This page provides a plain-English summary of key elder care and estate planning information specific to Maryland residents. It covers Maryland Medicaid limits, estate and inheritance tax rules, advance directive information, and links to important Maryland agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
Maryland Medicaid — 2026 Eligibility Limits for Long Term Care
Maryland’s Medicaid program is called Medical Assistance — MA — and is administered by the Maryland Department of Health. Long term care programs are delivered through the Long Term Services and Supports — LTSS — system. Maryland expanded Medicaid under the Affordable Care Act in 2014 providing coverage to a broader range of residents.
Income rules for nursing home Medicaid — no hard income cap Maryland nursing home Medicaid does not use a fixed income cap. Instead virtually all of a nursing home resident’s monthly income — with the exception of a personal needs allowance Medicare premiums and a spousal allowance — must be paid toward the cost of nursing home care. Applicants whose income exceeds $2,982 per month must use a Qualified Income Trust — also called a Miller Trust or QIT — to direct excess income.
Asset limit — single applicant A single applicant must have $2,500 or less in countable assets in 2026 — slightly higher than the $2,000 standard used in most states. Exempt assets include the primary residence with equity up to $1,130,000 — Maryland uses the federal maximum home equity limit reflecting the state’s high real estate values — if the applicant intends to return home, one vehicle, personal belongings and household furnishings, and irrevocable burial trusts.
Home and community based care — HCBS Waivers Maryland offers several HCBS Waiver programs providing home and community based services as an alternative to nursing home placement. The primary program is the Home and Community-Based Options Waiver — HCBOW. The asset limit is $2,500 for a single applicant and the income cap is $2,982 per month. Note that HCBS Waiver programs may have limited enrollment slots.
Community First Choice and Community Personal Assistance Services Maryland offers two additional programs — Community First Choice — CFC — and Community Personal Assistance Services — CPAS — that provide personal care services without requiring nursing facility level of care. These are entitlement programs with no waiting lists. CFC has the same income and asset limits as nursing home Medicaid. CPAS has a very low income limit of $350 per month but no asset test.
Married couples — one spouse applying When only one spouse applies for Maryland Medicaid the community spouse — the spouse who remains at home — may retain 50 percent of the couple’s combined countable assets up to a maximum of $162,660. If 50 percent of the couple’s assets is less than $32,532 the community spouse may retain up to $32,532. The applicant spouse retains $2,500.
Monthly Maintenance Needs Allowance The minimum Monthly Maintenance Needs Allowance for the community spouse is $2,643.75 per month in 2026. The maximum is $4,066.50 per month for community spouses with high housing costs.
Personal needs allowance Maryland nursing home Medicaid recipients are allowed to keep $102 per month as a personal needs allowance. The remainder of income is applied toward the cost of care.
Look-back period and divestment penalty Maryland has a 60-month — five year — look-back period for nursing home Medicaid and HCBS Waiver applications. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. The 2026 divestment penalty divisor in Maryland is approximately $11,700 per month.
Estate recovery Maryland requires Medicaid estate recovery. After a Medical Assistance recipient dies the state seeks reimbursement from the estate for long term care costs paid. Planning with an elder law attorney can help protect assets from estate recovery.
How to apply for Maryland Medical Assistance Applications can be submitted online through Maryland Health Connection at marylandhealthconnection.gov, by phone at 1-855-642-8572, or in person at your local Department of Social Services office.
Maryland Medicaid administering agency Maryland Department of Health — health.maryland.gov
Maryland Estate Tax and Inheritance Tax — 2026
Maryland holds a unique and important distinction — it is the only state in the United States that imposes both a state estate tax and a state inheritance tax. This makes Maryland estate planning significantly more complex than in most other states and makes working with a Maryland-licensed estate planning attorney especially important.
Maryland state estate tax Maryland imposes a state estate tax on estates exceeding $5,000,000 per individual in 2026. The exemption has been $5 million since 2019 and is not indexed for inflation. The Maryland estate tax rate is graduated with a top marginal rate of 16 percent on amounts above the exemption. Maryland allows portability of the estate tax exemption between spouses — meaning a married couple can protect up to $10,000,000 from Maryland estate tax with proper planning using a portability election on a timely filed estate tax return.
Important — the $10 million gap The federal estate tax exemption is $15,000,000 per person in 2026 while Maryland’s exemption remains at $5,000,000. This means Maryland residents with estates between $5 million and $15 million owe no federal estate tax but may owe substantial Maryland estate tax — up to $800,000 on a $10 million estate. This gap is a critical planning consideration for Maryland residents with significant assets including home equity retirement accounts business interests and life insurance.
Maryland inheritance tax Maryland also imposes a separate inheritance tax of 10 percent on assets received by non-exempt beneficiaries. The inheritance tax is paid by the beneficiary and is based on who receives the assets rather than on the total size of the estate.
The following beneficiaries are completely exempt from Maryland inheritance tax — spouses domestic partners children grandchildren parents grandparents siblings stepchildren and stepparents. Charities are also exempt.
The following beneficiaries are subject to Maryland’s 10 percent inheritance tax — nieces nephews cousins friends unmarried partners and any other beneficiary who does not fall into an exempt category.
This is a significant planning consideration for Maryland residents who wish to leave assets to people who are not immediate family members. Even modest bequests to a friend or unmarried partner could trigger a 10 percent tax.
