Medicaid & Assisted Living in Maryland: Yes

Updated September 3, 2026. Quick answer: yes, through Home and Community-Based Options Waiver (HCBOW), also known as the Community Options (CO) Waiver. Medicaid does not pay the facility’s room and board either way; only the care and service component.

What Maryland covers

Waiver / state plan option	Home and Community-Based Options Waiver (HCBOW), also known as the Community Options (CO) Waiver
Covers an assisted living setting?	Yes: a structured, supportive environment in a home-like setting including personal care/ADL assistance, housekeeping, meal preparation, medication-administration assistance, and 24-hour supervision
Room and board	Never covered by Medicaid, in Maryland or any state; see below.

The room-and-board split

Federal law is the floor every state builds on: “The Secretary may by waiver provide that a State plan approved under this subchapter may include as “medical assistance” under such plan payment for part or all of the cost of home or community-based services (other than room and board) approved by the Secretary” (42 U.S.C. §1396n(c)(1), Social Security Act §1915(c)). The words in parentheses do the work: whatever a state’s waiver pays for inside an assisted living community, it is not the rent, the meals, or the room itself. That portion stays the resident’s own to fund, out of income, savings, or a family contribution; the waiver only ever reaches the care and service layer on top of it. Maryland’s own materials say the same thing directly: “Assisted living services reimbursed under this chapter may not include room and board.” (COMAR 10.09.54.13).

The waitlist

Waitlisted: 23,730 individuals on the CO waiver registry as of FY2022 : There is a waitlist for this waiver. Call Maryland Access Point at 844-627-5465 to get your name on the Community Options Waiver Registry. As of FY 2022, there were 23,730 individuals on the CO waiver registry. (as of FY2022 (reported February 1, 2023))

What you get to keep: the personal needs allowance

Not published in the materials reviewed this session. This is the amount of a waiver participant’s own income the state lets them keep for personal spending after the rest goes toward the cost of their care; it varies by state because each state sets its own figure inside the federal floor.

Paying for care is the harder half

What a waiver covers is only part of the problem, because room and board still has to come from somewhere, and an adviser can look at income, savings and the likely timeline together before a placement decision is made.

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What this doesn’t answer

Maryland is one of the few states whose own regulation states the room-and-board exclusion explicitly (COMAR 10.09.54.13). The waitlist figure of 23,730 is the most recent primary-source dated figure found (FY2022, reported Feb. 2023); no more current registry count was located in a primary MDH document this session. The general institutional personal needs allowance (COMAR 10.09.24.10D(2)(c)) applies to nursing-facility eligibility and its current adjusted dollar figure was not extractable from the regulation text obtained; no COMAR section specific to HCBOW/assisted-living participants’ PNA was located, so no dollar figure is reported.

Sources

Read September 3, 2026.

Same question, other states: Iowa · Kansas.

General information drawn from each state’s own Medicaid agency and federal statute, not legal, tax or financial advice. Medicaid is administered state by state; waiver names, coverage decisions, waitlists and allowance amounts change by state budget and legislative action. This page cannot see your own state’s current caseload. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.

Related: Maryland’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.

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