The belief that costs Maryland families the most is that home care means a waiver, and a waiver means a waiting list. In Maryland it often does not. Maryland was an early adopter of Community First Choice, a Medicaid state-plan option for attendant services, and a state-plan benefit is an entitlement — no slot cap, no registry. A family that spends eighteen months on a waiver registry while an entitlement benefit sat available has lost eighteen months for nothing.
Maryland Medical Assistance is administered by the Maryland Department of Health. Community First Choice, always shortened to CFC, provides personal assistance and related supports in the home. The Home and Community-Based Options Waiver, often just called the Community Options Waiver, adds services CFC does not cover and does operate through a registry. Maryland Access Point is the state’s aging and disability resource network and is the practical front door, and the Maryland Department of Aging runs additional state programs alongside Medicaid.
Six beliefs follow, each set against the actual rule. Figures are stated as of 2026 and should be confirmed with the Maryland Department of Health.
In This Article
- Belief 1: “We have to get on the waiver list and wait”
- Belief 2: “The asset limit is $2,000, same as everywhere”
- Belief 3: “I make too much, so I need a Miller trust”
- Belief 4: “A family member can never be paid”
- Belief 5: “Maryland works like the states around it”
- Belief 6: “We should cash in the life insurance to qualify”
- Frequently Asked Questions
Belief 1: “We have to get on the waiver list and wait”
The rule: Community First Choice is a state-plan benefit under the federal 1915(k) option, which Maryland adopted early. Because it is a state-plan benefit rather than a waiver, an individual who meets the eligibility criteria is entitled to it — there is no capped number of slots and no registry.
CFC covers personal assistance with activities of daily living and instrumental activities, personal emergency response systems, assistive technology, transition services for someone leaving an institution, and supports that help a person maintain independence at home. The person must be Medicaid-eligible and meet an institutional level of care.
The Home and Community-Based Options Waiver is a different animal. It adds services outside CFC’s scope — including assisted living services in participating settings, adult day, home-delivered meals, respite and environmental modifications — and access runs through a registry with a wait.
What to do: ask Maryland Access Point or the Department of Health to screen you for CFC first, and register for the Options Waiver at the same time. Registering costs nothing and the registration date is the asset.
Belief 2: “The asset limit is $2,000, same as everywhere”
The rule: Maryland’s countable-asset limit for a single applicant is approximately $2,500 as of 2026 — modestly above the national norm, and the difference has decided real cases. Confirm the current figure with the Department of Health, since it is set by state policy.
More important than the number is the exclusion list, which is where families disqualify themselves wrongly. Excluded: the home you live in within the federal home equity ceiling; one vehicle; household goods and personal effects; an irrevocable burial arrangement; and life insurance whose combined face value across all policies on the applicant is at or under the small-policy threshold. Above that threshold, the cash surrender value of every policy is countable — face amounts aggregate, so two modest policies can jointly break an exclusion either alone would fit inside. The aggregation rule is set out here.
For a married couple where one spouse needs care, federal spousal impoverishment rules protect a share of countable resources for the at-home spouse plus a monthly income allowance. Ask for a written resource assessment before spending anything down — money spent before the snapshot is money that was never protected.
Belief 3: “I make too much, so I need a Miller trust”
The rule: Maryland does not use a hard income cap for long-term care Medicaid. It operates a medically needy program with a spend-down, so an applicant whose income exceeds the standard can still qualify by incurring medical and care expenses equal to the excess. That means Marylanders generally do not need the qualified income trust that Florida, Georgia, Arizona and Kentucky require.
This correction alone reopens the door for households that read national guidance, saw an income cap in the low-$2,900s per month, and concluded they were disqualified. Ask your caseworker to compute the spend-down amount and to confirm which expenses count toward meeting it — medical bills, insurance premiums and care costs typically do.
Understand what a large spend-down feels like in practice, though. It means paying substantial care costs out of pocket every month before Medicaid pays anything. It is a path, not a windfall.
| Belief | The Maryland Rule (as of 2026) | Confirm With |
|---|---|---|
| Home care means a waiver and a waiting list | Community First Choice is a state-plan entitlement with no slot cap | Maryland Access Point / Dept of Health |
| The asset limit is $2,000 | Approximately $2,500 for a single applicant | Maryland Department of Health |
| I need a Miller trust | No income cap; medically needy spend-down instead | Your eligibility caseworker |
| Family can never be paid | Self-direction pays most relatives; spousal pay possible in defined circumstances | Supports planner, in writing |
| Old gifts are forgiven | Standard 60-month look-back applies | A Maryland elder law attorney |
| Cash in the policy to qualify | Often a funeral trust or reduced paid-up solves it better | The carrier, then your CPA |
Belief 4: “A family member can never be paid”
The rule: Maryland’s programs include self-direction, under which the participant becomes the employer of record — recruiting, hiring, scheduling and supervising a personal assistant — while a financial management service handles payroll, withholding and background checks. An adult child, sibling, grandchild, niece, nephew or friend can generally be hired and paid.
A spouse is the harder question. Maryland has permitted legally responsible relatives to be paid in defined circumstances under CFC, which is not the flat prohibition most states apply, but the conditions are specific. Do not assume either way: ask the Department of Health or your supports planner directly whether a spouse may serve as a paid personal assistant in your particular case, and get the answer in writing before anyone leaves a job.
