Maryland
Maryland’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Peer-group price
- Case-mix level
- Facility average
- Classification
- PDPM
- Rate updates
- Quarterly
- Managed care (LTC)
- Short stays only
- Quality program
- Pay-for-Performance (P4P/P4I)
- Paid outside the rate
- Small
- Bed hold
- Not paid
- Published rates
- Rates only
- Assisted living
- Covered
- Personal needs allowance
- $109 / month
Overview
- Since 1/1/2015 Maryland pays a prospective, price-based per diem built from four cost centers.
- Administrative/routine (102.5% of the regional Medicaid-day-weighted median cost) and other patient care (107%) are flat regional prices.
- Capital is a home-specific fair rental value plus real estate taxes.
- Nursing is a regional price (108.25% of the case-mix-normalized median) x the home's average Medicaid PDPM nursing case mix / statewide average, cut back if the home's own adjusted nursing cost is below 95% of that amount.
- A yearly budget adjustment factor and the provider-tax (quality assessment) add-on sit on top.
- In the 7/1/2026 statewide rate file (216 homes), the Resident Care Day rate (revenue code 0120) has a median of $351.24 (range $273.08-$498.23).
What matters in Maryland
- Median Resident Care Day rate is $351.24 (7/1/2026), built from regional prices, home-specific capital and case mix.
- Nursing pays price x the home's average PDPM nursing CMI, but homes keep at most 5% above their own nursing cost.
- A Medicaid case-mix equalizer rescales every home's CMI to the July statewide average each quarter, so statewide acuity growth during the year does not raise pay.
- HealthChoice MCOs pay only the first 90 days; long-stay residents and all dual eligibles are fee-for-service.
- Provider tax is $34.11 per non-Medicare day; the five highest-Medicaid homes pay $2.80; small homes and CCRCs exempt.
- Pay-for-performance paid about $16.1M in FY2026, roughly 1% of the $1.6B nursing home budget, as lump sums.
- FY2027 rates were rebased on 2024 costs with a 1% budget increase, after a near-flat FY2026.
Frequently asked
Does Maryland Medicaid managed care pay for long-term nursing home stays?
No. HealthChoice MCOs pay only the first 90 continuous days of a nursing facility stay; after that the member is disenrolled to fee-for-service. People 65+, Medicare-eligible or on a spend-down are never enrolled in HealthChoice.
How does Maryland limit nursing home margins on the Medicaid nursing component?
The case-mix-adjusted nursing price is reduced by any amount by which the home's own Medicaid-adjusted nursing cost per day falls below 95% of that price, so a home keeps at most a 5% margin on nursing.
Which Maryland nursing homes pay the lower provider tax rate?
Only the five homes with the most Medicaid days the prior year: $2.80 per non-Medicare day in FY2027 versus $34.11 for others. Homes under 45 beds and CCRCs pay nothing.
How much is paid outside the posted rate in Maryland?
Small, about 1%: only the annual P4P lump sums sit outside the posted per diem.
What does Maryland Medicaid pay on Medicare coinsurance days?
Lesser-of: coinsurance paid only up to the statewide average Medicaid rate ($365.76) minus Medicare's per-day payment.
Does Maryland require a minimum share of spending on care?
Yes, built into the rate: the nursing component is cut if the home's adjusted nursing cost is below 95% of it.
