MARYLAND
B+Maryland's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Call the Autism Waiver registry at 1-866-417-3480 today and get your child's name on it — the wait is roughly eight years, so the date matters more than anything else you do this year. Then, separately, contact the Developmental Disabilities Administration and ask for a developmental disability determination and a Coordinator of Community Services. These are two different systems with two different lists and most families are only told about one. While you wait, keep the child's own resources under $2,000 and tell relatives not to gift money or name the child in a will, because the asset review looks back five years.
Last verified 2026-07-03
HOW WE GRADE MARYLAND
Full methodology (v2.1) →Maryland's strongest area is self-direction index; what pulls the grade down most is hcbs spending per capita.
Waitlist Burden
30% of grade77/10053 people waiting per 100,000 residents
Nobody waiting scores 100. 225 per 100,000 scores 0.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade72/100$540 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade100/100100 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade80/10080 out of 100 on program breadth
Scored directly on its own 0–100 scale.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so Maryland's grade moves when Maryland moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN MARYLAND
Use these exact words when you search, call, or fill out forms — they're what Maryland's own offices use.
- Medicaid here is
- Maryland Medical Assistance
- The DD agency is
- Developmental Disabilities Administration (MDH)
- You contact
- DDA regional office
- The plan is
- Person-Centered Plan
- Self-direction is
- Self-Directed Servicescontrolling your own budget and hiring your own people
- A denial arrives as a
- written notice of denialthe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In Maryland, you contact DDA regional office.
- 2
Health coverage — Maryland Medical Assistance
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Self-Directed Services. Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is Disability Rights Maryland.
Disability Rights Maryland · 1-800-233-7201
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for Maryland; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
Yes — a fixed dollar budget set by the Department, which you build into a Self-Directed Services Budget Sheet with your team each year
Can a family member be paid to provide care?
Yes for named services — DDA's manual carries a table of the services a relative or legally responsible person may provide, plus a separate standard for family member overtime. Ask which services on your plan qualify
Who is legally the employer of the people you hire?
You are — the common law employer and employer of record, with both budget and employer authority. A Designated Representative is required for a participant below a set age, so check whether that applies to you
How freely can money move between services?
Medium — you can request budget modifications during the year, but they route through your financial management provider and all wages and rates must sit inside DDA's reasonable and customary standards
Can the budget buy things, not just staff time?
Not verified yet — ask, don't assume the answer is no.
Is your case manager independent of your providers?
Partly — Maryland writes conflict-of-interest rules into self-direction: your financial management provider may not process budget changes sent by your Support Broker or by anyone who provides your services, and a Support Broker who is a relative or guardian is restricted
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN MARYLAND
- Managed care (HealthChoice): MCO internal appeal within 60 days of the notice of action
- State fair hearing with OAH within 120 days (MCO services) or 90 days (FFS services); to keep services, appeal within 10 days
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
DDA Community Pathways Waiver
SourceChildren and adults with developmental disabilities (comprehensive).
Waitlist: DDA waiting list by priority category; transitioning youth get priority at 21.
DDA Family Supports Waiver
SourceChildren with DD living at home; capped budget.
Waitlist: Verify current capacity with DDA regional office.
Autism Waiver (MSDE)
SourceSchool-age children with autism; run through the education department.
Waitlist: Long registry — join the moment you get a diagnosis.
Model Waiver (REM)
SourceMedically fragile children who are hospital-level.
Waitlist: Small capped program.
Full milestone guide
View the Maryland Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
