How Maryland pays for disability services

Waiver inventory

The Home and Community Based Options Waiver (MD.0265) and Medical Day Care Services Waiver (MD.0645) are excluded as aging and physical disability focused. The New Directions Independence Plus Waiver (MD.0424) terminated 6/30/2013.

State-only funded programs

• Low Intensity Support Services (LISS). Grants of up to $1,000 per funding round to children living at home with family and adults in their own community home who have developmental or intellectual disabilities and are not currently receiving other DDA support services. Awards are by random selection in designated rounds; FY2027 Round 1 opened August 1, 2026. The FY2026 budget bill added $2,000,000 to preserve the program and lower the per-participant cap from $2,000 to $1,000, instead of eliminating LISS entirely as originally proposed. Administering agency: DDA. health.maryland.gov and mgaleg.maryland.gov
• State-only funded service lines inside the LTSSMaryland rate chart. Four services are explicitly labeled "State Only Funded" and carry published rates: Camp Non-Respite (code 7248, upper payment limit $7,248); Nursing Skilled Nursing Services ($30.77 per quarter hour standard, $32.99 differential); Rent Individual Support (upper payment limit $20,000); and Other (upper payment limit $396,000). health.maryland.gov
• State Funded Conversions reserved slot category. One of DDA's 17 reserved waiver slot categories, covering individuals funded entirely with State funds. DDA held 1,424 reserved slots across all reserved categories in FY2025. Budget analysis, same URL as above.
• Waiting List Equity Fund (WLEF). Ensures funding attached to a person in a State Residential Center follows them into the community for their first year, after which they join the base budget. The Budget Reconciliation and Financing Act of 2025 removed the prohibition on using the fund to supplant emergency placement or transitioning youth spending, and the entire accumulated balance was consumed in FY2025 to supplant general fund spending. FY2025 expenditures grew to $18.9 million; the fund had run annual balances of $10.3 million to $14.8 million from FY2020 through FY2024. Same URL.
• Ethiopian Eritrean Special Needs Community grant. $25,000 in general funds added by Section 21 of the FY2026 Budget Bill for the Family Support and Empowerment Program; one-time, removed in FY2027. Same URL.
• Community Services Trust Fund. A special fund used for general fund relief. $15.0 million was transferred in the FY2026 appropriation, plus a $17.6 million deficiency fund swap. Special funds drop from $41.3 million in the FY2026 working appropriation to $2.5 million in the FY2027 allowance, a 94% decrease, indicating the balance has been largely exhausted. Same URL.

County / regional / local funding

None identified. Maryland's DDA system is state-administered through four DDA regional offices ($17.1 million in the FY2027 allowance), which are state units with no independent revenue. There are no county boards of developmental disabilities, county levies, or mill levies for developmental disabilities in Maryland.

The one county-touching item is state money flowing to counties, not local money: the FY2027 allowance adds $233,000 for a summer grant program for various county Parks and Recreation departments to support summer programs serving youth with disabilities. mgaleg.maryland.gov

I checked the DDA FY2027 legislative budget analysis in full, the DDA services and rates pages, and the DDA home page navigation, and found no sub-state revenue stream.

Funding scale

All figures from the Analysis of the FY 2027 Maryland Executive Budget, M00M, Developmental Disabilities Administration, unless noted. mgaleg.maryland.gov