How the rate is set
How the method got here
| Effective | From | To | Change | Headline | Source |
|---|---|---|---|---|---|
| 2012-07-01 | Hospital bed-hold days paid | No payment for hospital bed holds | Maryland stopped paying nursing homes to reserve beds for residents admitted to hospitals, as a cost-containment measure. | Hospital bed-hold payments ended | https://mmcp.health.maryland.gov/MCOupdates/pdf/NH_Transmitta…)_1.pdf |
| 2015-01-01 | Cost-based rates: allowable costs up to class ceilings plus a 40% efficiency allowance below the ceiling (admin/routine cost-settled through the June 2016 rate period); RUG-III case mix | Prospective price-based system: regional prices for admin/routine, other patient care and nursing (x case mix), plus fair rental value capital | Maryland replaced cost-settled, ceiling-based rates with regional prices set at a multiple of the Medicaid-day-weighted median cost. | Cost-based rates replaced by regional prices | https://www.medicaid.gov/State-resource-center/Medicaid-State… |
| 2020-07-01 | Five nursing-service regions (Baltimore, Central, Washington, nonmetro, Western) | Four nursing-service regions (Baltimore Metro, Washington Metro, Eastern, Western), blended 50/50 in SFY2020 | Maryland regrouped counties for the nursing price into four regions after a one-year 50/50 blend. | Nursing price regions consolidated to four | https://regs.maryland.gov/us/md/exec/comar/10.09.10 |
| 2025-07-01 | RUG-based facility average Medicaid CMI | PDPM nursing-component CMI (CMS weights), phased in 25% on 1/1/2025, 50% on 4/1/2025, 100% on 7/1/2025 | Maryland moved its nursing case-mix adjustment from RUGs to the PDPM nursing component over three quarters. | Case mix moved from RUGs to PDPM nursing | https://health.maryland.gov/regs/SiteAssets/Lists/Accordion/N… |
| 2025-07-01 | Two provider-tax rates recalculated each year at 6% of projected revenue under a CMS non-uniform waiver | Prior-year rates adjusted by a uniform percentage each year | After the 2025 federal budget law (H.R. 1) tightened provider-tax waiver rules, Maryland switched to uniform percentage updates of its two quality assessment rates. | Provider tax moved to uniform percentage updates | https://health.maryland.gov/mmcp/provider/Documents/transmitt… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
Maryland Nursing Home Uniform Cost Report (state form), desk reviewed by Myers and Stauffer LC
- Base year and rebasing
Prices are set from the most recent desk-reviewed cost report available 2 months before the rate period and rebased every 2-4 rate years (COMAR 10.09.10.09B). FY2027 rates (7/1/2026) 'include 2024 rebasing data specific to each facility' (PT 05-27). In non-rebase years prices are indexed by the market basket.
- Components
Component Method Notes administrative and routine Regional price = Medicaid-day-weighted median cost per day x 1.025 (4 classes: Baltimore metro counties, Baltimore City, Washington region, nonmetropolitan). Cost per day uses the greater of actual days or statewide average occupancy + 1.5 points. Admin, medical records, training, dietary, laundry, housekeeping, operation and maintenance. Kosher kitchen add-on up to 15% of median dietary cost. other patient care Regional price = Medicaid-day-weighted median cost per day x 1.07 (same county classes). Medical director, pharmacy, activities, consultants, raw food, social and religious services. Kosher add-on up to 15% of median food cost. capital Fair rental value: appraised value per bed (appraised at least every 4 years, capped at $120,000/bed) x beds x 8% (10% in Baltimore City), plus real estate taxes, each divided by the greater of actual days or occupancy-standard days. Home-specific; appraisal excludes CON value. nursing services Regional price = case-mix-normalized Medicaid-day-weighted median x 1.0825 (4 regions since 7/1/2020: Baltimore Metro, Washington Metro, Eastern, Western). Home rate = price x facility average Medicaid CMI / statewide average CMI, reduced by any amount by which the home's Medicaid-CMI-adjusted nursing cost per day falls below 95% of that rate. Updated quarterly with case mix; a CMI equalizer keeps the Oct/Jan/Apr quarters budget neutral to the July quarter. quality assessment add-on Prior-calendar-year assessed days x the assessment rate / total patient days (COMAR 10.09.10.11E). Returns the Medicaid share of the provider tax; the FY2025 JCR shows roughly $17-$30 per Medicaid day for taxed homes. - Inflation
A monthly market basket index (quarterly index values interpolated to months) moves costs from the cost-report midpoint to the rate-year midpoint and indexes prices in non-rebase years (COMAR 10.09.10.09B(3), D). Final totals are then scaled by the annual budget adjustment factor.
Verified October 11, 2026
Case mix
- System
PDPM
- Applied at
Facility average
- How it works
One Medicaid-average PDPM nursing CMI per home drives the nursing component each quarter, so every Medicaid resident in a home is paid the same Resident Care Day rate (COMAR 10.09.10.12C, F; manual: 'Rates are based on the average acuity of the facility').
