Medicaid Waiver, Explained · Part 1 of 8

Almost every family I sit down with has already lost time to the same misunderstanding. Not because they were careless — because the system teaches them the wrong lesson first.

Prefer to watch? The same material, as a conversation — about twelve minutes.

Why everyone gets this wrong

Here is how it usually goes.

Your mother falls. She goes to the hospital. From the hospital she goes to a rehab facility, and Medicare pays for that rehab.

You see a nursing bed, a facility, staff in scrubs, and a Medicare card that works. So when the rehab ends and someone says she cannot go home alone anymore, you assume the next place will be covered the same way.

It will not be. Not one dollar of it.

That assumption is the single most expensive mistake families make, and the cost is not only money — it is months. Months of paying out of pocket, or months in a rehab bed, while the paperwork that could have helped sits unstarted.

What Medicare actually pays for

Medicare covers skilled care. That word is doing a lot of work.

To get the skilled nursing facility benefit at all, there has to be a qualifying inpatient hospital stay of at least three days first. Then Medicare will cover up to 100 days in a benefit period — but “up to 100” is not “100.”

And it stops the moment the care is no longer skilled. If your mother stops making measurable progress in therapy, coverage can end at day 35. Families plan around a hundred days and get a notice in week five.

What Medicare never pays for

Assisted living.

Help with bathing, dressing, meals, medication management, someone awake in the house overnight — that is custodial care. Medicare has never covered it. Not in a nursing home, not in a large facility, not in a small licensed home like ours.

There is no Medicare plan you can upgrade to that changes this. If someone tells you otherwise, ask them to show you where.

So what does pay for it in Maryland?

Two things, and they are different from each other.

1. The Community Options Waiver

This is Maryland Medicaid paying for services in an assisted living home for someone who would otherwise need a nursing home. That is the whole logic of it: it costs the state less to support you in a small home than in a nursing facility, so the state will pay for the care where you actually live.

Two things to understand now, and we will go deeper in later parts:

• It pays for services, not for room and board. Under Maryland regulation (COMAR 10.09.54.03), a provider’s room-and-board charge for a Waiver participant may not exceed $420 a month.
• Federal rule (42 CFR 447.15) says a provider has to accept the Medicaid payment as payment in full. A home cannot bill a Waiver resident extra on top of it. That is worth knowing, because it does happen.

2. SOAR

SOAR is a Maryland state program run through the Department of Aging — not a county program, and people get that wrong constantly.

In 2026 the state folded three existing programs into it, one of which was the Senior Assisted Living Subsidy (SALS). Montgomery County moved SALS into SOAR as of July 1, 2026. Some counties, such as Howard, still run it under the SALS name — so what it is called depends on where you live.

SOAR is for adults 62 and older with income under 60% of the state median who need help with activities of daily living, and it provides partial support toward the monthly fee, subject to annual funding. For most families it is the bridge while they wait on the Waiver.

The part that actually costs people months

You do not apply for the Waiver. You register for it.

You go on the Community Options Waiver Registry through Maryland Access Point, and then you wait for an invitation to apply. That wait can run from months to years.

Which means the day to start is not the day you need it.

If there is any chance a parent will need assisted living in the next few years, make that call now. It costs nothing, it commits you to nothing, and it starts the clock.

Two calls to make this week

What to do with this

If you take one thing from this page: the rehab bed your parent is in right now is not the same benefit as the home they will move to next. Different program, different rules, different clock. Start the second one before the first one runs out.

We will take the rest apart one piece at a time — the hospital status that quietly disqualifies people, the three gates you have to clear, what the money actually looks like once you are approved, and the reasons applications come back rejected.

Aberdeen House III is a licensed assisted living home in Rockville, Maryland. This series explains how Maryland pays for assisted living. It is general information, not legal or medical advice — confirm your own situation with Maryland Access Point, OLTSS, or an elder law attorney. Figures are 2026 and change annually.

Sources: Medicare.gov and CMS 2026 Parts A & B fact sheet (100-day benefit, three-day qualifying stay, $217 daily coinsurance, $1,736 Part A deductible, custodial care exclusion) · COMAR 10.09.54.03 (room-and-board limit of $420) · 42 CFR 447.15 (payment in full) · Maryland Department of Aging (SOAR — age 62 and older, under 60% of state median income) · Montgomery County DHHS · Maryland Access Point