Most families call us the month the money runs out. Here is the same conversation from our video, written out – what Medicaid covers for long-term care in Maryland, and the part families get wrong: the nursing facility track and the Community Options Waiver run on different clocks. For the waiver you register, wait to be invited, and only then does the application begin. The registry alone commonly runs past two years, so register about two years before you expect to need the care.
In this article
Medical care and daily care
Medicare and Medicaid
How to read the eligibility numbers
What long-term care costs
Nursing facility coverage and your share of the cost
The waiver is community care inside Medicaid
Medical care and daily care
Her mother has been in a nursing home since March. The savings will cover about three more months. When that money is gone, does Medicare pick up the bill?
Generally, no. This is the difference families need to understand. If what she needs is help with daily living – bathing, dressing, getting to the bathroom – Medicare does not cover that kind of long-term care.
Then who does pay for it?
Some people pay out of pocket or through other coverage. Medicaid is the main program for long-term care, but it reviews your finances and the care you need. It does not start just because savings ran out.
If someone owns a home and has savings, should they assume Medicaid is out of reach?
Please do not assume that. Some assets are not counted, and there are rules that protect a spouse. You have to look at what kind of help is needed and how that program’s rules apply to you.
Why should a family learn this before it becomes urgent?
Because a decision made in a hurry can affect eligibility later. A long-term care application can look back at five years of transfers. Giving property away is not the same as spending it on your own care.
Medicare and Medicaid
My mother has Medicare. Why are we talking about Medicaid?
Medicare covers medical services like hospital care. If the conditions are met, it can also cover skilled nursing, rehab, or home health. But that is separate from paying for ongoing help with daily living.
How does Medicaid help with ongoing care?
Medicaid covers medical services, and for people who qualify it can also cover long-term care. It is not the only public help, and what is covered depends on the program and the person’s situation.
What exactly counts as help with daily living?
Helping someone bathe, get dressed, or get to the bathroom. Reminding someone when to take medication can be part of it too. That help can be needed steadily even when no skilled treatment is required right now.
If the only ongoing need is help with bathing and dressing, does Medicare pay?
Generally it does not. There is a difference between needing help to get through the day and needing skilled nursing that meets the coverage conditions. Do not judge coverage by the building someone is in.
Does Medigap pay for the long-term daily care that Medicare does not cover?
Medigap helps with some of your share of the cost for services Original Medicare already covers. It does not add coverage for long-term daily care that was excluded in the first place.
How to read the eligibility numbers
How does someone get onto Medicaid in Maryland?
Maryland has several coverage groups. The standard changes with age, disability, income and assets, and the services you need. You cannot judge every family by one number you saw online.
How are older adults and people with disabilities reviewed?
If you apply at sixty-five or older, or on the basis of blindness or disability, the state generally looks at income together with countable assets. Even within that, there are several coverage groups.
What amounts does Maryland publish for that group?
Maryland’s February 2026 chart lists the aged, blind and disabled group living in the community at three hundred fifty dollars a month for one person, three hundred ninety-two for a couple. That is the community standard, not the nursing home or waiver number.
Is that low income number the only thing they look at?
There is an asset standard too. Two thousand five hundred dollars for one person, three thousand for a couple. Countable assets are figured under the rules. It is not everything you own added together.
Do those same numbers apply to a nursing home or assisted living?
No. Those are community coverage numbers. Long-term care, like a nursing home or the waiver, is reviewed under its own financial standard. Mixing the two makes families give up when they did not have to.
If my mother’s Social Security is above that amount, is it automatically no?
No. Maryland itself says you may still qualify above the listed amount. Another coverage group or an exception may apply, so ask first which standard they are applying to her.
What should a family above the chart income ask about?
Ask whether there is a coverage group for long-term care, or one that takes medical expenses into account. Some groups do. That is not permission to give property away, so ask the caseworker how that calculation works.
Is there a different coverage group for adults under sixty-five?
