Maryland Community Pathways Waiver: Services, Eligibility, and the 2025 Consolidation

The 2025 Consolidation — What Changed

Before October 6, 2025, Maryland's DDA operated three separate home and community-based services (HCBS) 1915(c) waivers:

• Family Supports Waiver — capped at $12,000 annually, designed primarily for children living with family
• Community Supports Waiver — capped at $25,000 annually, a middle-tier option
• Community Pathways Waiver — comprehensive, no rigid dollar cap, covering the full array of residential, day, and support services

On October 6, 2025, CMS approved the Maryland Department of Health's amendment to consolidate the Family Supports and Community Supports waivers into the Community Pathways Waiver. The two smaller waivers no longer exist as standalone programs.

The consolidation eliminated the rigid $12,000 and $25,000 annual spending caps. Under the unified Community Pathways Waiver, services are authorized based on assessed functional needs through the person-centered planning process, not by which waiver category someone happened to be enrolled in. Previous participants in the smaller waivers were transitioned to the consolidated Community Pathways Waiver without a loss of services.

What Services the Community Pathways Waiver Covers

The Community Pathways Waiver funds services across several categories, available in both Traditional (agency-directed) and Self-Directed delivery models:

Personal Supports: Direct assistance with activities of daily living — bathing, dressing, meal preparation, mobility, community access. This is the most commonly used service category.

Meaningful Day Services: Day habilitation programs, prevocational services, and community-based day supports focused on skill development, socialization, and community integration.

Employment Services: Supported employment (job coaching in integrated competitive settings), customized employment, and career exploration. The DDA prioritizes employment as a first option before day program placement.

Residential Services: Supported living, shared living (living with a host family), group homes, and community living supports for people who need 24-hour or overnight assistance.

Respite Care: Temporary relief for primary caregivers — both in-home and out-of-home respite options.

Support Broker Services: For self-directed participants, a support broker assists with navigating the administrative requirements of managing staff, budgets, and service scheduling.

Behavioral Support Services: Behavioral assessments, behavioral intervention plans, and ongoing behavioral consultation.

Assistive Technology and Environmental Modifications: Equipment, devices, and home modifications needed for health, safety, or community participation.

Eligibility Requirements

To access the Community Pathways Waiver, a person must meet all of these criteria:

1. DDA eligibility — determined by the DDA based on documentation of a developmental disability originating before age 22 with substantial functional limitations in three or more life areas
2. Medicaid eligibility — either through SSI automatic enrollment (Section 1634 agreement), the Aged/Blind/Disabled pathway, or the Employed Individuals with Disabilities program
3. Waiver funding — a funded slot must be available, which depends on the individual's priority category on the DDA waiting list and the state's budget allocation for new slots

DDA eligibility alone does not give access to waiver services. The waiting list stands between eligibility and funded services. Only when funding is allocated to an individual's slot do waiver services begin.

Financial Rules

For waiver participants, the monthly income limit in 2026 is $2,982. Individuals with income above that threshold may still qualify through Maryland's medically needy spend-down process, where excess income is applied to medical expenses until the countable amount drops below the limit.

The standard resource limit for waiver participants is $2,000 (aligned with SSI). ABLE account balances up to $100,000 are excluded from this count.

Person-Centered Plan budgets are capped at $500,000 annually, with an exception process allowing up to $625,000 for individuals whose health and safety needs require it.

Participants must use at least one waiver service every 183 days to maintain enrollment. A service gap exceeding six months can trigger disenrollment.

How This Affects Families in Transition

For families with a teenager approaching 18, the consolidation simplifies the landscape. There is now one waiver to understand rather than three. The DDA application process feeds into this single waiver. The priority categories (Crisis Resolution, Crisis Prevention, Current Request) are the same as before.

The practical challenge hasn't changed: state budget constraints remain the bottleneck. The FY2026 and FY2027 budgets reduced DDA funding significantly, which means fewer new waiver slots opening each year even under the streamlined system.

For a step-by-step guide to coordinating the DDA waiver application with SSI, Medicaid, and school transition deadlines, the Maryland SSI at 18 & Adult Disability Benefits Guide maps the full multi-agency timeline.

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