When a parent or spouse in Maryland needs nursing-home care, the Maryland Medical Assistance Program can help pay for it once countable resources and available income fall within the state's standards. For 2026, a spouse at home may keep between $32,532 and $162,660 of the couple's resources. Gifts made within the 60-month look-back can delay coverage.
Most people facing a nursing-home admission in Maryland arrive at this question in the middle of something hard: a hospital discharge that cannot go home, a parent whose savings are draining at a rate of thousands of dollars each month, or a husband or wife who suddenly has to work out what will be left to live on. The family is usually trying to answer a few concrete questions at once: what Maryland will pay for, what it counts, what the spouse at home keeps, what happens to the house, and whether past gifts to children will cause a problem. This page sets out how Maryland's own manual and schedules answer those questions, and where the answer depends on facts or on rules that change.
What Maryland Medicaid Covers for Long-Term Care
Maryland's Medicaid program is the Maryland Medical Assistance Program, run by the Maryland Department of Health. Its manual addresses coverage for long-term care received in a nursing facility, in a medical institution with a level of care equivalent to a nursing facility, or through a home and community-based services (HCBS) waiver, as the Section 800 Resources manual describes. Medicaid is a different program from Medicare, which this page does not cover. It also does not cover private long-term-care insurance or veterans' benefits.
Medicaid is a joint federal and state program, according to the CMS eligibility policy page. Federal law, including 42 U.S.C. § 1396p and 42 U.S.C. § 1396r-5, sets a framework that every state follows. Each state then runs its own program with its own standards and procedures, so Maryland's figures differ from those of other states. Families comparing Maryland with a parent's former home state can see how Colorado long-term-care Medicaid or Texas long-term-care Medicaid set their own figures.
Maryland Medicaid Eligibility: Asset and Income Rules
Maryland compares an institutionalized person's countable resources to a state schedule. A countable asset, or countable resource, is property Medicaid counts toward the limit, as opposed to an exempt asset, which it does not count. The Section 1000 manual states that countable resources are compared to Schedule MA-2. If they are greater than the standard, the person is not eligible. If they are equal to or less than the standard, the person may be eligible, and income is then evaluated. The current MA-2 dollar figure, and the full list of what Maryland exempts, depend on Maryland's current rules in the 2026 Appendix schedules.
The home has its own limit. Under 42 U.S.C. § 1396p(f), federal law bars long-term-care coverage for a person whose home equity exceeds a limit, unless a spouse, a child under 21 or a blind or disabled child lives in the home. Maryland's Schedule MA-10 lists an excess home-equity limit of $752,000, with an effective date of 2025. Under Maryland's Section 800 manual, equity is reduced by bona fide, legally binding, documented encumbrances secured by the home. If equity exceeds the limit, Medicaid will not pay for nursing facility, equivalent institutional or HCBS waiver services. The person may still be covered for other State Plan services. For applicants found eligible after April 1, 2007, equity is re-evaluated at each redetermination.
Spend-down means becoming eligible by incurring medical expenses that use up income above a standard. Maryland's Section 1000 manual states that when monthly available income is greater than the average monthly cost of care, the Program will not assist with the cost of care, but the person may be eligible under spend-down. The excess available income for the whole period under consideration is compared with incurred medical expenses. Certification begins on the day spend-down is met. Schedule MA-6 lists the average monthly amount payable for skilled nursing facility care as $12,501, effective 7/1/25.
After eligibility, the manual deducts set amounts from available income before the person pays toward care. These deductions include a personal needs allowance, a residential maintenance allowance, a spousal allowance, a family or dependent allowance, Medicare and other health insurance premiums, and certain medical or remedial care.
Maryland's Look-Back Period and Transfer Penalties
The look-back period is the window of time Maryland reviews for transfers of assets when someone applies for long-term-care coverage. Federally, it is 60 months for any transfer made on or after February 8, 2006, under 42 U.S.C. § 1396p(c)(1)(B)(i). Maryland's Section 800 manual states that the look-back date is 60 months. It sets the date and period from the effective date of the person's first approval for nursing facility or 1915(c) waiver eligibility. Penalties may not be imposed for transfers before the look-back date. The look-back period has no end date, so Maryland reviews every transfer on or after that date.
A penalty period is a stretch of time when Medicaid will not pay for long-term care because of transfers made for less than their value. Maryland's manual adds up the total uncompensated value of all transfers not yet penalized, even when each transfer is small. It then divides that total by the Schedule MA-6 amount noted above.
The timing of the penalty comes from federal law. Under 42 U.S.C. § 1396p(c)(1)(D)(ii), the penalty starts on the later of two dates: the month of the transfer, or the date the person is eligible and would otherwise be receiving institutional-level care. That means a gift made four years ago and a gift made last month, both inside the look-back, are penalized the same way.
Transfers are not always penalized. Federal law lists exceptions, including a transfer to the person's spouse, which carries no transfer penalty under 42 U.S.C. § 1396p(c)(2)(B)(i). Whether any other exception fits a particular transfer depends on its facts and on Maryland's current rules.
Spousal Protections Under Maryland Medicaid
The community spouse is the husband or wife who stays at home while the other spouse receives nursing-facility or similar care. The federal spousal-impoverishment rules in 42 U.S.C. § 1396r-5 decide how a couple's income and resources are treated. When one spouse applies, the rules generally treat all resources held by either spouse as available to the applicant, but only to the extent they exceed the amount protected for the community spouse. After the month of eligibility, the community spouse's resources are not counted against the spouse in care.
The Community Spouse Resource Allowance (CSRA) is the share of the couple's countable resources the community spouse may keep. Maryland's Schedule MA-8 lists a maximum spousal share of $162,660 and a minimum spousal share of $32,532, both effective 1/1/26. Under 42 U.S.C. § 1396r-5(f), the institutionalized spouse may transfer resources up to this allowance to the community spouse, or for the community spouse's sole benefit, without a transfer penalty. This works alongside the general spousal-transfer exception under 42 U.S.C. § 1396p(c)(2)(B)(i).
The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the minimum monthly income the community spouse is allowed to have. Part of the institutionalized spouse's income can make up a shortfall. Maryland's Schedule MA-8 lists a Basic Maintenance and Shelter Allowance of $2,643 and an Excess Shelter Standard of $793, both effective 7/1/25. It lists a Maximum Maintenance and Shelter Allowance of $4,066, effective 1/1/26. The federal minimum is adjusted each July 1, according to the CMS 2026 standards bulletin. For that reason, Maryland's current figures are the ones its own schedule states. Whether Maryland allows spousal refusal depends on Maryland's current rules.