Maryland Nursing Home Medicaid

Last updated: August 21, 2026 Jurisdiction: Maryland

Maryland nursing-facility coverage has a medical-review step

Maryland Medical Assistance covers long-term care through its institutional eligibility pathway when the person satisfies the financial, nonfinancial, and medical requirements. For people age 21 or older, the institutionalized-persons manual says medical need for long-term care is certified by the Utilization Control Agent, or UCA, on the DHMH 257 Long-Term Care Patient Activity Report. The nursing facility initiates the form, and the certification is a separate requirement from the financial case review (Maryland institutionalized-persons manual).

The manual also identifies the DHMH 3871B Medical Eligibility Review Form for level-of-care and service requests. The physician completes designated sections, the facility completes the relevant DHMH 257 material, and both are sent to the UCA; the UCA completes the review portion. The forms list nursing-facility, medical-adult-day-care, waiver, PACE, Model Waiver, and chronic-hospital service types, which is why a family should keep the written clinical decision rather than rely only on an admission conversation (Maryland institutionalized-persons manual).

Personal needs and patient liability

Maryland’s current appendix lists a $106 monthly personal-needs allowance for an individual, effective July 1, 2025. The institutional manual says this allowance is deducted first in the post-eligibility calculation so that the institutionalized person can meet daily living expenses in the facility that are not covered by the program. This is a deduction in the contribution calculation, not an additional payment by the facility (Maryland 2026 appendix schedules; Maryland institutionalized-persons manual).

The manual contains special historical examples for SSI-only and other SSI recipients, but it directs users to the current Schedule MA-8 for the actual personal-needs amount. The current $106 schedule figure should therefore be confirmed at application instead of substituting an older $30, $40, $74, or $100 illustration found in a legacy manual section (Maryland institutionalized-persons manual; Maryland 2026 appendix schedules).

Transfers can interrupt the long-term-care payment span

Maryland’s transfer process can close the MMIS long-term-care span for nursing-facility services while leaving general Medicaid eligibility unaffected. This is why admission, clinical certification, income, resources, and five-year transfer records all need to be reviewed together before a family relies on a Medicaid start date (Maryland institutionalized-persons manual).

Maryland facility allowance: the current appendix lists $106 per month for an individual, effective July 1, 2025. Ask for the written patient-liability calculation and the UCA certification outcome (Maryland 2026 appendix schedules).

For program-wide context, see Maryland Medicaid Long-Term Care and Medicaid (Baseline). A discharge planner or qualified adviser can help assemble the UCA and financial records.

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Maryland nursing-facility coverage has a medical-review step

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