- Classification
PDPM nursing component only, using the CMS nursing CMIs (25 groups, PA1 0.62 to ES3 3.84; COMAR 10.09.10.31B). Delinquent MDS = lowest PDPM CMI.
- Applies to
Nursing services component only.
- Acuity measured from
Medicaid residents on the final quarterly resident roster (facility average Medicaid CMI); the total-facility CMI normalizes cost at rebasing. Preliminary rosters on the 5th of the 2nd month after quarter end, corrections due the 25th, final mid-3rd month.
- Updated
Quarterly: Jan-Mar CMI -> July rates; Apr-Jun -> October; Jul-Sep -> January; Oct-Dec -> April. A Medicaid CMI equalizer rescales the October, January and April quarters to the July statewide average.
- Move to PDPM
RUG CMIs were phased out: 75% RUG / 25% PDPM from 1/1/2025, 50/50 from 4/1/2025, 100% PDPM from 7/1/2025 (COMAR 10.09.10.07H-I, proposed 4/17/2026 and adopted effective 8/17/2026, codifying the schedule already used).
Verified October 11, 2026
Low-acuity residents
Yes, via Administrative Days (revenue code 0169): residents found no longer to need nursing facility level of care (or awaiting ICF/IID placement, or unable to be moved) are paid admin/routine + other patient care + capital + only 50% of the nursing component, less patient resources (COMAR 10.09.10.26D). 7/1/2026 file: median $257.94 vs $351.24 for a full Resident Care Day. There is no reduced rate tied to low PDPM groups; those residents only lower the home's average CMI. Checked: COMAR 10.09.10; NF Reimbursement Manual (June 2025).
Verified October 11, 2026
Capital
Fair rental value plus real estate taxes: appraised value per bed capped at $120,000, x 8% (10% Baltimore City), divided by the greater of actual days or statewide average occupancy + 1.5 points (COMAR 10.09.10.11). Changes only when a new appraisal (at least every 4 years) is used.
Verified October 11, 2026
Budget adjustment factor
Yes. Each year COMAR 10.09.10.07G applies a budget adjustment factor to the computed quarterly rates (excluding the ventilator add-on): a 9.652% reduction in FY2018, +2.703% in FY2025, +0.176% in FY2026 (about +$0.59/day, $3.04M). FY2027 rates reflect 'a one percent increase to the aggregate nursing facility budget appropriation' (SB 282 budget bill; PT 05-27); the FY2027 factor itself is not yet in COMAR. COMAR .07B also allows a uniform percentage cut to stay under the Medicare UPL.
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
small
- Estimate
About 1% of base: FY2026 P4P/P4I awards of about $16.1M against an FY2026 NF appropriation of $1.61B. The QA add-on is inside the posted rate. No UPL/IGT or directed payments for private homes were found.
- Components
P4P $13.7M + P4I $2.4M (FY2026 awards, lump sums). Possible UPL supplemental for state-owned homes only (amount not found). The Interim Working Capital Fund was a repayable advance, not revenue, and ended 5/1/2026.
Verified October 11, 2026
Payments by owner type
- Applies
yes
- Detail
Only state-owned and operated nursing facilities are paid reasonable cost under Medicare principles instead of the price system, with optional supplemental payments up to the Medicare UPL (COMAR 10.09.10.07F). This affects a handful of state facilities (e.g., the SNF units at Deer's Head Center and Western Maryland Center, which appear in the QA report). No county/IGT program for local-government homes was found.
- Funding
State funds plus federal match; no IGT arrangement found.
Verified October 11, 2026
Quality program
- Active
Yes
- Program
Nursing Facility Pay-for-Performance with Pay-for-Improvement (COMAR 10.09.10.14-.19)
- Funding
1% of the nursing facility budget allocation each year since SFY2021 (0.5% before), carved from the NF appropriation.
- Size
FY2026 awards: $13,712,880 P4P (58 of 153 eligible homes, $6.27-$12.54 per Medicaid day) + $2,419,920 P4I (44 homes, $1.45-$2.91 per Medicaid day) = about $16.1M.
- Paid as
Annual lump sum = per-Medicaid-day award x the home's Medicaid days on its latest cost report (max 1 year).
