Most US long-term care is paid for by Medicaid, not Medicare.1 Maryland calls its Medicaid program Medical Assistance, administered by the Maryland Department of Health (MDH) and delivered for most services through HealthChoice managed-care organizations (MCOs).

Three eligibility tests, in order

1. Medical eligibility

Maryland requires a level-of-care assessment confirming nursing-home-level need for institutional Medicaid or substantial ADL needs for CFC. Assessments are coordinated through the local Department of Social Services and the AAA, with the interRAI Home Care assessment used as the standardized tool.2

2. Income

Maryland applies the federal income cap of 300% of the SSI federal benefit rate — approximately $2,829/month gross in 2026. The cap is updated each January.

If your parent’s gross monthly income exceeds the cap, they aren’t automatically disqualified. Maryland allows the use of a Qualifying Income Trust (QIT) — sometimes called a Miller Trust — to divert above-cap income.3

3. Assets

The applicant’s countable assets must be at or below $2,500 at the moment of application . Maryland applies the standard federal exemptions:

The five-year look-back

Maryland applies the standard federal 60-month look-back to all long-term-care applications. Any uncompensated transfer in the 60 months before application generates a penalty period — a window during which the applicant is otherwise eligible but Medical Assistance will not pay.

The penalty math: transfer value divided by Maryland’s monthly penalty divisor (approximating the average private- pay nursing-home cost). The 2026 figure is approximately $9,800–$11,500/month. A $100,000 gift becomes roughly a 9-month penalty.

Community First Choice: Maryland’s progressive HCBS entitlement

Maryland operates the Community First Choice (CFC) state-plan option under §1915(k) of the Social Security Act.4 CFC is distinct from a waiver in one critical way: it’s an entitlement, not a slot-limited waiver. If your parent qualifies, they cannot be put on a waitlist.

CFC covers:

For families where the goal is keeping the parent at home with paid in-home support — rather than transitioning to a nursing facility — CFC is the key. Eligibility requires meeting nursing-home level of care PLUS the financial eligibility tests above.

The Community Options waiver

For services that CFC doesn’t cover — certain community-based settings, assisted-living services, some environmental modifications — Maryland operates the Community Options Waiver (often called CO Waiver).5 Unlike CFC, the waiver has slot limits and can have waitlists. Apply early.

HealthChoice and managed-care delivery

Most Maryland Medical Assistance services — including most LTC — are delivered through HealthChoice managed-care organizations. Major MCOs include Aetna Better Health, AmeriHealth Caritas, CareFirst Community Health Plan, Jai Medical Systems, Kaiser Permanente, MedStar Family Choice, Maryland Physicians Care, Priority Partners, UnitedHealthcare Community Plan, and Wellpoint. Your parent will be assigned to one or choose one at enrollment.

The community-spouse situation

If one spouse needs care and the other doesn’t, the rules become more favorable. The community spouse keeps:

Maryland’s estate recovery program

Maryland pursues estate recovery for Medical Assistance LTC services paid on behalf of a recipient age 55 or older. Recovery applies to the probate estate — meaning assets held in properly-structured trusts or passing by beneficiary designation generally escape recovery.6 A Maryland elder-law attorney can review the estate structure to understand exposure.

What to do this month

For the broader Medicaid context across states, see our Medicaid pillar overview. For Maryland’s estate-and-inheritance-tax landscape, see Legal & Financial in Maryland.