Yes. Maryland’s adult expansion group has a 2026 monthly income standard of one thousand eight hundred thirty-five dollars for one person. That is a different program from applying on age or disability.
Are assets reviewed for adults nineteen to sixty-four under that standard?
That group uses an income method called MAGI, and there is no asset test. Different rules can apply to someone applying as aged, disabled, or for long-term care.
What long-term care costs
You said the long-term care numbers are different. Why does the state do it that way?
Because long-term care looks at the level of care you need along with your finances. One general income chart is not the whole test for long-term care.
Is long-term care Medicaid one thing, or does it split in two?
It splits two ways. One is nursing facility coverage. The other is the Community Options Waiver, for care at home or in the community. Both sit inside Medicaid, and both need a nursing facility level of care finding.
What can she keep on each of those tracks?
Maryland puts countable assets for long-term care at two thousand five hundred dollars. The waiver is listed at two thousand or two thousand five hundred by category. The number looks like the community one, but it is a different program.
Is the income standard the same for both tracks?
This is where they differ most. On the nursing facility side, the cost of the home can be applied against excess income, so higher income does not rule you out by itself. The waiver has a hard income cap.
So which track has a chance for someone with higher income?
It is not the same for everyone, but someone over the waiver cap can still qualify on the nursing facility side. For someone who wants to stay home, that cap is a real barrier. Ask which standard applies.
What does a nursing home cost?
In CareScout’s 2025 survey, the national median for a semi-private nursing home room was three hundred fifteen dollars a day. That is over nine thousand a month. What an individual facility charges can be different.
And assisted living, in the same survey?
The national median was six thousand two hundred dollars a month. Medicare does not cover assisted living room and board or ongoing daily care. Separate medical services received there depend on the coverage conditions.
Which Medicaid care supports are we looking at today?
Nursing facility coverage and Maryland’s Community Options Waiver. There are other community supports too. These two show how the place of care and the coverage group change the rules.
Nursing facility coverage and your share of the cost
If my mother needs nursing home care and her savings are going down, when should we look into Medicaid?
For a nursing facility, start looking when what is left is about six months of care, and apply before it is down to three. Approval does not arrive on the day the money runs out. For care at home or in assisted living it is a different clock, and a much longer one. I will come back to that.
Why six months and three months?
Because of how long the review takes. Federal rules give the state ninety days to decide an application based on disability, and forty-five days for other applications. Missing paperwork adds to that.
How long does gathering the paperwork take?
A long-term care application looks at five years, sixty months, of financial records. If there were several accounts or a change of bank, pulling those statements alone can take weeks. That is why you start ahead of the review clock.
If we apply late, are all the bills in between on us?
Not necessarily. There is retroactive coverage for eligible services before the month you applied. But for applications filed on or after January 1, 2027, that period gets shorter. Do not read that as permission to apply late.
What should a family do right now?
Divide the money left by the monthly cost and write down how many months are left. Under six, call the facility social worker and the eligibility office that day and write down the document list.
Does applying take care of both the approval and the bed?
No. Your mother has to qualify, and the facility has to participate in Medicaid. It is not automatic, so check the timing and the paperwork separately with the facility social worker and the eligibility office.
Does the nursing facility side also need a level of care finding?
Yes. Nursing facility coverage also requires a finding that a nursing facility level of care is needed. That step is not unique to the waiver. They look at the finances and the level of care together.
If Medicaid approves nursing facility care, is there still an amount the resident pays?
Usually you pay your income toward the cost, minus the allowed deductions, and Medicaid pays the rest it covers under the rules. It is not simply handing over every dollar that comes in.
What gets deducted from that calculation?
A personal needs allowance is left. Depending on the situation, an amount for a spouse or dependent and some medical expenses can also be deducted. Ask for the calculation in writing.
Is the share of the cost you just described the nursing home version?