• FY2025 actual total DDA spending, all funds: $3,234,870,453. General funds $1,665,238,474. Special funds $18,912,490. Federal funds $1,550,719,489.
• FY2026 working appropriation: $3,817,924,048 (general $2,004,334,418; special $41,333,616; federal $1,772,256,014). This includes deficiency appropriations totaling $736.6 million, of which $356.6 million covers FY2025 shortfalls and $380.0 million covers FY2026 shortfalls.
• FY2027 allowance: $3,275,640,536, a decrease of $542,283,512 or 14.2% from the FY2026 working appropriation. General $1,728,261,933 (down 13.8%); special $2,500,000 (down 94.0%); federal $1,544,763,729 (down 12.8%); reimbursable $114,874.
• State vs federal share: essentially 50/50, consistent with Maryland's FMAP. FY2025 actual: 51.5% general fund, 47.9% federal.
• FMAP: 50.00% across FY2024, FY2025, FY2026, and FY2027. Maryland sits at the statutory floor. kff.org
• Spending per participant, FY2025: traditional services model $179,517 per participant ($2.6 billion serving 14,535 people); self-directed services model $138,425 per participant ($566.0 million serving 4,089 people).
• Residential cost per person: FY2025 average annual cost per residential services client $232,231; DDA estimates $239,616 for FY2027. Meaningful Day Services average annual cost per person is $37,296 (FY2025).
• People served: 19,158 individuals enrolled in DDA waivers in FY2025, of whom 15,190 (79%) were in the traditional model and 3,968 (21%) in self-direction. 20,376 served in Community Services excluding supports-only, up 295 (1.5%) from FY2024. 94.0% of Community Services participants were in a waiver in FY2025, down from 94.8% in FY2024.
• Waiting list: 3,465 individuals as of June 30, 2025, the lowest total in at least eight years and a decrease of 511 from FY2024. Broken out: Crisis Resolution 2, Crisis Prevention 202, Current Request 3,261. The FY2018 peak was 5,637. Individuals on the waiting list who do not meet the statutory definition of developmental disability are tracked separately in a supports-only category and are not in these counts. Everyone on the waiting list may receive case management from a Coordinator of Community Services. Average wait time is not published; DDA prioritizes by need category rather than queue position.
• Growth driver: Community Services program spending nearly doubled (96% increase) from $1.7 billion in FY2022 to $3.3 billion in the FY2027 allowance, driven primarily by the migration from the legacy PCIS2 prospective payment system to LTSSMaryland fee-for-service, which incorporated provider rate payments roughly 18% higher than the legacy system.

Residential funding detail

Residential services are the dominant cost center: $1,817.7 million, or 55% of the FY2027 Community Services allowance, against $610.9 million (19%) for Meaningful Day, $551.7 million (17%) for Support Services, $137.7 million (4%) for Coordinators of Community Services, and $103.9 million (3%) for other programs including state-only funded services and summer programs. FY2025 was the first year in which more participants received Residential Services (6,849) than Meaningful Day Services (5,984). Community Living Group Home alone accounted for 32% of all FY2025 spending, the single largest service line.

Community Living Group Home (W5600), per diem, priced by home size. Maryland's rate structure is unusual: the per diem varies non-monotonically with home size because it reflects modeled staffing patterns, not a simple economy-of-scale curve. FY2027 standard rates with overnight staffing, effective July 1, 2026:

Without overnight staffing: 1 person $438.02, 2 $328.52, 3 $255.51, 4 $328.52. A Trial Experience rate applies to short-term placements ($423.05 standard with overnight, $238.01 without). Retainer fee codes exist (W5604 group home, W5605 enhanced supports). Community Living Enhanced Supports (W5601) is priced on the same tab.

Supported Living (W5620), per diem, uses the identical rate schedule to group home: 1 person with overnight $737.16, 2 $478.09, 3 $355.23, 4 $403.30; without overnight 1 $438.02, 2 $328.52, 3 $255.51, 4 $328.52.

Shared Living, paid monthly rather than per diem, in three levels: Level 1 (W5611) $4,509.84 per month, Level 2 (W5892) $5,176.75, Level 3 (W5893) $6,177.08. No geographic differential applies to shared living.

Dedicated Hours, the acuity mechanism layered on top of residential per diems, billed by the quarter hour: Community Living Group Home 1:1 (W1999) $11.4423 standard / $12.59 differential; 2:1 (W2000) $22.8846 / $25.17. Community Living Enhanced Supports 1:1 (W2001) $12.7427 / $14.02; 2:1 (W2002) $25.4854 / $28.03. Supported Living 1:1 (W2031) $11.4423 / $12.59; 2:1 (W2032) $22.8846 / $25.17. Dedicated Hours accounted for 18% of all FY2025 spending, the third largest line, and are the primary target of FY2026 and FY2027 cost containment.