- Measures
Measure Source Weight How points are earned Staffing level vs acuity-based goal (PBJ hours vs PDPM expected hours x 1.26555) PBJ / MDS 20% Ranked: top home = 100% of points, day-weighted median = 50% Staff stability (% of nursing staff employed 2+ years) state report due May 31 15% Ranked MHCC Nursing Facility Family Survey Maryland Health Care Commission survey 30% Ranked (6 general + 24 specific points) Long-stay MDS quality indicators (pressure ulcers, falls with major injury, catheter, UTI, flu and pneumococcal vaccination) MDS QM 30% (5 points each) Ranked Staff influenza vaccination state survey 5% 2 points at 90-94.9%, 5 points at 95%+ - Scoring period
PBJ for the 9 months ending March 31; MDS QIs for the quarter ending December 31 of the prior SFY; scores reported about July 1 with a 30-day review.
- Payment formula
85% of the pool goes to the highest-scoring homes covering 40% of eligible days, with the top scorer paid twice the per-day amount of the lowest paid; 15% goes to improvers ranked by point gain (largest gain paid twice the smallest).
- Eligibility
Must be subject to the quality assessment (so homes under 45 beds and CCRCs are out). Excluded if, in the year ending March 31, it was a CMS Special Focus Facility, under a Department denial of payment for new admissions, cited for substandard quality of care, or late on quality assessment payments (added via PT 01-26 and COMAR .14B(4)).
- Cadence
Annual.
- Scores published
Yes, per-home scores and awards in xlsx on the NF Document Library: https://health.maryland.gov/mmcp/longtermcare/Nursing%20Facil…
- Notes
FY2026: 204 participating homes, 153 award-eligible (166 in FY2025), average score 62.29.
Verified October 11, 2026
Provider tax
- Charged
per non-Medicare day
- Standard amount
$34.11 per non-Medicare patient day for FY2027 (eff. 7/1/2026; PT 30-27). FY2026 $32.94 (revised from $32.92 by PT 10-27); FY2025 $33.21; FY2022 $29.20.
- Tiers
Who Test Amount The five facilities that reported the most Medicaid days in the prior fiscal year medicaid_utilization $2.80 per non-Medicare day (FY2027); $2.70 FY2026; $2.72 FY2025 Nursing facilities with fewer than 45 beds size exempt Continuing care retirement communities with a certificate of registration ccrc exempt - Lower for high-Medicaid homes
yes
- Returned in the rate
A facility-specific QA add-on in the per diem = prior-calendar-year assessed days x the assessment rate / total patient days (COMAR 10.09.10.11E), roughly $17-$30 per Medicaid day for taxed homes in the FY2025 JCR, plus general rate augmentation. 201 homes gained and 22 had a projected net loss in FY2025 (mostly low-Medicaid, high-private-pay homes).
Verified October 11, 2026
Provider tax notes
Nursing Facility Quality Assessment (Health-General 19-310.1; COMAR 10.01.20), per non-Medicare day: FY2027 $34.11 standard and $2.80 for the five homes with the most Medicaid days; homes under 45 beds and CCRCs exempt. Capped at 6% of operating revenue. FY2025 projected collections $193.1M. Returned through a per-day QA add-on and higher rates.
Verified October 11, 2026
Supplemental payments
None for private homes. State-owned and operated nursing facilities are paid reasonable cost under Medicare principles, and the State 'may elect' supplemental payments up to the Medicare UPL for that class (COMAR 10.09.10.07F). No IGT/county-home program or MCO directed payment for nursing facilities was found. The Interim Working Capital Fund (repayable advances up to 1.5% of prior-year Medicaid payments) expired 5/1/2026.
Verified October 11, 2026
Other add-ons
(1) QA add-on (see provider_tax_detail). (2) Kosher kitchen add-ons in admin/routine and other patient care (up to 15% of the regional median dietary/food cost). (3) Ventilator add-on of $285/day. (4) Separately billed per-day items (7/1/2026 file): Support Surface A $23.13 (0290), Support Surface B $92.14 (0299), Bariatric Bed A $2.05 (0946), Bariatric Bed B $5.49 (0291), negative pressure wound therapy $116.41 (0270); power wheelchairs by preauthorization. No COVID-era add-on remains.
