I/DD Waivers in Maryland

All states: Medicaid disability services map

Maryland I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Maryland?

The Developmental Disabilities Administration (DDA), part of the Maryland Department of Health (MDH), runs I/DD home and community services. DDA operates the Community Pathways Waiver, and MDH's Office of Long Term Services and Supports acts for the state Medicaid program. People start at one of four DDA Regional Offices, and private agencies certified by DDA provide case management.

• DDA: decides who is eligible, manages the waiting list, sets provider rates and certifies providers. Headquarters can be reached at (410) 767-5600 or toll free at (844) 253-8694.
• Maryland Department of Health: the state Medicaid agency. Its Office of Long Term Services and Supports oversees the waiver, and its Office of Health Care Quality (OHCQ) licenses group homes and day program sites.
• Front door: the DDA Regional Office for the county where the person lives: Central (410) 234-8200, Eastern Shore (410) 572-5920, Southern (301) 362-5100 or Western Maryland (301) 791-4670.
• Case management: called Coordination of Community Services (CCS). Coordinators work for private agencies that DDA certifies, and Medicaid pays for the service as targeted case management for people on the waiting list, people already getting services and people moving out of institutions.

What Medicaid waivers and programs serve people with I/DD in Maryland?

DDA runs one waiver, the Community Pathways Waiver. It is a 1915(c) waiver, a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The Family Supports Waiver and the Community Supports Waiver were merged into Community Pathways on October 6, 2025, so people in those waivers now get services through Community Pathways.

• Community Pathways Waiver (1915(c), control number MD.0023): serves Maryland residents of any age who have a developmental disability as defined in state law, meet the level of care for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) and meet Medicaid financial rules. School-age participants do not get waiver services during school hours. The current approved amendment took effect October 6, 2025, within a waiver period that began July 1, 2023.
• Services: residential services (Community Living Group Home, Community Living Enhanced Supports, Supported Living and Shared Living); meaningful day services (Employment Services, Career Exploration, Community Development Services, Day Habilitation and Medical Day Care); support services (Personal Supports, Respite Care, Nursing Support, Behavioral Support, Remote Support, Housing Support, Support Broker and Transportation); and Assistive Technology, home and vehicle modifications, Individual and Family Directed Goods and Services, Family and Peer Mentoring, Live-in Caregiver Supports and Transition Services.
• Two ways to get services: a Provider Managed model, where agencies deliver services, and a Self-Directed model, where the participant is the employer of their own staff and works with one of three Financial Management and Counseling Services (FMCS) providers that handle payroll.
• Size: in fiscal 2025 the waiver had 21,209 authorized slots and served 19,158 people, according to the Department of Legislative Services fiscal 2027 budget analysis.
• Limits: cost containment approved by the Centers for Medicare and Medicaid Services (CMS) in September 2025 capped Individual and Family Directed Goods and Services at $5,000 per plan year.

Related programs: the Autism Waiver is a separate 1915(c) waiver for children with autism spectrum disorder from age 1 through the end of the school year in which they turn 21. The Maryland State Department of Education runs it, with local school systems coordinating services, and families join its registry by calling 866-417-3480. Maryland also offers Community First Choice, a 1915(k) state plan option open to all disability groups, and Low Intensity Support Services, a state-funded grant (not Medicaid) capped at $1,000 per person in fiscal 2026. The state operates two State Residential Centers, the Holly and Potomac centers, as its ICF/IID institutions.

Does Maryland pay for I/DD services through managed care?

No. DDA waiver services are paid fee-for-service. Providers bill each service as a claim in LTSSMaryland, the state's billing and tracking system for long-term services. There are no health plans in the middle, and case management stays with the independent CCS agencies.

• Billing change: DDA used to pay providers through an older system called PCIS2, which made payments in advance (prospective payments). DDA finished moving all providers to fee-for-service claims in LTSSMaryland in September 2024.
• Service plans: the coordinator from the CCS agency builds the person-centered plan, and services are authorized and billed in LTSSMaryland.

Is there a waiting list for I/DD services in Maryland?

Yes. DDA places eligible people on a waiting list by priority category, and people enter the waiver when funding for their category is available. As of June 30, 2025, 3,465 people with a developmental disability were on the list. That was 511 fewer than a year earlier and the lowest count in eight years.

