Maryland Medicaid Long-Term Care Eligibility

Your parent's Medicare rehab days are running out, the nursing home billing office is asking questions, and you need to know whether Maryland Medicaid will cover long-term care. The financial eligibility rules are strict — but Maryland's "medically needy" structure gives families more flexibility than most states.

Asset Limits for 2026

A single applicant for long-term care Medicaid in Maryland can hold no more than $2,500 in countable assets. Countable assets include bank accounts, investment accounts, IRAs, 401(k)s, non-primary real estate, and cryptocurrency.

Maryland counts retirement accounts as resources regardless of payout status — unlike some states that exempt IRAs already in distribution. This catches many families off guard.

Exempt assets that don't count toward the limit:

• Primary residence (up to $752,000 in equity, if a spouse or dependent child lives there)
• One vehicle of any value
• Household goods, furniture, clothing, and personal jewelry
• Irrevocable prepaid burial plans and designated funeral funds

The Medically Needy Spend-Down

Maryland does not use an income cap. Unlike "income-cap" states that require a Miller Trust when income exceeds the threshold, Maryland uses a medically needy spend-down. If your parent's monthly income exceeds the Medically Needy Income Level ($350 for an individual, $392 for a couple), they qualify by deducting incurred medical expenses from their income.

The calculation works like this: gross monthly income minus $350 equals the excess (the monthly "deductible"). Your parent must incur medical expenses equal to or greater than this excess during a one-to-six-month spend-down period. The expenses don't need to be paid — only legally incurred.

Qualifying expenses include nursing home costs, home health services, physician visits, prescriptions, dental work, and even outstanding medical debt from before the application period.

Applying While in a Nursing Home

When a Medicaid application is pending and your parent is already in a skilled nursing facility, they're classified as "Medicaid Pending." During this period:

• The resident must pay their estimated monthly patient liability (available income minus personal needs allowance) directly to the facility
• The facility cannot evict a Medicaid Pending resident for non-payment of the private-pay rate, as long as a completed application is actively being processed and the resident is paying their estimated liability
• If approved, Medicaid coverage is retroactive to the application date

The application goes through the local Department of Social Services and can take several months. Start gathering financial documentation — bank statements, retirement account balances, property records, insurance policies — before the Medicare days expire.

What to Do Next

The Maryland Hospital Discharge Guide walks through the full Medicaid application process alongside discharge planning, including asset protection strategies, spousal impoverishment rules, and the Community Options Waiver waitlist bypass for families transitioning from a nursing home back to community care.

See more Maryland guides →