Verified October 11, 2026
Units paid separately
(1) Ventilator Resident Care Day (code 0129): nursing component recalculated with a ventilator-only Medicaid CMI (no equalizer) plus $285/day; new vent units start at the ES3 CMI; up to $1,026.13/day in the 7/1/2026 file; ventilator validation recoups unsupported days. (2) State-owned and operated homes: Medicare reasonable cost, UPL-capped. (3) Out-of-state homes: lesser of the in-state average rate minus the QA or the home-state rate; special rehabilitation facilities negotiated. (4) Administrative days at a reduced rate (see low_acuity_rates).
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
short_stay
- Detail
HealthChoice (COMAR 10.67.06.12; CY2026 MCO Agreement): MCOs pay medically necessary nursing facility care for the first 90 continuous days after admission (and until MDH rules on medical necessity). Members institutionalized more than 90 successive days are disenrolled to fee-for-service (COMAR 10.67.02). People 65+ and Medicare-eligible people are excluded from HealthChoice entirely. Maryland has no MLTSS program.
Verified October 11, 2026
Who pays
mixed, mostly fee-for-service: HealthChoice MCOs pay only the first 90 continuous days of a nursing facility stay; the member is then disenrolled to FFS once MDH confirms medical necessity. People 65+, Medicare-eligible or on a spend-down are not enrolled in HealthChoice at all, so nearly all long-stay NF days are FFS.
Verified October 11, 2026
Managed care rate floor
Not found. The CY2026 HealthChoice MCO Agreement sets FFS-rate floors for some services (e.g., E&M codes, vaccines) but no nursing facility rate floor was located; MCO NF exposure is limited to the first 90 days. Source: https://health.maryland.gov/mmcp/healthchoice/Documents/CY%20…).pdf
Verified October 11, 2026
Included in the daily rate
Included: routine care, nursing, PT/OT/speech therapy, over-the-counter drugs, medical supplies and standard equipment (wheelchairs, walkers, standard beds), occasional/emergency oxygen, IV therapy, portable X-ray, special diets, tube feeding, restorative nursing (COMAR 10.09.10.04). Paid separately: support surfaces, bariatric beds, power wheelchairs, negative pressure wound therapy (COMAR 10.09.10.07C-E), continuous oxygen (COMAR 10.09.18), prescription drugs via pharmacy, physician and audiology services.
Verified October 11, 2026
Bed hold
- Hospital stays
Not paid since 7/1/2012.
- Leave days
Up to 18 days per calendar year for home visits or State-approved therapeutic programs, with physician authorization; paid at admin/routine + other patient care + capital (no nursing component), less patient resources (revenue code 0183; 7/1/2026 median $176.26/day).
- Occupancy rule
None.
- Notes
Residents keep re-admission rights after hospital stays even though the bed is not paid.
Verified October 11, 2026
Personal needs allowance
- Per month
109
- Effective
2026-07-01 (FY2027; PT 05-27)
- Notes
Indexed each July to the Social Security COLA (up to 5%) under COMAR 10.09.24.10; FY2026 was $106. An extra $50/month ($100 with two guardians) for guardianship fees; up to $90/month of a VA pension is excluded for single veterans.
Verified October 11, 2026
Medicare coinsurance days
- Method
lesser_of
- Rule
For dual eligibles on Medicare Part A days 21-100, Medicaid pays the coinsurance only up to the gap between the STATEWIDE average Medicaid rate and Medicare's per-day payment (Coinsurance Day, revenue code 0101). The Jan-Jun 2026 worksheet uses an average Medicaid rate of $365.76 (as of 7/1/2025) and the $217.00/day 2026 coinsurance: Medicaid pays the lesser of the coinsurance or (average Medicaid rate - Medicare paid per day). Treatment of Medicare Advantage cost-sharing was not found.
- Effect
Medicare's net SNF payment usually exceeds about $366/day, so Medicaid usually pays little or none of the $217 coinsurance; it pays the full coinsurance only when Medicare's net payment is below about $149/day.
Verified October 11, 2026
Required care spending
- Applies
yes
- Rule
Built into the nursing rate rather than a settlement: the nursing component is reduced by any amount by which the home's Medicaid-CMI-adjusted nursing cost per day (from its cost report) falls below 95% of its case-mix-adjusted nursing price, so a home keeps at most a 5% margin on nursing (COMAR 10.09.10.12C(4)). No minimum spending rule applies to other cost centers, and payments are not cost-settled.
