Who Qualifies for Maryland Medicaid Nursing Home Coverage?

To qualify for Maryland Medicaid nursing home coverage, a single applicant generally needs countable assets of $2,500 or less (as of February 1, 2026, per the Maryland Department of Health) and a certified need for full-time nursing care. Income, married couples, and transfers made in the prior 60 months follow separate rules.

Who qualifies for Maryland Medicaid nursing home coverage?

There are two tests, one medical and one financial. Medically, Maryland pays for nursing facility care only when a person's condition requires care under the full-time supervision of a licensed nurse, and the applicant must be certified as medically eligible. Part-time nursing visits or personal care alone do not meet that test. Financially, the applicant's countable assets must fall under a limit, and income is compared with the cost of care. Source: Maryland Department of Health, nursing facility resident information, checked October 15, 2026.

This guide covers nursing facility care for a parent who is 65 or older or disabled. If you searched for general health coverage instead, Maryland lists a separate monthly income limit of $1,835 for one adult applying through Maryland Health Connection, effective February 1, 2026, on its income and asset limits page. That is a different pathway from the nursing home rules below.

Maryland does not apply one flat income cutoff to nursing home coverage. It starts with the person's total monthly income, subtracts allowances such as the personal needs allowance, an allowance for a spouse at home, and certain health insurance and medical costs, and compares what remains with the facility's cost of care. When that available income is less than the cost of care, the person can be eligible and the program helps pay, but the resident contributes the available income toward care. When it is more, the person may still qualify through a spend-down. Source: Maryland Medicaid Manual, Section 1000. That manual page is dated 2014, so the dollar amounts above come from the 2026 schedules, and the local office can confirm current practice.

Maryland's schedules also list a separate $2,000 resource standard for one person under another coverage category (schedules updated January 1, 2026, Maryland 2026 schedules). Which standard applies depends on the applicant's coverage group, and the local Department of Social Services decides that. Being under a number does not guarantee approval, because the office also reviews documentation and past transfers.

What can a healthy spouse keep when the other spouse needs a nursing home?

Maryland follows the federal spousal impoverishment rules, which protect part of a couple's assets and income for the spouse who stays home, called the community spouse. Medicaid.gov explains the federal framework. Maryland's version works like this:

• Assets. Maryland adds up the couple's countable assets as of the start of the first continuous stay in a facility. Half of that total is the spousal share. The spouse at home may keep that share, but not less than $32,532 and not more than $162,660 (effective January 1, 2026, Maryland Schedule MA-8). Assets above the protected amount, beyond the applicant's own limit, generally must go toward care or other documented expenses before Medicaid starts to pay.
• Income. The spouse at home keeps their own income. If it falls short of a monthly maintenance and shelter standard, part of the nursing home spouse's income may be allowed to the spouse at home, up to a maximum of $4,066 a month (effective January 1, 2026, Maryland Schedule MA-8). The allowance counts only if it is actually made available to the spouse at home.
• A resource assessment. Either spouse can ask for an assessment of the couple's assets as of the start of the stay, even before applying. Maryland's manual notes that a fee may apply when it is requested before an application (Section 1000).

The limits are real. Assets above the protected amount count toward the cost of care, the protections have to be claimed and documented rather than applied automatically, and the dollar figures change each year, so check them again when you apply.

What counts toward the asset limit, and what does not?

• Usually counted: bank accounts, cash, and real estate other than the home. Maryland's manual lists these as examples of countable resources (Section 1000).
• The home: Maryland's manual lists the home among excluded resources, and the rules turn on whether the applicant intends to return home and who lives there, such as a spouse or certain relatives. Maryland also has a separate excess home equity rule that can bar payment for nursing facility care when equity is above an annually adjusted limit (COMAR 10.09.24.10-2). Confirm the current limit before assuming a house is protected.
• A car: Maryland generally excludes an automobile used for necessary transportation, while boats, recreational vehicles, and airplanes may be counted (COMAR 10.09.24.08 and Maryland Medicaid Manual, Section 800).
• Retirement accounts: this depends on the account and whether the money is accessible. Maryland's manual indicates that retirement funds a person can reach may be counted even when withdrawing them carries a cost, while funds that cannot be reached may be excluded (Section 800). Withdrawals can also have tax consequences, so ask a tax professional before drawing on an account to pay for care.
• Other items: the manual also lists certain burial funds and personal effects among excluded resources.

