Maryland's Community Pathways Medicaid Waiver

What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers and Waiver Funded Services, allow qualifying program participants to receive services out of the nursing homes. Medicaid’s standard benefit is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of the care outside of a nursing home needs to be less than the cost of care in a nursing home.

Waiver Description

The Maryland Community Pathways Waiver provides disabled Maryland residents with home and community based services to enable them to continue residing in their homes.

This waiver combines the Independence Plus and the New Directions waivers. Because the New Directions waiver was focused on supporting developmentally disabled persons, much of the waiver language is targeted towards that audience. However, the Community Pathways Waiver is open to those suffering from a physical disability related to aging, provided the cause is not due to mental disease. This waiver serves elderly individuals with limited physical abilities, but not with neurological disabilities like Alzheimer's Disease or other forms of dementia.

Services are funded by the Maryland’s Developmental Disabilities Administration (DDA), under the Department of Health and Mental Hygiene. Services are delivered via both licensed providers and in a self-directed model. Self-direction means program participants can elect who provides their care services. As such, certain family members can be retained to provide some care services.

 

Eligibility Guidelines

To be eligible for services under the Community Pathways Waiver, candidates must:

  • Be a Maryland resident.
  • Have a chronic, physical disability, but not be physically disabled as a result of a mental disability.
  • Meet the Medicaid waiver's income and asset requirements. In 2017, single applicants are permitted annual income of less than $26,460 ($2,205 a month). Applicants are permitted $2,500 in countable assets. Countable assets do not include the value of one's home or vehicle.

Note that persons who exceed these limits may still qualify through "spending down" their income and assets on their care and qualifying through what’s known as the “medically needy” pathway. A benefits adviser or an elder law attorney knowledgeable about Maryland Medicaid rules can provide guidance and strategies on the best ways of meeting the requirements. Learn more.

This program does not have age requirements. Participants’ eligibility must be reevaluated annually.

Benefits and Services

Among the many benefits, the waiver provides support for caregiving in the home, live-in caregiver rent, accessibility adaptations (up to $17,500 including vehicle modifications), and various types of housing arrangements and family/individual support. Participants are empowered to select and self-direct their own service providers.  A list of other common services follows.  Note that not every applicant is eligible for all of these services. 

  • Adult day health services
  • Case management
  • Day and residential rehabilitation 
  • Home health aide
  • Homemaker assistance
  • Home modifications
  • Personal care
  • Respite care

 

How to Apply / Learn More

One can learn more about this waiver on the Community Pathways webpage.

To apply, one should contact their Maryland Department of Health Area Agency on Aging.  Look up the Area Agency on Aging for your region of the state using this search tool