Credit between Maryland estate tax and inheritance tax If an estate owes both Maryland estate tax and Maryland inheritance tax on the same assets the inheritance tax paid is credited against the estate tax — so the same assets are not fully double-taxed. However this credit does not eliminate the burden entirely for large estates.
No Maryland gift tax Maryland does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026. Lifetime gifting is an effective strategy for Maryland residents looking to reduce their state estate tax exposure since gifts remove assets from the taxable estate without any Maryland gift tax consequences.
Federal estate tax Maryland residents may also be subject to the federal estate tax on estates exceeding $15,000,000 per person in 2026.
Maryland estate tax is serious business Given Maryland’s relatively low $5 million estate tax exemption its high top rate of 16 percent its unique dual estate and inheritance tax system and the significant home values in the Baltimore and Washington DC metro areas Maryland residents approaching or exceeding the $5 million threshold should consult a Maryland estate planning attorney. Many Maryland families are surprised to find they have more than $5 million in combined home equity retirement accounts and other assets.
Maryland Advance Directives
Maryland law recognizes the following advance directive documents:
Maryland Advance Directive Maryland uses a single combined Advance Directive form that includes both the appointment of a healthcare agent and the declaration of treatment preferences. Must be signed and witnessed by two adults who are not the healthcare agent.
Maryland MOLST — Medical Orders for Life-Sustaining Treatment Maryland uses a MOLST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be signed by a physician or nurse practitioner. Maryland’s MOLST is one of the more comprehensive POLST forms in the country and is widely used in hospitals nursing homes and hospice settings.
Maryland Do Not Resuscitate Order A physician order directing emergency personnel not to perform CPR. Maryland has standardized out-of-hospital DNR protocols.
Maryland Advance Directive Registry Maryland maintains a statewide advance directive registry through the Secretary of State’s office. Maryland residents can register their advance directives to ensure healthcare providers can access them. Website: sos.maryland.gov — search Advance Directive Registry
Free Maryland advance directive forms Free Maryland-specific advance directive forms are available at caringinfo.org and from the Maryland Attorney General’s office at oag.state.md.us.
Maryland Key Agencies and Resources
Maryland Department of Health — MDH Administers Medical Assistance — Maryland Medicaid — and the LTSS long term care programs. Website: health.maryland.gov Maryland Health Connection: marylandhealthconnection.gov Phone: 1-855-642-8572
Maryland Department of Aging — MDoA Coordinates programs and services for older Marylanders including home care nutrition programs caregiver support and the Maryland SHIP program for free Medicare counseling. Website: aging.maryland.gov Phone: 1-410-767-1100 Maryland SHIP — free Medicare counseling: 1-800-243-3425
Maryland Area Agencies on Aging Maryland is served by 19 Area Agencies on Aging that coordinate local services for older adults and caregivers. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
Maryland Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and assisted living facilities. Investigates complaints and helps resolve problems free of charge. Website: aging.maryland.gov/Pages/long-term-care-ombudsman.aspx Phone: 1-410-767-1074
Maryland Comptroller — Estate Tax Administers Maryland’s estate and inheritance taxes. Website: comp.state.md.us Phone: 1-410-260-7850
Maryland State Bar Association Lawyer Referral Service Connects Marylanders with attorneys including those who specialize in elder law and estate planning. Website: msba.org Phone: 1-800-492-1964
Maryland Legal Aid Provides free civil legal services to low income Marylanders including seniors on issues related to Medicaid benefits housing and elder law. Website: mdlab.org Phone: 1-800-999-8904
Maryland Veterans Resources
Maryland Department of Veterans Affairs — MDVA Provides services and benefits to Maryland veterans and their families including free VA claims assistance and connections to Maryland veterans resources. Website: veterans.maryland.gov Phone: 1-800-446-4926
Maryland State Veterans Homes Maryland operates veterans homes providing long term care to eligible veterans and their spouses. Facilities are located in Charlotte Hall and Thurmont. Website: veterans.maryland.gov/veterans-homes
Maryland Senior Property Tax Benefits
Homeowners Tax Credit — Circuit Breaker Maryland offers a Homeowners Tax Credit program that limits property taxes to a percentage of income for qualifying homeowners of any age including seniors. Income and property value limits apply. Apply through the Maryland Department of Assessments and Taxation — SDAT. Website: dat.maryland.gov Phone: 1-410-767-4433
Senior Tax Credit Homeowners aged 70 and older who meet income requirements may qualify for an additional property tax credit in Maryland. The credit reduces property taxes for qualifying seniors with lower incomes. Apply through your county government.
Renters Tax Credit Maryland also offers a tax credit for lower income renters including seniors. Apply through the Maryland Department of Assessments and Taxation.
Finding Elder Law and Estate Planning Attorneys in Maryland
The following resources can help you find a qualified elder law or estate planning attorney in Maryland:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- Maryland State Bar Association Lawyer Referral Service — msba.org — 1-800-492-1964
- Maryland Chapter of NAELA — Maryland has an active NAELA chapter with members throughout the state
- Maryland Legal Aid — mdlab.org — free legal assistance for income-qualifying seniors — 1-800-999-8904
The information on this page is for general informational purposes only and does not constitute legal or financial advice. Maryland Medicaid rules estate tax rates and other figures change frequently — Maryland estate tax law in particular is actively discussed in the legislature and may change. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: April 2026