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 Medicaid Waiver provides developmentally and intellectually disabled Maryland residents with home and community based services to enable them to continue residing in their homes.

This waiver is strictly for individuals who are developmentally or intellectually disabled, and is unfortunately not available to those who are physically disabled. Therefore, it does not serve seniors suffering from a physical disability related to aging. However, there is a Medicaid waiver program suitable for individuals who are physically disabled, as well as those seniors who need a nursing home level of care due to the process of aging: Community Options.

Services via Community Pathways are funded by Maryland’s Developmental Disabilities Administration (DDA) under the Department of Health and Mental Hygiene. Services can be delivered via licensed providers or one may choose 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. However, spouses cannot be paid to provide services.

 

Eligibility Guidelines

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

  • Be a Maryland resident.
  • Have a developmental disability OR intellectual disability.
  • Meet the Medicaid waiver's income and asset requirements. In 2018, single applicants are permitted annual income of less than $27,000 ($2,250 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 income limits may still qualify through "spending down" their income on their care / medical expenses and qualifying through what’s known as the “medically needy” pathway.

Unfortunately, this pathway to Medicaid eligibility does not help one spend down extra assets. However, one can spend extra assets on assets that are not counted towards eligibility. For instance, one may add a first floor bedroom or make other home modifications that allow one to age in place.

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 income and asset requirements. Learn more.

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

 

Benefits and Services

Among the many benefits, this waiver provides support for caregiving in the home, live-in caregiver rent, accessibility adaptations (up to $15,000 in a three year period, 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
  • Habilitation and residential rehabilitation 
  • Live-in caregiver supports
  • Assistive technology – voice activated lights, weighted utensils, video magnifiers, etc. 
  • Behavioral support services
  • Family / Peer mentoring
  • Family caregiver training
  • Individual / Family directed goods / services
  • Nurse consultation
  • Home health aide
  • Homemaker assistance
  • Home modifications
  • Personal care
  • Respite care
  • Non-medical transportation

 

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