted living? It pays for assisted living services, not room and board.

How long is the wait? It varies; the registry is large.

What if my income is too high? See Increased Community Services.

Can I attend medical day care while on the Community Options Waiver? Medical day care is a separate waiver, the Medical Day Care Services Waiver. A person cannot be enrolled in it and another Medicaid HCBS waiver at the same time, so families choose the waiver that best fits their needs.

Related pages

• Maryland Long-Term Care Medicaid guide
• Maryland Community First Choice
• Maryland ICS
• Three kinds of Long-Term Care Medicaid
• PACE programs

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