Maryland Supported Decision-Making: The 2022 Law, How It Works, and SDM vs. Guardianship

What Supported Decision-Making Is

When a young adult with intellectual or developmental disabilities turns 18, they become a legal adult with full decision-making authority. Many parents assume guardianship is the only option to stay involved in their adult child's medical, financial, and housing decisions. But guardianship is the most restrictive choice available — it requires a court proceeding, strips the individual of specific civil rights, and imposes ongoing judicial oversight.

Maryland enacted its Supported Decision-Making (SDM) statute in October 2022, under Title 18 of the Estates and Trusts Article (§§ 18-101 to 18-109). SDM provides a legally recognized alternative. Instead of transferring decision-making authority to a guardian, it keeps full legal capacity with the individual while formally designating trusted "supporters" who help them understand, evaluate, and communicate decisions.

The adult remains the decision-maker. The supporters help by gathering information, explaining options, and assisting with communication — but they cannot make decisions on the individual's behalf.

How an SDM Agreement Works

Under § 18-107, a valid Maryland SDM agreement must be:

• In writing and dated
• Signed by the adult and each named supporter
• Witnessed by two independent adults — neither witness can be a named supporter, and neither can be an employee or agent of any named supporter

The agreement must specify:

• At least one named supporter
• The specific areas where the supporter may provide assistance (healthcare, finances, employment, housing, or any combination)
• How multiple supporters will coordinate if more than one is appointed
• How potential conflicts of interest will be addressed
• The process by which the adult selected the supporter
• A clear statement that the supporter has no authority to make decisions or execute transactions on behalf of the adult
• A clear statement that the agreement does not replace a Durable Power of Attorney or an Advance Directive

This last requirement is important. SDM is not a power of attorney. A supporter cannot sign a lease, authorize a medical procedure, or open a bank account on the individual's behalf. They can attend appointments, help the individual understand what the doctor is recommending, and support the individual in communicating their decision — but the individual signs, not the supporter.

Legal Recognition by Third Parties

Maryland law requires doctors, bankers, landlords, and other third parties to recognize valid SDM agreements. If an adult presents a properly executed SDM agreement and their supporter is present, the third party must engage with both of them — providing information to the supporter, accepting the individual's decisions made with support, and not refusing service simply because a supporter is involved.

This legal recognition is what makes SDM practically useful rather than just aspirational. Before the 2022 law, a parent sitting in on their adult child's doctor appointment had no formal standing. The doctor could legally refuse to share information with the parent, even if the adult child wanted them there. With a valid SDM agreement, the supporter's role is codified and enforceable.

SDM vs. Guardianship: When Each Applies

SDM is appropriate when the individual can make decisions with support — they understand the concept of choices, can express preferences (even non-verbally), and can participate in the decision-making process when information is presented accessibly. Most adults with intellectual and developmental disabilities fall into this category.

Guardianship may still be necessary when the individual has such severe cognitive impairment that they cannot participate in decision-making even with support. Court guardianship requires:

• Filing a petition in the local circuit court
• Two clinical certificates of incapacity from qualified professionals
• A formal hearing with notice to the individual
• Ongoing court supervision and annual reporting

Maryland law requires courts to consider less restrictive alternatives — including SDM — before granting guardianship. If a family petitions for guardianship and the court determines that SDM would be sufficient, the petition may be denied or the guardianship may be limited in scope.

The practical spectrum for most Maryland families:

Many families use SDM in combination with a Durable Power of Attorney and/or an Advance Directive — a layered approach that preserves autonomy in areas where the individual can participate while providing legal authority in areas where they need full representation.

Supporter Duties Under the Law

Under § 18-105, a supporter must:

• Respect the preferences and self-determination of the adult
• Avoid substituting their own judgment for the adult's
• Act in good faith
• Avoid conflicts of interest
• Maintain detailed records of their actions
• Make records available to the adult on request

The record-keeping requirement is more than a formality. If a dispute arises — whether with a third party who refuses to recognize the agreement, or between the supporter and another family member — the supporter's records are the primary evidence of how the agreement has been operating.

Getting Started

An SDM agreement does not require an attorney, though legal guidance can help ensure the document meets all statutory requirements and is properly witnessed. Parents' Place of Maryland (PPMD), the Maryland Developmental Disabilities Council, and Disability Rights Maryland all offer resources and guidance on creating SDM agreements.

The conversation should start before the 18th birthday — ideally at age 17, when the family is evaluating the full spectrum of decision-making options. Waiting until a crisis forces the issue (a hospital demanding a guardian's signature, a landlord refusing to rent without a co-signer) creates unnecessary pressure.

For the complete decision-making framework alongside SSI, Medicaid, and DDA transitions at age 18, the Maryland SSI at 18 & Adult Disability Benefits Guide covers each legal structure and when to use it.

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