Community Options Waiver caregiver reading with a senior at home

Maryland Community Options Waiver (HCBOW) 2026

The Community Options Waiver (HCBOW) covers services CFC doesn't — assisted living support, adult day care, home modifications, and respite care. The tradeoff: 24,015 people are on the statewide waitlist as of early 2025, with typical waits of several years. We help you apply for CFC immediately and add your name to the Community Options registry at the same time. Call (667) 400-0648.

Call (667) 400-0648Apply for CFC now and skip the waitlist
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Are you currently on Medicaid?

How to Apply

The process differs if you are in the community vs. a nursing home.

  1. In the Community

    You must join the Service Registry (waitlist). Call Maryland Access Point (MAP) at (667) 400-0648 to add your name.

  2. In a Nursing Home

    Nursing home residents are prioritized and can apply without waiting on the registry. Contact Long Term Care services at (667) 400-0648.

  3. Approval

    The application process can take 3+ months. You must submit documentation including bank statements (60-month look-back period) and proof of income.

Eligibility Criteria

To qualify for the Community Options Waiver, applicants must meet the following strict criteria.

Medical & Demographic

  • Age/Disability: Must be elderly (65+) OR physically disabled (18+).

  • Level of Care: Must require a Nursing Facility Level of Care (NFLOC) as determined by the interRAI Home Care assessment.

  • Functional Need: Requires assistance with Activities of Daily Living (ADLs) such as bathing, grooming, and mobility.

Financial Limits

  • Income Limit: $2,982/month per applicant (300% of the 2026 Federal Benefit Rate of $994). Significantly higher than standard CFC — many families who don't qualify for CFC may qualify here. health.maryland.gov/mmcp/eligibility/Pages/incomelimits.aspx

  • Asset Limit: $2,000 for an individual applicant.

  • Spousal Rules: Non-applicant spouses can keep up to $157,920 in assets and may receive a Monthly Maintenance Needs Allowance up to $3,948.

Over the limits?
Strategies like "Medically Needy Spend-Down," Irrevocable Funeral Trusts, or Spousal Impoverishment rules may help you qualify. Consult a Medicaid Planner.

Services Covered

Services can be received in a home or assisted living setting.

Assisted Living Services

Personal care and homemaker services in an assisted living facility. (Note: Room & board costs are NOT covered).

Adult Day Health Care

Daytime supervision, nursing services, and socialization in a community group setting.

Respite Care

Short-term care to provide relief for a primary unpaid caregiver.

Senior Center Plus

A structured program providing supervision and activities (no medical services provided).

Behavior Consultation

Assistance for caregivers in understanding and managing behavioral issues.

Family Training

Counseling and training services for unpaid family caregivers.

Nutritionist Services

Dietician services to support health needs.

Case Management

Professional coordination of your care plan and services.

What is the Community Options Waiver?

The Community Options Waiver was formerly known as the Waiver for Older Adults.

The Community Options Waiver provides services to prevent or delay nursing home admission. It allows elderly and disabled individuals to receive care in their own home, a relative's home, or an assisted living residence. Unlike other programs, this waiver's services are provided by licensed agencies and currently do not offer a self-directed option for hiring friends or relatives.

CFC vs Community Options Waiver

FeatureCFCCommunity Options Waiver
WaitlistNone24,000+ statewide
Income limit$350/month *$2,982/month
Covers home modificationsNoYes
Covers assisted livingNoYes
Covers adult day careNoYes
Family member as paid caregiverYes (self-direction)Limited

* CFC spend-down pathway applies — most Social Security incomes still qualify.

Important: Waitlist Information

This is not an entitlement program. Meeting eligibility requirements does not guarantee immediate benefits. As of January 31, 2025, there are 24,015 persons on the Service Registry (waitlist).

What if I disagree with a decision?

If your plan of service is denied, or if you disagree with any decision about your case made by Medicaid, you have a right to appeal.

Current Recipients

Appeal within 10 days of receiving the denial letter to keep current services in place.

New Applicants

Appeal within 90 days of receiving the denial letter.

Submit appeals in writing to
Maryland Department of HealthAttention: Medicaid Appeals
201 West Preston St., L9
Baltimore, MD 21201
Fax:(410) 333-5154
Email:mdh.medicaidappeals@maryland.gov

You can also request a fair hearing online through the Maryland Medicaid appeals portal. Always follow the instructions on your denial notice if they differ.

What Maryland families say about Community Options care

Real stories from patients and caregivers who enrolled through Cottage Home Care Maryland

FAQ

The Community Options Waiver is a Maryland Medicaid home and community-based waiver that helps eligible individuals receive services at home or in the community to avoid or delay nursing facility placement.

Yes. Applicants in the community must join the Maryland Service Registry waitlist through Maryland Access Point (MAP). Nursing home residents may be prioritized and can apply without waiting on the registry.

Applicants must meet Maryland Medicaid financial and medical eligibility, require a nursing facility level of care, and meet program-specific criteria reviewed during the application process.

Covered services can include personal care, adult day health care, respite care, assisted living services (excluding room and board), environmental modifications, and other supports defined in an approved plan of care.

Call (667) 400-0648. If you are in the community, MAP will add you to the Service Registry. Nursing home residents can contact Long Term Care services. Cottage Home Care Maryland guides families through eligibility and provider enrollment.

CFC is an entitlement program with no waitlist focused on personal care at home. The Community Options Waiver offers a broader benefit package but has a waitlist and different eligibility pathways.

Ready to Discuss Your Options?

We can help you determine the best care payment path for your needs.

Call (667) 400-0648
Statewide in Maryland

Counties We Serve

Community First Choice, Community Options Waiver, and Private Pay home care — available in every county below. Select yours to see programs and how we help local families.

24

Counties

Click any to learn more

Not sure which program fits your family? Our advisors serve all 24 counties at no cost.

Call (667) 400-0648