Verified October 11, 2026
Occupancy rules
- Applies
yes
- Rule
Administrative/routine cost per day (at rebasing) and the capital fair rental value and real estate tax per diems are divided by the greater of actual resident days or licensed beds x (statewide average occupancy, excluding homes with waivers, + 1.5 points). Waivers are limited to new construction, disasters, bed reductions for renovation, and certain acquisitions (up to 12 months). Nursing and other patient care use actual days.
Verified October 11, 2026
MDS accuracy penalties
MDS data not submitted by the 25th day of the second month after the quarter are not used, and delinquent MDS are assigned the lowest PDPM CMI (PA1 0.62). Periodic MDS validation reviews compare coding with records and 'may be used to adjust a nursing facility's per diem payment rate to reflect the validated case mix index' (COMAR 10.09.10.12E-F, .24A). No error-rate threshold or fixed penalty is published.
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
quarterly
- When
January 1, April 1, July 1 and October 1: the nursing component is recalculated from the home's Medicaid CMI two quarters earlier (with the equalizer in Oct/Jan/Apr). Each July 1 prices are re-indexed or rebased, the budget adjustment factor and QA add-on are reset, and capital changes when a new appraisal is used.
Verified October 11, 2026
When rates change
July 1 state fiscal year plus quarterly case-mix updates on October 1, January 1 and April 1. Rate letters are issued through the Myers and Stauffer portal.
Verified October 11, 2026
Posted rates
- Home-level rates published
Yes
- Where
https://health.maryland.gov/mmcp/longtermcare/Pages/Nursing-F… (folder 'Quarterly Facility Case Mix and Rate Files' > 'Nursing Facility Rates Summary')
- Format
xlsx
- Cadence
Quarterly (one statewide rate transmittal per rate quarter, all billing revenue codes)
- History
Rate summaries from 7/1/2018 onward; quarterly CMI files from SFY2021 onward
- Home identifier
MSLC (Myers and Stauffer) ID, 9-digit Maryland Medicaid provider number, and facility name (no CCN or NPI)
Verified October 11, 2026
Rate build-ups
- Published
No
- Where
Facility rate letters with the cost-center build-up go privately through the Myers and Stauffer secure portal. Public: statewide rate transmittal and quarterly facility CMI averages (prelim/final, Section S) in the NF Document Library.
- What they show
Public: Resident Care Day (0120), ventilator (0129), administrative day (0169), leave-of-absence (0183) and per-day DME rates per home; facility average CMIs by quarter. Not public: cost-center prices, capital, QA add-on, BAF per home.
- Format
xlsx
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2024-07-01 | SFY2025 rates were increased by a 2.703% budget adjustment factor. | Budget adjustment factor of 2.703 percent | increase | BAF +2.703% | https://health.maryland.gov/regs/SiteAssets/Lists/Accordion/N… |
| 2025-01-01 | Case mix began a three-step phase-in from RUG to PDPM nursing CMIs, reaching 100% PDPM on 7/1/2025. | PDPM case-mix phase-in began | structural | https://health.maryland.gov/regs/SiteAssets/Lists/Accordion/N… | |
| 2025-07-01 | The SFY2026 budget gave no general rate increase; rates moved with case mix and a 0.176% budget adjustment factor. | Budget adjustment factor cut to 0.176 percent | structural | BAF 2.703% -> 0.176%; +$0.59/day, $3,042,972 | https://health.maryland.gov/regs/SiteAssets/Lists/Accordion/N… |
| 2025-07-01 | Quality assessment rates switched to a uniform percentage update (FY2026: standard $32.92 -> $32.94, top-five Medicaid homes $3.04 -> $2.70); FY2026 Q1-Q3 were reconciled and QA add-ons re-paid by gross adjustment. | Provider tax switched to uniform percentage method | structural | standard +$0.02/day; top-five homes -$0.34/day | https://health.maryland.gov/mmcp/provider/Documents/transmitt… |
