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    Home and Community-Based Services (HCBS)

    Maryland Medicaid offers home and community-based services for:
    • Older adults;
    • Persons with disabilities; and
    • Children with chronic illnesses.
    Maryland Medicaid’s home and community-based services are offered through the regular Medicaid program and special Medicaid programs called “waivers.” Each waiver has different eligibility criteria and target a different population, such as older adults or people with a certain disability.

    Public Notice for the Model Waiver Renewal Application

    Submit public comments February 16, 2023, through March 17, 2023.

    The Maryland Department of Health (MDH) will submit a 1915c home and community-based services waiver renewal application​ for the Model Waiver for Fragile Children (“Model Waiver”) to the Centers for Medicaid and Medicare (CMS) to renew the waiver for five (5) additional years effective July 1, 2023. The Model Waiver provides home and community-based services to medically fragile individuals who, before the age of 22, would otherwise be institutionalized. The goals of the Model Waiver are to enable 200 medically fragile children to live and be cared for at home rather than in an institution, provide quality services, and ensure the well-being and safety of the individuals served. The Model Waiver includes both State plan and waiver services such as (1) Case Management; (2) Nursing Services (private duty) rendered by registered nurses (RN) and licensed practical nurses (LPN) and delegated Nursing Services rendered by certified nursing assistants (CNA) and home health aides (HHA) who are also certified as medication technicians (CMT); (3) Physician participation in Plan of Care development; and (4) Medical Day Care. When applicable, all services must be provided in settings that meet the federal Community Settings requirements.

    The renewal application for the Model Waiver contains changes such as removing Certified Nursing Assistant/Home Health Aide and Certified Nursing Assistant/Home Health Aide shared services. These changes reflect the review of service utilization, which revealed that no more than one (1) participant per year used Certified Nursing Assistant and Certified Nursing Assistant shared services since Fiscal Year 2016. The delegated Nursing Services rendered by certified nursing assistants and home health aides who are also certified as medication technicians remains a waiver service. 

    Of note, upcoming changes include the MDH’s implementation of Electronic Visit Verification (EVV) for private duty nursing services in Fiscal Year 2024 pursuant to its receipt of CMS' approval of the state’s Good Faith Effort exemption request. The implementation of EVV is not addressed in this renewal; however, waiver amendments will be submitted prior to implementation.

    Comments may be sent to Dawnn Williams, Division of Nursing Services, MDH, 201 W. Preston St., Baltimore, MD 21201, fax to 410-333-5085, or email to mdh.pdnpreauthorization@maryland.gov. 

    Public Notice​​: Statewide Transition Plan for Compliance with Home and Community-Based Settings Requirements (Final Rule)​

    Waiver and Service Programs

    For more information, see the 2019 Bluebook Guide to Home and Community Based Programs.


    The program, administered by Behavioral Health Administration (BHA),  provides opportunities for community-based services to individuals who have experienced a traumatic brain injury after the age of 17. 
    Community Pathways
    The Community Pathways waiver, administered by the Developmental Disabilities Administration (DDA), provides services and supports to individuals, of any age, living in the community, meet the criteria for a developmental disability.
    The Community Supports program, administered by the Developmental Disabilities Administration (DDA), will provide individual and family supports for people with developmental disabilities on the DDA Waiting List.
    The Family Supports program,  administered by the Developmental Disabilities Administration (DDA), will provide individual and family supports for children birth to 21 with developmental disabilities on the DDA Waiting List.
    Medical Day Care Waiver
    Medical Day Care is a structured group program that provides health, social, and related support services to functionally disabled adults, age 16 and older.
    Model Waiver for Disabled Children
    This waiver targets medically fragile individuals including technology dependent individuals who, before the age of 22, would otherwise be hospitalized and are certified as needing hospital or nursing home level of care.

    Programs and Services

    The Community Personal Assistance Services Program (CPAS; formerly MAPC), Community First Choice (CFC) and Community Options Waiver all offer a similar service package. Services vary based on eligibility. The core services are personal assistance, supports planning, and nurse monitoring. The Community Options Waiver also offers services in assisted living.
    Employed Individuals with Disabilities (EID
    The EID Program provides Medical Assistance to working Marylanders with disabilities who meet the program’s eligibility criteria. 

    Hospice Services
    The provision of hospice care is generally in the home to avoid an institutional setting and to improve the individual’s quality of life during the end of a participants' terminal illness. However, individuals eligible for Medicaid may choose to reside in a nursing facility and receive hospice care in that setting.

    Maryland Health Homes
    The program targets populations with behavioral health needs who are at high risk for additional chronic conditions, including those with serious persistent mental illness, serious emotional disturbance, and opioid substance use disorders. 
    Program of All-Inclusive Care for the Elderly (PACE)
    PACE is a voluntary health program designed to provide and coordinate all needed preventive, primary, acute and long-term care services so that older individuals can continue living in the community.

    Rare and Expensive Case Management (REM)
    The Rare and Expensive Case Management (REM) Program is a case management program for recipients with specified rare and expensive conditions.

    HCBS Forms


    Help Leaving a Nursing Facility
    Community Resources
    Medical Equipment, Supplies or Transportation

    CO Advisory Council Meeting Archive

    Public comment is closed. Documents for reference only.