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Maryland home care payment guide
Last updated: 13 September 2026
Maryland has several ways to reduce the cost of care at home. The right route depends on whether you need medical home health, ongoing personal care, caregiver relief, or higher-level long-term support.
For most families, the best first call is Maryland Access Point at 1-844-627-5465. Ask for a long-term services and supports screening. MAP can sort through Medicaid, state aging programs, and local services. You can also use our Maryland aging offices guide.
Bottom Line
Do not assume Medicare will pay for ongoing nonmedical home care. In Maryland, the main public payment paths are Medicaid personal-care programs, the Community Options Waiver, the new state-funded SOAR program, In-Home Aides Services through local social services, PACE in limited service areas, and VA benefits for eligible Veterans. Start with Maryland Access Point if you are not sure which door fits.
Urgent Help
If someone is in immediate danger, call 911. If an older or vulnerable adult may be abused, neglected, self-neglecting, or financially exploited, call Maryland Adult Protective Services at 1-800-917-7383. The Maryland APS page also explains how to report concerns.
If a caregiver cannot safely cover basic needs today, tell MAP or the local Department of Social Services the situation is urgent. Ask about respite, adult services, and a safety plan.
Start Here
- Call MAP at 1-844-627-5465. Ask for screening for home- and community-based services, including Medicaid options and SOAR.
- Write down the help needed each day. Include bathing, dressing, toileting, transfers, eating, meal preparation, medication reminders, supervision, laundry, shopping, and nighttime needs.
- Do not hire first and ask later. Public programs usually require an assessment, approved plan, and approved worker or agency before they will pay.
| Situation | Best first route | What it may cover | Main limit |
|---|---|---|---|
| Skilled nursing or therapy after illness | Medicare home health | Part-time skilled nursing, therapy, and limited aide care | Not general 24-hour custodial care |
| Medicaid recipient needs daily personal care | CFC or CPAS | Personal assistance and related supports | Medical and Medicaid rules apply |
| Nursing-facility level needs at home | Community Options Waiver | Medicaid plus added long-term supports | Community registry has a waitlist |
| Age 62+, limited means, not served by Medicaid | SOAR | Personal care, chores, respite, meals, safety supports | Funding is limited and eligibility applies |
| Adult with disability needs an aide | DHS In-Home Aides | Personal care and household help | Funding and ranking affect service |
| Veteran needs help at home | VA social worker | Home health aide, skilled care, respite, self-directed care | Clinical need and local availability |
Home Care and Home Health Are Not the Same
Home care usually means help with daily life: bathing, dressing, toileting, meals, shopping, supervision, and light housekeeping. This is often called personal care, attendant care, or custodial care. Home health usually means medical services such as nursing, wound care, physical therapy, or occupational therapy.
Medicare may cover qualifying medical home health, but usually not ongoing personal care by itself. Our home care basics guide explains common service levels.
Maryland Medicaid Is the Main Long-Term Home Care Route
Maryland Medicaid has several home- and community-based programs. They are not interchangeable. A person may fit one route but not another. Call MAP at 1-844-627-5465 or the Office of Long Term Services and Supports at 410-767-1739 before assuming you need a waiver.
Community First Choice
What it helps with: Maryland’s Community First Choice program can provide personal assistance, nurse monitoring, home-delivered meals, assistive technology, accessibility adaptations, personal emergency response systems, and supports planning.
Who may qualify: The state says there is no age limit. You must live in the community, already have full Medicaid, and meet an institutional level-of-care test.
How to start: Call MAP or 410-767-1739. An assessment and person-centered plan are part of the process.
Reality check: Having Medicaid alone does not guarantee personal-care hours. The amount and type of service come from your assessed needs and approved plan.
Community Personal Assistance Services
What it helps with: Community Personal Assistance Services can provide personal assistance, nurse monitoring, and supports planning.
Who may qualify: There is no age limit. You must live in a community setting, have full Medicaid, and need help with at least one activity of daily living.
How to start: Call MAP or 410-767-1739 and ask whether CPAS or Community First Choice better matches the person’s needs.
Reality check: CPAS uses a different medical rule from Community First Choice. CPAS requires help with at least one daily activity; Community First Choice requires institutional level of care.
Community Options Waiver
What it helps with: The Community Options Waiver adds long-term supports such as case management, medical day care, nutrition services, family training, and Senior Center Plus. Participants also receive Medicaid benefits.
