Money Follows the Person Maryland: How to Move a Parent Out of a Nursing Home

The Fastest Way Off the COW Waitlist

The Community Options Waiver (COW) in Maryland has a statewide registry of over 20,000 people. For community-dwelling seniors, that waitlist can mean years before receiving an enrollment invitation. But there is one pathway that bypasses the registry entirely: the Money Follows the Person (MFP) transition.

If your parent is currently residing in a nursing facility and has been Medicaid-eligible for at least 30 consecutive days, they can apply directly for the COW without waiting on the registry. The state prioritizes institutional residents for community transition slots because moving someone from a nursing home to home-based care costs Medicaid substantially less per month.

This is not a loophole — it is an explicit regulatory exception built into the COW's structure. The federal MFP demonstration program provides enhanced matching funds to states that successfully transition residents from institutions to the community.

Who Qualifies

Your parent is eligible for an MFP-facilitated COW transition if they meet all of these criteria:

• Currently residing in a Medicare or Medicaid-certified nursing facility
• Medicaid has been paying for their nursing facility care for at least 30 consecutive days
• They meet the nursing facility level of care clinically (which they already must, given their current placement)
• A safe community living arrangement can be established — either their own home, a family member's home, or an assisted living facility

The 30-day Medicaid payment requirement is the key threshold. If your parent entered the nursing home on private pay and later transitioned to Medicaid coverage, the 30-day clock starts from when Medicaid began paying, not from the admission date.

The ICS Alternative for Higher-Income Residents

If your parent qualifies medically but their monthly income exceeds the COW's $2,982 cap (300% of SSI), the Increased Community Services (ICS) program provides an alternative transition pathway. ICS is specifically designed for nursing facility residents who have been institutionalized for at least six months and have been Medicaid-eligible for at least 30 consecutive days.

Under ICS, participants contribute all monthly income above the $2,982 threshold toward the cost of their community-based care. The program has limited target slots, but it serves residents whom the COW's income cap would otherwise exclude.

How the Transition Process Works

The transition from a nursing facility to community-based care involves coordination between multiple state entities. Here is the sequence:

Step 1: Request a transition assessment. Contact Maryland Access Point at 1-844-627-5465 or ask the nursing facility's social worker to initiate an MFP referral. The state will assign a transition coordinator.

Step 2: Clinical evaluation. A nurse from the local health department conducts (or reviews) a functional assessment to confirm your parent's care needs can be safely met in the community. This assessment uses the interRAI Home Care instrument.

Step 3: Housing and safety planning. The transition coordinator works with your family to identify an appropriate community residence. If your parent is returning to their own home, the coordinator assesses whether modifications are needed — grab bars, wheelchair ramps, stair rails — and whether CFC or COW funding can cover them.

Step 4: Select a Supports Planning Agency. Your parent chooses a Supports Planning Agency to draft their Person-Centered Plan of Service. This plan specifies the type and number of care hours, whether services are agency-managed or consumer-directed, and which additional supports (meals, transportation, emergency response) are included.

Step 5: Arrange care providers. Before discharge, confirm that a licensed Residential Service Agency or an FMCS provider (for consumer-directed care) is ready to begin services on the day your parent leaves the facility. Gaps in care coverage during transition are a primary safety risk.

Step 6: Discharge and follow-up. The transition coordinator monitors your parent's adjustment during the initial weeks. The local health department conducts clinical reassessments annually, or sooner if a significant change occurs.

What Services Are Available After Transition

Once enrolled in the COW through MFP, your parent has access to the full range of waiver services:

• Personal care assistance (bathing, dressing, meals, mobility)
• Licensed assisted living support (if transitioning to an ALF rather than a private home)
• Medical day care
• Family caregiver training
• Behavioral consultation
• Home modifications
• Home-delivered meals
• Personal emergency response systems

If your parent also qualifies for CFC (which has no waitlist), the two programs can work in tandem — CFC covers the core personal care, while the COW adds services like medical day care and assisted living subsidies that CFC does not include.

Why This Matters for Your Family

Many families accept a nursing home placement as permanent when it does not have to be. A parent who entered a facility after a hospital stay, a fall, or a rehabilitation period may be stable enough to return home with proper supports. The MFP pathway gives you a structured way to make that happen with state-funded services rather than paying out of pocket.

The Maryland Home Care, Waivers & Support Guide covers the full MFP transition process alongside every other Maryland home care program, including worksheets for comparing your parent's options and tracking the application timeline.

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