Maryland · waiver service
Community Options Waiver (Home and Community-Based Options Waiver) in Maryland
The Community Options Waiver helps adults 18 and older who need nursing facility level of care live at home or in assisted living. It lets people with income up to 300% of the SSI benefit qualify for Medicaid, and members get all Medicaid benefits, including Community First Choice personal assistance, where a family member can be the paid worker. There is a long registry to get in.
Also called: Community Options Waiver · HCBOW · Home and Community-Based Options Waiver · Maryland Medicaid waiver for seniors · Community Options Registry
Who do you care for?
Quick facts
- Pay
- Via CFC: $16–$20/hr reported; agency rate $25.58/hr (FY2025)
- Adult children & other relatives
- Yes
- Spouse
- Sometimes
- Parent of a minor child
- Not right now
- Waitlist
- long
Who qualifies for Community Options Waiver (Home and Community-Based Options Waiver)
- Age 18 or older and living at home or in the community.
- Needs nursing facility level of care.
- Monthly income no more than 300% of the SSI benefit; countable assets no more than $2,000 or $2,500 depending on category.
- Not enrolled in another waiver or PACE at the same time, and community services cost no more than institutional care.
Who can be paid as the caregiver
- Adult children & other relatives Yes
- paid in-home help comes through Community First Choice personal assistance, where relatives such as adult children can be hired.
- Spouse Sometimes
- follows the CFC rules; reported allowed, but older state guidance barred spouses, so confirm.
- Parent of a minor child Not right now
- the waiver serves adults 18 and older.
- Living together
- the worker can live with the participant or not.
Who employs the caregiver: Either, for personal assistance through CFC: agency model or self-directed model with a fiscal intermediary.
Spouse rules differ by program — see spouse pay in Maryland.
How much Community Options Waiver (Home and Community-Based Options Waiver) pays
Via CFC: $16–$20/hr reported; agency rate $25.58/hr (FY2025). Personal assistance for waiver members is paid through Community First Choice at $6.3962 per 15-minute unit ($25.58/hour) as of July 1, 2024. Waiver-specific services such as case management and assisted living are paid separately. Family-caregiver wages are not published by the state.
Hours and budget: A plan of service based on the interRAI assessment; total community service cost must not exceed the cost of institutional care.
Compare with other Maryland programs on the Maryland caregiver pay page, or across states in pay rates by state.
Is there a waitlist?
There is a waitlist. You call Maryland Access Point to join the Community Options Waiver Registry and are invited to apply when it is your turn; states.json reports about 20,616 people on it in early 2026 with about 700 invited per month. People in a nursing facility for at least 30 days paid by Medicaid can apply with no wait.
How to apply for Community Options Waiver (Home and Community-Based Options Waiver)
- Call Maryland Access Point at 844-627-5465 to put your name on the Community Options Waiver Registry.
- Wait for an invitation to apply (or, if you have been in a nursing facility on Medicaid for 30+ days, ask the facility social worker to help you apply now).
- Complete the Medicaid long-term care application and the level-of-care assessment; you may ask for an options counselor.
- With your case manager, set up CFC personal assistance and name the relative you want to hire.
- Maryland Access Point (registry) · 844-627-5465 · official site
- Office of Long Term Services and Supports · 410-767-1739 · official site
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Community Options Waiver (Home and Community-Based Options Waiver) questions
How long is the Community Options Waiver waiting list?
Long. Reports put it around 20,000 people in early 2026, with several hundred invited each month. Nursing home residents on Medicaid for 30 days or more can skip the wait.
Why join the waiver if CFC has no waitlist?
The waiver lets people with income up to 300% of SSI qualify for Medicaid and adds services like assisted living, medical day care and case management.
Can my daughter be my paid caregiver on the waiver?
Yes. Paid personal assistance comes through Community First Choice, which lets you hire relatives such as adult children.
What if my income is too high?
The state says you may qualify for the Increased Community Services Program instead.
Which rule governs this waiver?
COMAR chapter 10.09.54.
Sources: health.maryland.gov · health.maryland.gov · health.maryland.gov · medicaidplanningassistance.org · Updated 2026-10-08. Program rules change — always confirm with the program.
Where most Maryland caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in Maryland — pick yours for the local picture.
Across the line
States that border Maryland
Each state writes its own rules, and they differ more than people expect — a spouse who can be paid on one side of the line often cannot be on the other.