Increased Community Services Maryland: The ICS Program for Nursing Home Transitions

What the ICS Program Is

The Increased Community Services (ICS) program is a Maryland Medicaid demonstration program that exists for a specific population: nursing facility residents whose monthly income exceeds the Community Options Waiver's $2,982 cap but who could live safely in the community with proper supports.

ICS is governed by COMAR 10.09.81 and fills a gap that other programs leave open. The COW cannot enroll someone who earns above 300% of SSI. CFC is available regardless of income (through the medically needy spend-down), but it does not cover the broader services — medical day care, assisted living, behavioral consultation — that a person transitioning out of a nursing home often needs. ICS provides those broader services while requiring the participant to contribute their excess income toward care costs.

Who Qualifies

ICS has strict eligibility requirements:

Institutional residency. The applicant must be currently residing in a nursing facility and must have been there for at least six consecutive months.

Medicaid-eligible. The applicant must have been Medicaid-eligible for at least 30 consecutive days during their nursing facility stay. This means Medicaid must have been paying for their institutional care.

Income above the COW cap. The applicant's monthly income must exceed $2,982 (300% of SSI in 2026). If income falls at or below this amount, the COW is the appropriate pathway instead.

Nursing facility level of care. The applicant must meet the clinical standard — significant impairment requiring the level of care that a nursing home provides. This is already established by their current institutional placement.

Safe community plan. A viable community living arrangement must be identified — the applicant's own home, a family member's home, or an approved assisted living facility — with adequate supports in place before discharge.

How the Income Contribution Works

Under ICS, the participant keeps enough income to cover basic living expenses and contributes everything above the 300% SSI threshold toward the cost of their community-based care. This income contribution functions like a copay — it reduces what Medicaid pays on the participant's behalf.

The exact contribution amount is calculated by the state based on the participant's total monthly income minus allowable deductions (housing costs, personal needs allowance, and spousal maintenance allowances if applicable). The remaining surplus goes toward care.

This structure means ICS is not free in the way that CFC or the COW can be, but it funds community-based services that would otherwise cost far more than the participant's income contribution — nursing home care in Maryland runs $12,927 per month for a semi-private room.

What ICS Covers

ICS provides community-based services designed to support a successful nursing home-to-community transition:

• Personal care assistance (bathing, dressing, meals, mobility)
• Home modifications for accessibility and safety
• Assisted living facility placement support
• Medical day care
• Home-delivered meals
• Personal emergency response systems
• Transition coordination during the discharge process

The Supports Planner develops a Person-Centered Plan of Service that allocates the approved budget across these services based on the participant's clinical needs and chosen living arrangement.

The Spousal Exclusion

One important restriction distinguishes ICS from CFC: under COMAR 10.09.81.13B, a spouse or the parent of a minor dependent child is explicitly prohibited from serving as a paid participant-employed attendant under ICS's consumer-directed option.

If a spouse wants to provide daily care, the agency-managed model through a licensed Residential Service Agency is the alternative. The RSA sends professional aides — the spouse can supplement informally but cannot be the paid attendant.

This contrasts with CFC, where Maryland's approved state plan does not exclude a spouse from the consumer-directed caregiver role.

How to Initiate the Transition

If your parent is in a nursing home and their income puts them above the COW cap, request an ICS evaluation:

1. Ask the facility social worker to initiate a referral for community transition. The facility social worker can help connect your parent with community-based alternatives.

2. Contact Maryland Access Point at 1-844-627-5465 to request a transition assessment. Explain that your parent's income exceeds the COW limit and you are seeking ICS enrollment.

3. Work with the transition coordinator to identify a community living arrangement, arrange home modifications, and select care providers who can start services on the day of discharge.

4. Select a Supports Planning Agency to draft the Person-Centered Plan of Service, choosing between agency-managed and consumer-directed care models.

The transition planning process typically takes several weeks to coordinate. The critical step is ensuring that care providers, home modifications, and medical equipment are all in place before discharge — gaps in coverage during transition are the primary safety risk for nursing home residents returning to the community.

For a comprehensive comparison of ICS alongside CFC, COW, CPAS, and SOAR — including eligibility worksheets and transition checklists — the Maryland Home Care, Waivers & Support Guide covers every program pathway in one place.

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