Three further questions worth asking at the same time: the current personal assistant pay rate, the number of authorized hours, and what happens to the authorization if the family assistant stops. Private-pay home care in Maryland runs in the low- to mid-$30s per hour as of 2026 in Genworth-style state cost-of-care surveys, which is the number that tells you what a gap between authorized and needed hours will cost — see how households fund it.
Belief 5: “Maryland works like the states around it”
The rule: it does not, in three specific ways.
Where Maryland departs from the baseline: the early adoption of Community First Choice as a state-plan entitlement, which is the structural difference that matters most; the asset limit at roughly $2,500 rather than $2,000; and the medically needy spend-down in place of a hard income cap, which removes the Miller trust requirement entirely. Maryland also runs a statewide long-term services and supports tracking system that supports planners and case managers use, and Maryland Access Point functions as a genuine single front door in a way that many states’ resource networks do not.
Where Maryland simply follows federal law: the 60-month look-back on transfers made for less than fair market value, with a penalty period computed against a state average private-pay rate; the community spouse resource and income allowances; the federal home equity ceiling; and estate recovery for recipients aged 55 and older, deferred while a surviving spouse lives and while a minor or disabled child survives, with a hardship waiver process. Maryland recovers from the probate estate. Our Maryland estate recovery page covers the claim mechanics.
The look-back is the belief families most want to be wrong about and it is not. A gift to a grandchild three years ago is inside the window, and no Maryland exception forgives it. Review any past transfer with a Maryland elder law attorney before applying.
Belief 6: “We should cash in the life insurance to qualify”
The rule: sometimes, but usually not first, and never before the policy has been priced.
Start with documents, not decisions. Ask each carrier in writing for the face amount, the current cash surrender value and an in-force illustration. Every option below is priced off those, and no attorney, accountant or eligibility worker can advise without them.
Then work in order. A reduced paid-up election converts a whole life policy to a smaller fully-paid death benefit with no further premiums — it cuts countable cash value while keeping coverage in force, and it is the right move when the premium, not the cash value, is the strain. An irrevocable funeral trust or properly structured irrevocable burial arrangement is excluded within Maryland’s limits and converts a countable dollar into an excluded one with no gift and no transfer penalty, which frequently resolves a resource problem cleanly at Maryland’s $2,500 threshold. Surrender takes the cash value, ends the coverage and may create taxable income above premiums paid. A life settlement sells the policy to a licensed buyer in Maryland’s regulated secondary market and, for an older insured in declining health, can exceed surrender value substantially — though the proceeds are countable, must be spent on care, and any gifted portion falls inside the 60-month look-back.
And the belief that most needs correcting in the other direction: selling is often the wrong answer. A burial-sized policy already inside the exclusion, a policy the at-home spouse still needs, or a policy on a relatively healthy insured that the market would price poorly should stay in force. We publish that position openly. Pine Lake Legacy does not purchase policies; the free policy review exists so a family knows the real number before making a move it cannot undo. Nothing here is legal, tax or Medicaid-eligibility advice — take it to a Maryland elder law attorney, your CPA, the Maryland Department of Health, or Maryland’s State Health Insurance Assistance Program.
Frequently Asked Questions
Is there a waiting list for Maryland Medicaid home care?
Not for Community First Choice, which Maryland adopted as a Medicaid state-plan option. A state-plan benefit is an entitlement, so an eligible person is not queued. The Home and Community-Based Options Waiver, which adds services outside the CFC scope, does operate through a registry with a wait. Ask to be screened for CFC and register for the waiver at the same time.
What is Maryland’s Medicaid asset limit?
Approximately $2,500 for a single applicant as of 2026, modestly above the $2,000 used in most states. The home you live in, one vehicle, household goods, an irrevocable burial arrangement and life insurance within the small-policy face threshold are excluded on top of that. Confirm the current figure with the Maryland Department of Health, since it is set by state policy.
Do I need a qualified income trust in Maryland?
Generally no. Maryland uses a medically needy spend-down rather than a hard income cap for long-term care Medicaid, so an applicant with income above the standard qualifies by incurring medical and care expenses equal to the excess each month. Ask your caseworker to compute the spend-down amount and confirm which expenses count toward meeting it.
Can a spouse be paid as a caregiver in Maryland?
Possibly, which makes Maryland different from most states. Maryland has permitted legally responsible relatives to serve as paid personal assistants under Community First Choice in defined circumstances rather than applying a flat prohibition. The conditions are specific, so ask the Department of Health or your supports planner about your particular case and get the answer in writing.
What is the difference between CFC and the Options Waiver?
Community First Choice is a state-plan entitlement covering personal assistance with daily activities, personal emergency response, assistive technology and transition supports. The Home and Community-Based Options Waiver is capped and registry-gated, adding services outside CFC’s scope such as assisted living services, adult day, home-delivered meals, respite and environmental modifications. Many people use both.
Should I surrender a whole life policy to meet the $2,500 limit?
Usually that is not the best first move. An irrevocable funeral trust converts a countable dollar into an excluded one with no gift and no transfer penalty, and a reduced paid-up election cuts cash value while keeping coverage. Surrender ends the policy and may create taxable income. Get the carrier’s written surrender value and in-force illustration before deciding anything.
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Related Reading
- Maryland Medicaid Asset Income Limits
- Medicaid Estate Recovery Maryland
- Maryland Insurance Department Consumer Help
- Life Insurance Guaranty Association Maryland
- Life Insurance Counts Medicaid Asset
- Keeping The Policy Is The Right Answer
- Home Care Hourly Cost Funding
- Reduced Paid Up Vs Settlement
Pine Lake Legacy does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.