Who may qualify: Applicants must be 18 or older, need nursing-facility level of care, meet financial rules, and meet the waiver’s community-safety, cost, and technical rules.
Waitlist status: As of 13 September 2026, Maryland’s program page says there is a waitlist. People in the community should call MAP to join the registry. The state also says a person in a nursing facility whose Medicaid has paid for services for at least 30 days may apply without waiting on the registry.
Income too high? Ask about Increased Community Services. Maryland says it may help some people denied the waiver for excess income. You cannot apply directly; a Medicaid eligibility unit must refer you, and other nursing-facility and technical rules apply.
Need help with a Medicaid application itself? Maryland’s Benefits portal handles health and other benefit applications. For long-term-care screening, MAP is still the better first call.
SOAR Is a Major New Maryland Option in 2026
In 2026, Maryland consolidated Senior Care, Senior Assisted Living Subsidy, and Congregate Housing Services into Supporting Older Adults with Resources (SOAR). Older material may still use the former program names.
The SOAR program page lists case management, personal care, homemaker or chore help, meals, transportation, minor safety modifications, adult day care, supplies, emergency response systems, respite, and partial assisted-living support. State funding is subject to annual availability.
| Program | Key rule | 2026 financial point | First contact |
|---|---|---|---|
| SOAR | Age 62+ and needs help with daily activities | Net-income test: $4,358/month one person; $4,983/month couple. Asset test: $20,064 one person; $26,400 couple. | MAP or local AAA |
| Community First Choice | Full Medicaid plus institutional level of care | Uses Medicaid eligibility; do not apply a simple SOAR limit | MAP or 410-767-1739 |
| CPAS | Full Medicaid plus help with at least one daily activity | Uses Medicaid eligibility | MAP or 410-767-1739 |
| Community Options Waiver | Nursing-facility level of care; age 18+ | Income may not exceed 300% of SSI; assets may not exceed $2,000 or $2,500, depending on category | MAP registry |
The Maryland Department of Aging’s 2026 eligibility chart, effective 1 July 2026 for SOAR, lists the figures above. Do not use old Senior Care limits. If you are married or near a Medicaid financial limit, ask for an eligibility review; spouse protections can change how Medicaid counts income and resources.
If SOAR sounds like a fit, call MAP or your local Area Agency on Aging. Our Maryland senior benefits guide can help you check other assistance at the same time.
Other Maryland Programs Can Fill Gaps
In-Home Aides Services through DHS
Maryland’s In-Home Aides Services can help adults 18 and older with functional disabilities who need personal care, chores, or other daily-living help. Priority goes to people with greater risk or need.
Apply through the local Department of Social Services; a home visit is part of the process. Funding limits service, and some participants may pay part of the hourly cost based on income and family size. DHS: 1-800-332-6347.
Attendant Care for some adults under 65
For a Marylander age 60–64 with a severe physical disability, the Attendant Care Program may reimburse attendant services. Extra work, education, nursing-facility transition, or nursing-home-risk rules apply. The 2026 state eligibility chart lists gross income under $119,999 a year and no asset test. Applicants first join the OneStop registry; a full application is offered as waiting-list space becomes available.
Family caregiver and respite support
Maryland’s caregiver support program serves adult family members or other informal caregivers age 18 and older who care for someone age 60 or older, as well as caregivers of people of any age with Alzheimer’s disease or a related disorder. Local programs may offer information, counseling, training, respite connections, and other support.
This is not the same as a guaranteed caregiver paycheck. If your goal is to see whether a spouse, adult child, or other relative can be paid, use our Maryland caregiver pay guide and ask the actual program whether the family relationship is allowed before care starts.
What Medicare May Pay for at Home
Medicare home health can cover part-time or intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and limited home health aide care when you meet its rules. A provider must order the care, you must be homebound, and a Medicare-certified home health agency must provide the service.
Medicare home health is not a general long-term custodial-care benefit. Home health aide care is covered only when you are also receiving qualifying skilled services. For ongoing bathing, dressing, meals, supervision, or housekeeping, look at other payment routes.
If a plan or agency tells you Medicare will not cover something and you are unsure, Maryland’s SHIP counselors provide free, unbiased Medicare help. Our Maryland Medicare Savings guide may also help lower other Medicare costs, freeing money for care at home.