Yes, that is for someone in a nursing facility. With the waiver in assisted living the structure is different. You have to separate the care services from room and board. I will come back to that in the waiver section.
Is nursing facility care a regular Medicaid benefit, or a waiver service?
For someone who qualifies, nursing facility care is part of the regular Medicaid benefit. It does not work like a waiver with a limited number of service slots to wait for.
So a nursing home bed is guaranteed right away?
No. It can take time to find a facility that participates and has an open bed, and the application still has to be reviewed. No waiver waiting list is not the same as immediate admission.
The waiver is community care inside Medicaid
How does Maryland’s Community Options Waiver relate to Medicaid?
It is a program inside Medicaid, not separate insurance. It supports approved care at home or in the community, and that can include a participating assisted living home.
What are the income and asset standards for the Community Options Waiver?
The income cap is three hundred percent of the SSI rate, two thousand nine hundred eighty-two dollars a month in 2026. Countable assets are two thousand or two thousand five hundred by category. Unlike the nursing facility side, over the cap means no.
If you meet those financial standards, do you get into the waiver right away?
No. You also have to need a nursing facility level of care and meet other conditions. There is a registry and a wait. Meeting the money test does not reserve a spot.
I have heard the wait after you register is about a year. Is that right?
There is no set length. Maryland calls this a registry, not a waiting list. People are not called in the order they signed up, so no one can promise you a year.
Then who gets called first?
Maryland Access Point does a short review called a Level One Screen. The result places you in one of six priority groups, and group one is for people at the greatest risk of going into a facility.
How many people are invited each month?
By the state’s report, seven hundred invitations go out each month. Eighty percent of those are chosen by risk level and twenty percent by how long someone has been on the registry.
How many people are on the registry now?
As of the end of February 2026, twenty thousand six hundred sixteen. Dividing that by seven hundred a month gives about twenty-nine months. People are not called in order, so that is not your personal wait, but it does tell you the registry alone runs past two years.
So two people who register the same day can wait very different lengths of time?
Yes. Someone in group one may hear back in months, and someone lower can wait years. And the application has not started yet. It begins when the invitation arrives, and the forty-five and ninety day review clocks run from there, not from the day you registered.
Is the backup because there are no slots?
Not only that. In the same report, four thousand two hundred fifty-three of six thousand three hundred forty-eight approved slots were filled. Slots are open and the registry still is not clearing, for another reason.
What is that reason?
People get the invitation and never send the application back. In one year the state mailed seven thousand nine hundred fifty-one invitations and got back two thousand fifty applications. About one in four.
How long do you have after an invitation arrives?
Six weeks from the day it is mailed. It used to be eight. Miss that window and the chance is gone and you register again.
So what does a family need to watch for after they register?
Watch the mail. Report a change of address right away, and open the envelope even if it looks like junk. A lot of people register and then miss the letter and start waiting over.
Are more slots coming?
Register about two years before you expect to need the care. Registering is not a financial test, so there is no reason to wait until the savings are low. On January first, twenty twenty-seven, approved slots go from six thousand three hundred forty-eight to seven thousand five hundred, but priority and the paperwork deadline do not change.
Who do we call to register and to ask what help is available while we wait?
Call Maryland Access Point at eight four four, six two seven, five four six five. Ask about the Community Options registry and what else is available now. Being on the registry is not a Medicaid approval.
Can someone already in a nursing facility on Medicaid apply without that wait?
Maryland lets someone apply directly when Medicaid has paid for nursing facility services for at least thirty days. The other eligibility conditions still apply. Ask the facility social worker about the transition process.
Does that waiver pay the room and board at an assisted living home?
No. Room and board is separate from the care services the waiver covers. Do not assume the whole assisted living bill is covered. Ask for the two amounts separately.
How does a family find out what they will actually pay?
Ask the caseworker and the home to walk you through the covered care, your required share of the cost, and room and board, one at a time. The step-by-step waiver process is its own series.
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