• Priority categories: Crisis Resolution (most urgent), Crisis Prevention, Current Request and Future Needs. On June 30, 2025 the list held 2 people in Crisis Resolution, 202 in Crisis Prevention and 3,261 in Current Request.
• Reserved slots: in fiscal 2025 DDA kept 1,424 slots in 17 reserved categories, such as Crisis Resolution, State Funded Conversions and Transitioning Youth.
• Who is not counted: the 3,465 figure covers people in the Developmentally Disabled eligibility category. People found eligible as Supports Only are not included.

The count comes from the Department of Legislative Services budget analysis, which cites MDH. We did not find a newer state count. For a person's place on the list, families can ask their coordinator or DDA Regional Office.

How do people apply for I/DD services in Maryland, and how are budgets set?

A person or family sends a signed DDA eligibility application to their DDA Regional Office. A Coordinator of Community Services is assigned, meets the person face to face, completes an assessment and reports to the Regional Office. The Regional Office decides eligibility and priority category and sends a letter that explains reconsideration and appeal rights.

• Application: the application is available in English, Spanish and Arabic. It can be downloaded, requested by mail or picked up at a Regional Office, and handwritten forms are accepted. Regional staff can help fill it out. DDA encourages youth ages 14 to 21 to apply while still in school.
• Eligibility categories: Developmentally Disabled (a disability that began before age 22 and creates a need for supports to live independently) and Supports Only. Eligible people go on the waiting list, then apply for the waiver when funding for their priority category opens. Waiver enrollment also requires ICF/IID level of care.
• Assessment tools: the coordinator completes DDA's Comprehensive Assessment for eligibility and level of care. The Health Risk Screening Tool (HRST), completed each year, and the Supports Intensity Scale (SIS) are used in person-centered planning.
• Budgets: we did not find a published description of how DDA turns these assessments into a dollar budget for provider-managed services. A new method for setting self-directed budgets is part of a waiver amendment that is still under federal review (see the last section).

What day and residential services can I/DD providers offer in Maryland?

Community Pathways covers five meaningful day services and four residential services. Day Habilitation, Career Exploration, group homes and Enhanced Supports homes need a site license from the MDH Office of Health Care Quality. Community-based services such as employment, personal supports and respite need DDA certification instead.

Meaningful day services

• Day Habilitation: skill building for daily living, community participation and pre-employment (including volunteering and time-limited internships), at licensed sites or in the community. Provided in small groups (2 to 5) or large groups (6 to 10), or 1:1 or 2:1 when a behavior support plan or nursing care plan documents the need. Billed per 15-minute unit ($6.20 for small group at the standard rate in the October 1, 2026 rate chart). New agencies need at least 5 years of day habilitation experience.
• Community Development Services: activities in the community alongside people without disabilities, in groups of up to 4, or 1:1 or 2:1, billed per 15-minute unit. The research did not confirm a separate license for this service.
• Career Exploration: time-limited services that teach work skills toward a regular community job. Provided in small or large groups at OHCQ-licensed sites, billed per 15-minute unit.
• Employment Services: discovery, job development, ongoing job supports, follow-along supports, co-worker supports and customized self-employment, provided by DDA-certified agencies. Discovery and self-employment are paid by milestone, job development and job supports per 15 minutes, and follow-along per month. The research did not find a published ratio. Maryland calls itself an Employment First state.
• Medical Day Care: medically supervised day services in a licensed adult medical day care center for participants 16 and older, paid by the day when the person attends at least 4 hours. Medicaid, not the DDA fee schedule, sets this rate.

Day Habilitation and the other meaningful day and employment services together are limited to 8 hours a day and 40 hours a week, and Medical Day Care cannot be billed at the same time as them.