PACE Can Combine Medical and Long-Term Care
The Program of All-Inclusive Care for the Elderly (PACE) combines medical and social services for some people living in the community. Maryland’s PACE page says participants must be at least 55, need nursing-facility level of care, meet its financial rules, and agree to receive health and long-term-care services through the PACE provider.
Maryland currently lists four PACE organizations: Hopkins ElderPlus, Senior CommUnity Care of Maryland, Trinity Health PACE Montgomery County, and West Baltimore PACE Community Coalition. Ask whether your address is in the service area.
Veterans May Have Extra Home Care Paths
For enrolled Veterans, VA home- and community-based services can sometimes reduce private-pay hours. VA homemaker care can help with daily activities such as bathing, dressing, grooming, eating, transfers, and shopping when clinical and community-care rules are met. Services vary by location, and a copay may apply for some Veterans.
Veteran-Directed Care gives eligible Veterans a budget and more control over hiring workers. VA says the worker may include a family member or neighbor. Ask the Veteran’s VA social worker whether the program is available locally.
Some Veterans or surviving spouses may also qualify for VA Pension with Aid and Attendance, which can increase pension income when care needs and other rules are met. Do not assume every Veteran qualifies. The current VA pension rates and eligibility rules should be checked before building a care budget. For Maryland-specific help, see our Maryland veteran benefits guide.
Long-Term Care Insurance and Private Pay
Families may combine public help with long-term care insurance, income, savings, or family support. For insurance, ask about the home-care benefit trigger, elimination period, payment maximum, lifetime pool, and family-caregiver rules.
When paying privately, check the provider type. Maryland licenses Residential Service Agencies that provide paid home health or personal-care services. Separate home health agencies provide skilled nursing and therapy.
| Question | Why it matters | What to get in writing |
|---|---|---|
| Is the agency properly licensed? | Maryland regulates agencies that provide these services for pay. | Legal business name and license information |
| What is the minimum shift? | A low hourly rate can still cost more if four-hour minimums apply. | Hourly rate, minimum hours, weekend and holiday rates |
| What happens if the aide calls out? | Backup coverage can be critical for transfers, toileting, or dementia care. | Replacement and cancellation policy |
| Who handles payroll and insurance? | Hiring a worker directly can make the household an employer. | Worker status, insurance, tax and payroll responsibilities |
If you are comparing an agency with hiring a caregiver directly, see our agency vs. caregiver guide. If care needs are becoming too high for home, compare the real cost with our Maryland assisted living guide rather than waiting for a crisis.
How to Start Without Wasting Time
- Make a seven-day care log. Record each task, how long it takes, nighttime help, and supervision.
- Call MAP. List current coverage and ask which programs should screen the person now.
- Apply for full Medicaid if needed. Use Maryland Benefits or ask MAP/DSS for help. Do not assume Medicare and Medicaid are the same.
- Ask about more than one route. A person waiting for a waiver may still fit SOAR, IHAS, caregiver respite, PACE, or private home care.
- Keep every notice. Save assessments, service plans, denial letters, registry letters, and contact names.
Document checklist
- Photo ID and Maryland address.
- Medicare and Medicaid cards, if any.
- Social Security and pension income records.
- Recent bank and other asset statements when a program has financial rules.
- Health insurance and long-term care insurance information.
- Medication list and names of doctors.
- Hospital discharge papers or recent medical notes.
- Care log showing help needed with activities of daily living.
- Power of attorney or authorized-representative papers, if another person is handling the application.
Reality Checks
- Waiver does not mean immediate service. The Community Options Waiver has a registry waitlist for people applying from the community.
- SOAR is not unlimited home care. It is state-funded, provides limited supports, and is subject to annual funding availability.
- IHAS can be limited by funding. Local social services uses a ranking process, and some people may pay a share of cost.
- Medicare is narrower than many families expect. It is mainly a skilled home health benefit, not a long-term personal-care benefit.
- Provider availability matters. Approval for hours does not always mean an aide can start immediately in every county.
Common Mistakes to Avoid
- Using old “Senior Care” income limits instead of the 2026 SOAR rules.
- Waiting for a hospital crisis before calling MAP.
- Assuming a waiver is the only Medicaid home-care route.
- Hiring a relative first and expecting a public program to reimburse past care.