Treatment varies by coverage group and by facts such as who lives in the house, and Section 800 of the manual carries a 2012 revision date. Use this list as a starting point, not as a determination for your parent.

What is the 60-month look-back, and what is estate recovery?

When a person applies for nursing facility coverage, Maryland reviews transfers made for less than fair market value in the 60 months before the person both applies and is institutionalized. The review can include transfers by the applicant or the spouse (COMAR 10.09.24.08-1).

A transfer penalty does not end all Medicaid coverage. It means Medicaid will not pay for nursing facility or waiver long-term care services for a period of time. The length is based on the uncompensated value of the transfer divided by Maryland's average monthly nursing facility amount, listed at $12,501 a month (effective July 1, 2025, Maryland Schedule MA-6). As an illustration, a $25,002 gift divided by $12,501 is about two months in which the family would pay privately. The state's exact calculation, start date, and exceptions depend on the case.

This is a hypothetical example and is not representative of any specific investment. Your results may vary.

That is why giving assets to children shortly before applying can backfire, and transfers can carry tax and control consequences of their own. Our Medicaid planning page explains how timing fits into a family plan.

Estate recovery is a separate rule. Maryland seeks to recover certain Medicaid benefits paid for a person who was 55 or older from that person's estate after death. It may not do so while a spouse is living, or when the person has a surviving child under 21 or a blind or disabled child of any age (COMAR 10.09.24.15 and Medicaid.gov on estate recovery). Recovery can still reach the estate after a surviving spouse dies, and hardship waivers exist only in limited cases. If a family member with a disability is involved, ask an attorney how these protections apply.

How do I apply, and when should I bring in an elder law attorney?

1. Apply through the local Department of Social Services in the county where the applicant lives, or the county where the facility is located if the person is already in one. Maryland says applications can be made by mail or in person, with documentation of income and resources (Maryland Department of Health).
2. Get medical eligibility certified. If the person is in a hospital or a facility, the facility generally applies for the medical review. Otherwise the applicant's physician completes Maryland's medical eligibility review form.
3. Expect requests for records of income, accounts, and past transfers inside the 60-month review period.
4. Ask about timing. Maryland's manual describes a 30-day decision target for most applications, or 60 days when a disability determination is needed. That manual page is dated 2014, so ask the local office what to expect now.
5. If a spouse is at home, ask about the resource assessment before the application is filed.

Bring in a Maryland elder law attorney before moving assets, retitling a home, signing a deed, or using trusts or other legal structures. The same goes for any case where a transfer may fall inside the look-back window, a spouse is at home, or a family member with a disability is involved. The attorney drafts documents and handles the legal strategy and the application. We do not provide legal advice, and we coordinate with attorneys on the financial side, including what care costs in Maryland. Attorney fees are an added cost, and no one can promise that an application will be approved.

Documents such as powers of attorney work best when they are in place while capacity is clear. Our article on the cognitive decline conversation covers how families approach it.

What questions should I ask before applying or hiring help?

Ask these of the local office, an elder law attorney, and any advisor you consider, including us.

1. What is the applicant's countable asset total today, and which assets are excluded?
2. Did the applicant or a spouse make any gifts or transfers in the last 60 months, and what records show them?
3. Does a spouse live at home, and have we requested a resource assessment?
4. What is the current excess home equity limit, and how does it apply to the house?
5. Which accounts can the applicant reach, and what are the tax consequences of using them to pay for care?
6. What would estate recovery mean for the home, and does an exception apply?
7. What does the facility charge each month, and how long can private funds cover it before Medicaid begins?
8. How is each professional paid, and does anyone earn a commission if I buy something?
9. What happens if the application is denied, and what is the appeal process?

How we are paid: our planning engagement is $500 one time, as published on our pricing page and checked October 15, 2026. If your plan calls for insurance and you buy it through us, we are paid a commission, and we disclose the amount in dollars and percentages, in writing, before you decide. A commission gives us a financial interest in that purchase, which is why we put it in writing first. Our retirement planning page shows the rest of what we cover.

Maryland Financial Advocates and LPL Financial do not provide legal advice or tax services. Please consult your legal advisor or tax advisor regarding your specific situation.

This material is for general information and educational purposes only and is not intended to provide specific advice or recommendations for any individual. Investing involves risk including the loss of principal.