The geographic differential adds roughly 10% to the standard rate for most services in designated higher-cost jurisdictions. The FY2026 budget bill added $37.69 million specifically to lower the differential to 10% for services previously receiving a higher percentage, rather than eliminate it.

Live In Caregiver Supports (W5877), upper payment limit $20,000.

Room and board is excluded from Medicaid payment and falls to the participant. The Community Pathways waiver application states, in Appendix I-5, that the rate consultant "excluded the cost of room and board from service costs in determining payment rates for Community Living-Group Home and Community Living-Enhanced Supports. The Medicaid payment does not include either of the following items which the provider is expected to collect from the participant: (1) Room and board; or (2) Any assessed amount of contribution by the participant for the cost of care." Respite rates likewise exclude room and board. This is the standard 42 CFR §441.310(a)(2) exclusion, so participants pay housing costs from SSI and other income. Maryland does provide a state-only funded Rent Individual Support line with a $20,000 upper payment limit on the LTSS rate chart, which is the one place state dollars touch housing directly. health.maryland.gov

Rate structure link: health.maryland.gov (tabs: LTSS Rates, CL Rates, SL Rates)

Comparable service rates

All rates from the FY2027 LTSSMaryland Rate Chart, effective July 1, 2026. Standard rate first, geographic differential rate second where applicable.

Additional lines of interest: Behavioral Support Services Behavioral Consultation (W5707) $43.26 per quarter hour; Nursing Support Services (W5804) $30.77 / $32.99; Housing Support Services (W2018) $20.29 / $22.32; Family and Peer Mentoring Supports (W2012) $16.54; Environmental Modification (W5750) $50,000 UPL; Remote Support Services (W5820) $64,000 UPL; Transition Services (W5860) $5,000 UPL; Transportation (W5862) $7,500 UPL; Vehicle Modification (W5871) $15,000 UPL; Assistive Technology and Services (W5690) $100,000 UPL with a new monthly service fee (W5696) of $90.

Official rate schedule links

• DDA rates hub with full version history: health.maryland.gov
• FY2027 LTSSMaryland Rate Chart, effective July 1, 2026 (current): health.maryland.gov
• FY2026 LTSSMaryland Rate Chart, effective October 6, 2025: health.maryland.gov
• FY2026 LTSSMaryland Rate Chart, effective July 1, 2025: health.maryland.gov
• FY2025 LTSSMaryland Rate Chart, effective July 1, 2024: health.maryland.gov
• Self-Directed Services Reasonable and Customary Standards, May 2026, Employees: health.maryland.gov
• Self-Directed Services Reasonable and Customary Standards, May 2026, Individual Providers: health.maryland.gov
• Self-Directed Services Reasonable and Customary Standards, May 2026, DDA Providers: health.maryland.gov
• Medicaid Rate Transmittal PT 09-25, FY25 Rates for Medicaid Waiver Programs Operated by DDA: health.maryland.gov
• Legacy PCIS2 prospective payment rates, effective 7/1/2024: health.maryland.gov
• FY2024 Brick Components (rate build-up detail): health.maryland.gov
• Self-Directed Services Reasonable and Customary Wages and Rate Update Guidance: health.maryland.gov
• Community Pathways Waiver renewal application MD.0023.R08.00: health.maryland.gov