| 2025-07-01 | Homes late on quality assessment payments became ineligible for pay-for-performance awards. | Late provider-tax payers lose P4P eligibility | structural | https://health.maryland.gov/regs/SiteAssets/Lists/Accordion/N… | |
| 2026-05-01 | The Interim Working Capital Fund (repayable advances up to 1.5% of prior-year Medicaid payments; about $20.5M projected in FY2026) expired, with balances due by 5/1/2026. | Interim Working Capital Fund expired | cut | $20,522,954 projected FY2026 advances | https://regs.maryland.gov/us/md/exec/comar/10.09.10 |
| 2026-07-01 | FY2027 rates were rebased with 2024 cost data and funded with a 1% increase in the aggregate nursing facility appropriation; the PNA rose from $106 to $109. | Rates rebased with one percent budget increase | increase | +1% aggregate NF appropriation | https://health.maryland.gov/mmcp/provider/Documents/transmitt… |
| 2026-07-01 | FY2027 quality assessment rates rose 3.54% to $34.11 per non-Medicare day (top-five Medicaid homes $2.80). | Provider tax raised 3.54 percent | structural | $32.94 -> $34.11/day | https://health.maryland.gov/mmcp/provider/Documents/transmitt… |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
Home and Community-Based Options Waiver (Community Options, 1915(c); COMAR 10.09.54), for adults meeting nursing facility level of care
- What is paid
Assisted living services only; room and board are excluded and paid by the resident (provider room-and-board charge counted up to $420/month, with the PNA protected; COMAR 10.09.54.07, .13C).
- Rate
Maximum per diem from 7/1/2024: Level II $90.74, Level III $114.51 (no medical day care); $68.09 / $85.86 when the person also attends medical day care (COMAR 10.09.54.22D(2)).
- Limits
CMS cap of 6,348 waiver slots through 2026, rising to 7,500 on 1/1/2027; 4,941 budgeted slots in FY2026 (4,562 filled as of 3/31/2026); entry is from a registry (waitlist), with about 700 invitations a month.
Verified October 11, 2026
Sources
- COMAR 10.09.10 Nursing Facility Services (full chapter, incl. amendments eff. 8/17/2026) · regulation
- Maryland Register 53:8 (4/17/2026) proposal amending COMAR 10.09.10 (PDPM, FY2026 BAF 0.176%, P4P eligibility, IWCF) · regulation
- COMAR 10.01.20 Nursing Facility Quality Assessment · regulation
- PT 30-27 / NH Transmittal 315: FY 2027 Quality Assessments Reporting and Payments (9/29/2026) · agency page
- PT 10-27 / NH Transmittal 313: Nursing Facility Quality Assessment Methodology Change (8/17/2026) · agency page
- PT 05-27 / NH Transmittal 312: FY 2027 Rates for Nursing Facility Services (7/10/2026) · agency page
- PT 06-26 / NH Transmittal 303: FY 2026 Rates for Nursing Facility Services (8/5/2025) · agency page
- FY 2025 Nursing Home Quality Assessment Implementation Annual Report (Sept 2025) · agency page
- Nursing Facility Reimbursement Manual (revised June 2025) · agency page
- Statewide NF Rate Transmittal effective 7/1/2026 (rev. 7/13) · rate file
- Nursing Facility Document Library (rate summaries, CMI files, coinsurance worksheets, P4P scores) · agency page
- Medicare Coinsurance Worksheet January-June 2026 · rate file
- FY2026 Pay-for-Performance scores and awards · rate file
- CY 2026 HealthChoice MCO Agreement (incl. COMAR 10.67 appendix) · agency page
- COMAR 10.67.06 HealthChoice benefits (long-term care facility services, first 90 days) · regulation
- COMAR 10.09.24 Medical Assistance eligibility (personal needs allowance) · regulation
- COMAR 10.09.54 Home and Community-Based Options Waiver · regulation
- CFC and Community Options Waiver financial and registry data report (Aug 2026) · agency page
- Nursing Home Transmittal 241: Reimbursement of Hospital Bedhold (July 2012) · agency page
- MD SPA 15-0001, Attachment 4.19-D (2015 price-based system) · state plan
- MACPAC Nursing Facility Payment Policies compendium (2019 baseline, Maryland tab) · secondary
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