The Community Options Waiver

Last verified: October 2026

What is Maryland's Community Options Waiver?

The Home and Community-Based Options Waiver (HCBOW), also called the Community Options Waiver is a Maryland Medicaid program that pays for services at home or in an assisted living program for adults who need a nursing facility level of care but can live safely in the community.

It is governed by COMAR 10.09.54 and run by the Maryland Department of Health. Services: All Medicaid State Plan services including Community First Choice, plus assisted living services, behavior consultation, case management, dietitian and nutritionist services, family training, medical day care and Senior Center Plus.

Source: MDH: Community Options Waiver

Who is eligible for the Community Options Waiver?

Age 18 or older, nursing facility level of care, living at home or in the community, not in another waiver or PACE, community services must cost no more than institutional care; monthly income up to 300 percent of the SSI benefit and countable assets of $2,000 or $2,500 depending on eligibility category.

The 300 percent income line is $2,982 a month (300 percent of the 2026 SSI federal benefit rate of $994). People whose income is higher may be eligible for the Increased Community Services program instead: For nursing facility residents of at least six months (Medicaid-eligible 30 days in a row) whose income is above 300 percent of SSI; assets up to $2,500; income above the 300 percent line is paid toward the cost of care. Services include assisted living.

How long is the wait, and how do you get on the registry?

There is a waitlist. Call Maryland Access Point at 844-627-5465 to be placed on the Community Options Waiver Registry; you are invited to apply when your name comes up. A nursing facility resident whose stay Medicaid has paid for at least 30 days can apply with no wait.

The registry is a list, not an application, so get on it early -- even before a move is certain. Keep Maryland Access Point updated with phone and address changes so the invitation is not missed. Questions: Office of Long Term Services and Supports, 410-767-1739.

Does the waiver pay for assisted living room and board?

The waiver pays for assisted living services, not room and board; the resident's own income covers room and board.

212 Baltimore-area programs told MHCC they participate -- see the waiver directory. A program can limit how many waiver residents it accepts, so confirm before applying.

What other Maryland Medicaid programs help at home?

Community First Choice (CFC): A Medicaid State Plan benefit for people who already have full Medicaid and need an institutional level of care while living in the community: personal assistance, nurse monitoring, supports planning, home-delivered meals, personal emergency response systems, accessibility adaptations, assistive technology and transition services. No waitlist.

Community Personal Assistance Services (CPAS): For people with full Medicaid who need help with at least one activity of daily living: personal assistance, nurse monitoring and supports planning. Medical Day Care Services Waiver: For people with full Medicaid who need nursing facility level of care and have a medical order for medical day care: at least four hours a day, up to seven days a week.

Is the Community Options Waiver the same as Medicaid expansion?

No.

Maryland expanded Medicaid under the Affordable Care Act in 2014. That adult expansion is income-based and separate from the aged, blind and disabled long-term care pathway, which applies its own income and asset tests.