Residential services

• Community Living Group Home: a provider-owned or operated home, licensed by OHCQ, usually with no more than 4 participants unless DDA approves more. Paid a daily rate based on the number of residents and overnight supervision, plus dedicated 1:1 or 2:1 hours when authorized.
• Community Living Enhanced Supports: a licensed group home with extra supervision for people with challenging behaviors or court-ordered conditions, with no more than 4 participants unless DDA approves more. It pays higher daily rates than a group home.
• Supported Living: supports for a person in their own home. If they choose housemates, no more than 4 people live together. Paid daily by household size and overnight supervision.
• Shared Living: a host home, where a person, couple or family shares their home and daily life with the participant. Paid monthly at three levels, about $4,510 to $6,177 in the October 1, 2026 rate chart.

The research did not confirm the license or certification needed for Supported Living or Shared Living agencies. The DDA Providers page lists requirements by service.

How are I/DD provider rates set and how do agencies enroll in Maryland?

DDA publishes a fee schedule, the LTSSMaryland rate chart. Rates come from a 2017 rate study that used the Brick Method, which builds each rate from a direct support wage based on federal Bureau of Labor Statistics data, plus employee benefits, program support, training, transportation, facility costs (for day habilitation only) and 12% for general administration. Agencies apply to DDA, license any sites that need it and enroll with Maryland Medicaid before billing.

• Units: residential services pay daily rates by household size and overnight supervision, Shared Living pays monthly by level, and most other services pay per 15-minute unit. For example, Personal Supports pays $12.11 per 15 minutes in the October 1, 2026 chart.
• Higher-cost counties: a geographic differential rate applies to people living in Frederick, Montgomery, Prince George's, Calvert and Charles counties. Cost containment effective October 6, 2025 lowered that differential to 10%.
• Recent rate history: providers got at least 3% a year from fiscal 2016 through fiscal 2025, including 3% in fiscal 2025. There was no increase in fiscal 2026, and DDA cut the dedicated hours rate by 1% that year. The fiscal 2027 budget includes no increase and requires a 2% reduction. That cut applied to Coordination of Community Services on July 1, 2026 ($441 per Comprehensive Assessment and $27.76 per 15 minutes, per the state's public notice). Provider-managed waiver rates in the October 1, 2026 chart are unchanged from October 2025.
• Rate input: a Rate Review Advisory Group advises DDA on rates.
• Enrollment: agencies complete the DDA Qualified Services Provider Application and its addenda, get OHCQ licenses for sites that need them, and enroll with Maryland Medicaid through ePREP, its online provider enrollment system. Forms are on the DDA Providers page.
• EVV: electronic visit verification (EVV) is required for Personal Supports, Personal Supports Enhanced and 15-minute Respite, in both service models. Agency staff clock in and out with the state's LTSSMaryland EVV app or its phone line. Self-directed staff use the EVV system of the participant's FMCS provider. Daily respite and respite camp are billed outside EVV. Details are in DDA's EVV training module.

What is changing next for I/DD services in Maryland?

A Community Pathways Waiver amendment that includes a 2% provider rate cut is under review by CMS. Until CMS approves it, DDA says provider-managed waiver rates stay at their June 30, 2026 levels. The state has not set a date for the cut to reach those rates.

• Waiver Amendment #4: DDA sent it to CMS on July 1, 2026, and CMS asked for more information on September 25, 2026. It would carry out fiscal 2027 changes, including the 2% provider rate reduction required by the state budget and a new method for setting self-directed budgets.
• Changes already in place: the 2% cut already applies to Coordination of Community Services from July 1, 2026. DDA's waiver changes page says some fiscal 2027 changes took effect July 1, 2026 and others will follow in the coming months. Public comment on the amendment ran from April 29 to May 28, 2026.

Maryland I/DD sources

• Maryland DDA: Medicaid Waiver Program (Community Pathways Waiver)
• Maryland DDA: Community Pathways Waiver, effective October 6, 2025
• Maryland Department of Legislative Services: Fiscal 2027 budget analysis, Developmental Disabilities Administration
• Maryland DDA: Eligibility application process
• Maryland DDA: Community Pathways Waiver Amendment #4 (2026)
• Maryland DDA: Rates
• Maryland DDA: FY2027 LTSSMaryland rate chart (effective October 1, 2026)
• Maryland DDA: Providers
• Maryland DDA: Electronic Visit Verification training module (October 2025)
• Maryland Department of Health: Autism Waiver

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• What is Active Support in Disability Services?
• I/DD services in every state (map)
• Maryland EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.