Notable features and flags

• October 6, 2025: DDA consolidated its three waivers into one. Community Supports Waiver (MD.1506) and Family Supports Waiver (MD.1466) both terminated October 5, 2025, and their participants moved into Community Pathways (MD.0023.R08.00). DDA cited streamlined access, more consistent person-centered support, and system simplification. Community Pathways was already the only waiver offering residential services and the only one covering all three service categories. This is the single most consequential structural change in any of these three states.
• September 1, 2024: the LTSSMaryland transition completed. All 338 DDA providers moved from the legacy PCIS2 prospective payment model to fee-for-service billing in LTSSMaryland. The transition carried roughly 18% higher aggregate provider payments and is the primary reason Community Services spending nearly doubled from $1.7 billion (FY2022) to $3.3 billion (FY2027 allowance). Because the fee-for-service system allows claims up to a year after service, FY2025 absorbed a large tail of prior-period claims, contributing to a $356.6 million FY2025 shortfall ($189.8 million general funds).
• FY2026 and FY2027 cost containment is the dominant policy story. The Governor's FY2026 plan proposed $52.3 million (FY2025) and $202.3 million (FY2026) in general fund reductions. The General Assembly restored $34.2 million (FY2025) and $132.2 million general plus $15 million special (FY2026), itemized as: $51.85 million to lower the dedicated hours rate rather than require shared hours be maximized first; $37.69 million to cap the geographic differential at 10% rather than eliminate it; $36.0 million to freeze self-directed reasonable and customary wages; $12.7 million to cap wage exceptions at 15% standard and 10% differential rather than eliminate the exception process; $7.0 million to move day-to-day administrator services out of IFDGS onto a separate service line; and $2.0 million to preserve LISS at a $1,000 cap. The FY2027 allowance nonetheless includes $149.5 million in general fund reductions across four cost containment actions (dedicated hours, reasonable and customary wages, wage exception process, and a new cap on person-centered plan budgets), totaling $299.0 million in all funds.
• June 30, 2026: DDA had not yet submitted its Community Pathways waiver amendment to CMS, which has 90 days to review. Disability Rights Maryland reports DDA postponed the self-direction budget methodology to January 1, 2027, postponed direct DDA payment of Financial Management and Counseling Services costs to January 1, 2027, and extended the unlicensed vendor transition deadline by 45 days to August 15, 2026. The proposed amendment covers rate methodology changes, new provider licensure requirements, and changes to the 60/40 Rule with emergency staffing-continuity exceptions. disabilityrightsmd.org and health.maryland.gov
• Self-direction is large and cheaper per person. 3,968 of 19,158 waiver participants (21%) self-direct, accounting for 15% of the FY2027 allowance. Self-directed cost per participant is $138,425 versus $179,517 in the traditional model, though the gap partly reflects that self-directing participants have limited access to residential services. Self-directed participants get IFDGS and Support Broker services that traditional-model participants cannot use. Reasonable and Customary wage standards for self-direction were last updated May 2026.
• The waiting list is shrinking while spending climbs. 3,465 people as of June 30, 2025, down 511 year over year and the lowest in eight years, against an FY2018 peak of 5,637. Crisis Resolution is down to 2 people. Meanwhile DDA filled only 19,158 of 21,209 authorized slots (90%), with 1,424 slots deliberately reserved across 17 priority categories. The FY2027 allowance budgets 994 new participants.
• Legislative oversight is intensifying. DLS recommends four budget language restrictions on FY2027 funds pending quarterly community services spending reports, a utilization trends report, a cost containment implementation report, and a restriction limiting Community Services appropriations to that purpose only, plus committee narrative on person-centered plan review processing times. A May 2026 Office of Legislative Audits review addressed four repeat findings from the October 2022 DDA fiscal compliance audit. health.maryland.gov

Confidence

Solid: every rate in the comparable services table and the residential detail section, taken cell by cell from the FY2027 LTSSMaryland Rate Chart spreadsheet; the full fund breakdown for FY2025 actual, FY2026 working, and FY2027 allowance; enrollment, slot fill rates, waiting list counts by priority category across FY2018 to FY2025; per-participant costs by service model and by residential status; the waiver consolidation and the CMS control numbers and termination dates; the itemized cost containment restorations; and FMAP. Estimated: nothing material. Not found: enrollment figures for the Maryland Waiver for Children with Autism Spectrum Disorder (MD.0339), the Model Waiver for Fragile Children, or the Brain Injury Waiver, since none are DDA-administered and the MDH waiver program pages I could retrieve now describe only Community Pathways; published average wait time on the DDA waiting list; State Residential Center census; and any published dollar total for the state-only funded service lines beyond their per-unit rates and upper payment limits. The Maryland Autism Waiver's own program page returned errors during this session, so its row in the inventory carries only what medicaid.gov confirms.