- Assuming an agency is Medicare-certified or Medicaid-approved because it uses the words “home health.”
- Ignoring caregiver burnout while waiting for a long-term program.
Denied, Delayed, or Overwhelmed
If a program denies services, ask for the decision in writing. Follow the notice’s appeal or fair-hearing instructions and deadline. If proof is missing, ask exactly what document is needed.
While waiting for the Community Options Waiver, ask MAP whether SOAR, Community First Choice, CPAS, IHAS, caregiver respite, PACE, or another service can cover part of the need.
If the current home arrangement is no longer safe, compare home care with another setting instead of adding hours without a plan. Our home care vs. assisted living guide can help frame that decision. Seniors with disability-related needs may also find useful next steps in our Maryland disability help guide.
Maryland Official Resources
- Area Agencies on Aging: local aging services for Maryland’s counties and Baltimore City.
- Maryland Access Point: long-term care screening, options counseling, and referrals.
- Maryland Medicaid LTSS: official long-term services and supports program information.
- DHS Adult Services: in-home aides, respite, case management, and protective services.
Phone Scripts for the Most Important Calls
Maryland Access Point
“An older adult needs help with [bathing/dressing/transfers/meals/supervision]. They [do/do not] have Medicaid. Please screen us for Community First Choice, CPAS, the Community Options Waiver, SOAR, and local services.”
Local Department of Social Services
“I want to ask about In-Home Aides Services. Is this county accepting referrals, is there a waiting list or ranking process, and what financial information should we prepare?”
Maryland SHIP
“We need [nursing/therapy/aide care]. Can you explain whether Medicare home health may cover it and what to do if the service is denied or ends?”
VA social worker
“The Veteran needs help at home. Is Homemaker/Home Health Aide, Veteran-Directed Care, respite, or skilled home health available here, and what assessment or copay rules apply?”
Resumen en español
En Maryland, Medicare puede pagar cuidado médico en el hogar si se cumplen sus reglas, pero normalmente no paga cuidado personal continuo por sí solo. Para ayuda diaria, llame a Maryland Access Point al 1-844-627-5465.
Pregunte por Community First Choice, Community Personal Assistance Services, Community Options Waiver y SOAR. En 2026, SOAR reemplazó programas estatales anteriores, incluido Senior Care. Tiene reglas de edad, ingresos, bienes y necesidad funcional.
Un consejero SHIP puede explicar Medicare. Para un veterano, pregunte al trabajador social de VA sobre cuidado en el hogar. Guarde las cartas de decisión y pregunte por apelaciones si hay una demora.
Frequently Asked Questions
Does Medicare pay for home care in Maryland?
Medicare may pay for medically necessary, part-time or intermittent home health when you are homebound and need skilled care. It generally does not pay for ongoing custodial help when that is the only care you need.
Does Maryland Medicaid pay for help with bathing and dressing at home?
It can. Community First Choice and Community Personal Assistance Services can cover personal assistance for eligible Medicaid participants. They use different medical rules. Call Maryland Access Point at 1-844-627-5465 for screening.
Is the Maryland Community Options Waiver open in 2026?
Maryland Medicaid says the Community Options Waiver has a waitlist. People in the community can call Maryland Access Point to join the registry. A nursing-facility resident whose Medicaid has paid for services for at least 30 days may apply without the registry wait.
What is SOAR in Maryland?
Supporting Older Adults with Resources, or SOAR, is a Maryland state-funded program for certain adults age 62 and older who need daily-living help and meet financial rules. It may fund personal care and other community supports, subject to available funding.
Can a family member be paid to provide home care in Maryland?
Sometimes. Some self-directed Medicaid or VA options may let participants choose workers, but family-caregiver rules vary. Ask the program or supports planner what is allowed before care begins; do not assume past care will be reimbursed.
What if my income is too high for the Community Options Waiver?
Ask about Increased Community Services. Maryland says it may help after a Community Options Waiver denial for excess income, but other eligibility rules apply. You cannot apply directly; a Medicaid eligibility unit must refer you.
Can veterans in Maryland get home care through VA?
Possibly. VA Homemaker/Home Health Aide and Veteran-Directed Care can help some enrolled Veterans who meet clinical and community-care rules. Ask the VA social worker what is available locally and whether a copay applies.
About This Guide
Sources
This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 13 September 2026 · Next review: 13 December 2026
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