Maryland offers several programs to help older adults and people with disabilities receive the care they need in their homes and communities, rather than in nursing facilities. These home and community-based services (HCBS) promote independence, dignity, and choice while ensuring that individuals have access to the supports necessary for daily living.
Long-term care needs can often be met outside of nursing facilities. Maryland’s HCBS programs make it possible for people to:
- Stay connected to family and community life.
- Maintain independence in familiar surroundings.
- Access services tailored to individual needs and preferences.
This article provides an overview of Maryland’s HCBS programs. Each program is designed for different circumstances. Some focus on individuals living at home who need ongoing personal assistance, while others support people transitioning out of nursing facilities. The following chart provides a list of services by program:
| CPAS | CFC | CO Waiver/ICS | |
|---|---|---|---|
| Personal Assistance Services | X | X | X ** |
| Case Management/Supports Planning | X | X | X ** |
| Nurse Monitoring | X | X | X ** |
| Home-Delivered Meals | X | X ** | |
| Environmental Assessments | X | X ** | |
| Accessibility Adaptations | X | X ** | |
| Assistive Technology | X | X ** | |
| Personal Emergency Response Systems | X | X ** | |
| Consumer Training | X | X ** | |
| Transition Services | X | X ** | |
| Respite | X | ||
| Nutritionist/Dietitian | X | ||
| Family Training | X | ||
| Assisted Living | X | ||
| Medical Day Care * | X | ||
| Behavioral Consultation * | X | ||
| Senior Center Plus * | X |
*These services are allowable in an Assisted Living Facility. All other services are not.
**CO Waiver and ICS participants access CFC services by virtue of enrollment in those waivers.
- From the Plan of Service Reviewer Training Manual.
While the services of the programs may overlap, the eligibility requirements and application processes differ. For more information on eligibility, services, and how to apply, visit the Maryland Department of Health’s Home and Community-Based Services (HCBS) and Community Support Services pages.
Home and Community-Based Options Waiver (HCBOW)
The HCBOW provides a wide range of long-term services and supports to older adults and individuals with disabilities who need the level of care provided in a nursing facility but wish to remain in the community. The HCBOW was created by combining the former Living at Home Waiver and the Waiver for Older Adults.
- Eligibility: Nursing facility level of care, Medicaid financial eligibility, Maryland resident, 18 years or older.
- Services: Assisted living, behavioral consultation, case management, nutritionist and dietician, family training, medical day care, Senior Center Plus. (see the Code of Maryland Regulations for detailed services.)
- Learn more: Home and Community-Based Options Waiver – Maryland Department of Health
Read the Law: Md. Code, Health–General §2-104(b), § 15-103, § 15-105, § 15-132 and § 15-141.2
Read the Regulations: Code of Md. Regulations 10.09.54
Community First Choice (CFC)
CFC offers personal assistance and other supports to individuals who meet a nursing facility level of care but prefer to live at home. Services can include help with activities of daily living, caregiver support, and options for self-direction.
- Eligibility: Nursing facility level of care, Medicaid financial eligibility, live in the community.
- Services: Personal assistance, supports planning, consumer training, nurse monitoring, assistive technology and items that substitute for human assistance, environmental assessments and home adaptations, personal emergency response systems (PERS), and transition services for moving from institutions to the community. (see the Code of Maryland Regulations for detailed services.)
- Learn more: Community First Choice – Maryland Department of Health
Read the Law: Md. Code, Health–General §2-104(b), § 15-103, and § 15-105
Read the Regulations: Code of Md. Regulations 10.09.84
Community Personal Assistance Services (CPAS)
CPAS provides personal care and support services for individuals who need help with daily tasks but do not require a nursing facility level of care. The program supports independent living in the community.
- Eligibility: Medicaid financial eligibility, need for assistance with activities of daily living, live in the community.
- Services: Personal assistance, supports planning, and nurse monitoring (see the Code of Maryland Regulations for detailed services).
- Learn more: Community Personal Assistance Services – Maryland Department of Health
Read the Law: Md. Code, Health–General §2-104(b), § 15-103, and § 15-105
Read the Regulations: Code of Md. Regulations 10.09.20
Increased Community Services (ICS) Program
ICS is designed to help individuals living in nursing facilities transition back into the community. The program provides services like HCBOW but is specifically for people who are already in a nursing facility and want to move home or into another community setting.
- Eligibility: Current nursing facility resident, Medicaid financial eligibility, nursing facility level of care.
- Services: Participant training, family training, case management, transition services, environmental assessments and accessibility adaptations, personal emergency response systems (PERS), assistive technology, attendant care services, nursing supervision of attendants, home delivered meals, dietitian and nutritionists, behavioral consultation, medical day care, Senior Center Plus, and assisted living. (see the Code of Maryland Regulations for detailed services).
- Learn more: Increased Community Services – Maryland Department of Health
Read the Law: Md. Code, Health–General §2-104(b), § 15-103, and § 15-105
Read the Regulations: Code of Md. Regulations 10.09.81