When home care alone isn’t enough
Some families need more than a few hours of help. A mother in Dundalk may need hands-on care, a day program while her daughter works, and maybe assisted living later. A husband leaving rehab at Johns Hopkins Bayview may need a full set of services to go home safely at all.
That is what the Community Options Waiver is for. It bundles extra services on top of regular Medicaid for adults who would otherwise qualify for a nursing facility. The catch is the registry, so it helps to know the real numbers and the routes around the wait.
What the Community Options Waiver in Maryland is
The Home and Community-Based Options Waiver started in 2003 and is run by MDH’s Office of Long Term Services and Supports. In MDH’s February 2026 table, it had FY25 enrollment of 4,477, 6,348 waiver slots and a registry of 23,750 (MDH waiver eligibility update, Feb. 23, 2026). The October 2025 waiver consolidation merged two developmental disability waivers into Community Pathways. It did not merge the CO Waiver.
MDH lists the waiver’s services as all Medicaid benefits including Community First Choice, plus assisted living, behavior consultation, case management, dietitian and nutritionist services, family training, medical day care and Senior Center Plus (MDH Community Options Waiver page).
It’s one of several programs in our guide to Medicaid home care in Maryland.
Who qualifies for the Community Options Waiver
Waiver eligibility has medical, technical and financial parts.
| Requirement | Community Options Waiver rule |
|---|---|
| Medical | Nursing facility level of care |
| Age | 18 or older |
| Where the person lives | At home or in the community |
| Other programs | Not enrolled in another waiver or in PACE at the same time |
| Cost | Community services cost no more than institutional care |
| Safety | Able to live safely in the community with the services |
| Monthly income | No more than 300% of SSI: about $2,982 in 2026 (3 × the $994 SSI rate, our calculation) |
| Countable assets | No more than $2,000 or $2,500, depending on eligibility category |
Asset transfers matter too. Maryland’s look-back rule covers the 60 months before a person is both institutionalized and has applied for Medicaid. A penalty can bar Medicaid payment for nursing facility care and 1915(c) waiver services. Talk to a benefits counselor or elder law attorney before moving money or property.
Since May 1, 2025, an applicant denied on one or more of the three criteria can file a reconsideration application within the original 6-month application period. Our Maryland Medicaid eligibility page explains the financial review in more depth.
The Community Options Waiver registry: what the numbers say
The registry is the waitlist. To get on it, call Maryland Access Point at 844-627-5465. When it’s your turn, you get an invitation to apply.
These are MDH’s own figures, each with its date, mostly from the End the Wait report (October 2025):
| Measure | Figure | Date |
|---|---|---|
| People on the registry | 25,563 | July 1, 2023 |
| People on the registry | 23,461 (down 8.2%) | June 30, 2025 |
| Registry in MDH’s waiver table | 23,750 | Table dated Feb. 23, 2026 |
| Invitations mailed | About 700 a month | Since December 2024 |
| Invitations that led to an application | 26% | FY 2025 |
| Deceased registrants found in the first Vital Statistics match | 2,457 | June 2025 |
| Plan-of-service review backlog | 11,740 down to 3,318 | August 2024 to August 2025 |
MDH’s goal is a 50% registry reduction by FY 2028. It credits the End the Wait Act of 2022 with helping raise unique waiver participants by 16%, over 6,000 people, from 2020 to 2025.
Two practical points stand out. First, only about a quarter of invitations turned into applications in FY 2025, so watch the mail and keep MAP updated if your address or phone changes. Second, MDH reports no waitlist for a Supports Planning Agency assignment once you’re applying.
Skipping the registry: the nursing facility route
There is one documented way around the wait. A nursing facility resident whose stay Medicaid has paid for at least 30 days may apply without waiting on the registry. The facility social worker can help, or refer the family to an options counselor. The Office of Long Term Services and Supports is at 410-767-1739.
In April 2025, MDH and the Maryland Department of Aging began reaching out to registrants living in nursing facilities. An initial 694 were referred to Options Counseling.
If a nursing facility resident’s income is above 300% of SSI, the CO Waiver won’t fit. Increased Community Services serves people who have lived in a nursing facility at least six months and whose income is too high for the waiver (MDH ICS page).
Community Options Waiver vs other Maryland options
For families, the real question is often which program to pursue first. All four below require a nursing facility level of care.
| CO Waiver | CFC on its own | PACE | Medical Day Care Waiver | |
|---|---|---|---|---|
| Age | 18+ | Any age | 55+ | 16+ |
| Registry | Yes (23,750 in MDH’s Feb. 2026 table) | Not described as a registry program | Ask the PACE site | None (MDH, Feb. 2026) |
| Money rules | Income up to 300% of SSI; assets $2,000 or $2,500 | Full Medicaid required | Income up to 300% of SSI; assets up to $2,000 | Full Medicaid required |
| What it adds | Assisted living, case management, medical day care, family training | Personal assistance and related supports at home | All health and long-term care from one PACE provider | Day program of at least four hours, plus a medical order |
A person can’t be in the CO Waiver and PACE at the same time. MDH lists Hopkins ElderPlus, based at Johns Hopkins Bayview, as a PACE site at (410) 550-7044 (MDH PACE page). The Medical Day Care Services Waiver starts with a level-of-care assessment through the local health department or MAP.
How to join the registry and apply from Baltimore
- Call MAP. Use the statewide line or your local office: MAP of Baltimore City at 410-396-CARE (2273), or the Baltimore County Department of Aging at 410-887-2594 in Towson. Ask to be placed on the Community Options Waiver Registry.
- Don’t wait idle. If the person has full Medicaid, ask about Community First Choice or CPAS now.
- Answer the invitation. When it arrives, start the application promptly. The medical, technical and financial reviews all happen in this stage.
- Choose a supports planner. The planner builds the plan of service with you.
- Plan review. Since June 2024, the utilization control agent Telligen has reviewed plans of service.
- Services start once the plan is approved.
For a document checklist, see how to apply for Medicaid home care. Questions about where your family stands? Call our Canton office at 410-421-1041.
Where Beulah fits
Beulah Home Care is an in-home care agency based in Canton. We serve Baltimore families who use Maryland Medicaid personal assistance programs, and our office helps families through the steps above.
We can’t get anyone off the registry, move them up the list or decide eligibility. MDH controls invitations and approvals.
What we do is the care itself: personal care, dementia home care and 24-hour home care for families across the Baltimore neighborhoods we serve and in Baltimore County. We also offer live-in care and disability home care. Some families pay privately for respite care while they wait, and the full list is on our home care services page. To talk it over, request a free consultation.
This page is general information, not legal or benefits advice. Program rules change, so confirm the details with Maryland Medicaid or Maryland Access Point before you act.