For most Maryland families, the question of how to pay for assisted living is harder than the question of whether to make the move. The CareScout 2025 Cost of Care Survey, released in March 2026 from data collected between July and November 2025, put the national median for assisted living at $6,200 a month, and Maryland runs above that national figure. Boutique homes in Montgomery and Howard County typically fall between $6,000 and $10,000 a month. Even the most prepared families discover, usually late, that Medicare does not cover long-term residential care. The good news: in Maryland, there are more funding paths than most families realize — and combining two or three of them often turns an impossible-looking number into a workable plan. This 2026 guide walks through every major option that real families use to pay for assisted living in Maryland, including the state Medicaid waiver, VA benefits for wartime veterans and their spouses, long-term care insurance, bridge loans, and home equity strategies. It is written specifically for families navigating Montgomery County, Howard County, and the greater Washington-Baltimore corridor.

Private Pay: The Most Common Starting Point

Most Maryland families begin with private pay — using retirement income, Social Security, pensions, savings, and investment accounts to cover monthly costs. Private pay gives families the widest choice of communities, the shortest path to admission, and the most flexibility in level of care. It is also the route most boutique homes prefer, because the small-home model depends on consistent, predictable revenue rather than the complex billing cycles tied to government programs.

The disadvantage of private pay is duration. At $7,000–$9,000 a month, a $400,000 nest egg lasts roughly three and a half to five years if it is the only resource being drawn down — and less than that once annual cost increases are factored in. Most families who start with private pay eventually layer in another source — typically a VA benefit, long-term care insurance, or the Maryland Community Options Waiver — once their loved one has been in care for a year or two. The smartest planning question is not “can we afford five years of private pay?” but “what is our bridge to the next funding source once private pay thins?”

Families often underestimate income they already have. Social Security, a small pension, an annuity, rental income, and modest IRA withdrawals can together cover 60–80% of a boutique home’s monthly rate. A fee-only financial planner — not a salesperson — can map out which sources to draw down first and extend private-pay runway by years.

Maryland Medicaid: The Community Options Waiver

Maryland’s Community Options Waiver — officially the Home and Community-Based Options Waiver (HCBOW) — is the state Medicaid program that helps qualifying seniors pay for assisted living in licensed community settings, including small homes like Brookeville House. An important distinction families miss: the waiver pays for assisted living services, not room and board. The resident contributes their own income toward room and board, minus a personal needs allowance. For families whose loved one has limited assets, the waiver can be the difference between an unaffordable private-pay situation and a sustainable long-term plan.

Eligibility rests on three tests — medical, technical, and financial:

• Medical: the applicant must require a nursing-facility level of care. (Our guide to the levels of assisted living in Maryland explains how these care levels are defined.)
• Technical: age 18 or older, living at home or in the community, and not enrolled in another waiver or in PACE at the same time. (See the nursing-facility exception below — being in a nursing home now does not disqualify you.)
• Financial: monthly income may not exceed 300% of the SSI federal benefit rate — $2,982 per month for an individual in 2026 — and countable assets may not exceed $2,000 or $2,500 depending on your eligibility category. Your primary home, one vehicle, and certain burial accounts are generally excluded.

Maryland also has community spouse protections, so a healthy spouse remaining at home keeps a significant portion of the couple’s joint assets plus a minimum monthly income allowance.

The waitlist is the part to plan around. The Community Options Waiver operates a registry, and it is not a short one. You call Maryland Access Point at 844-627-5465 to get your name on the registry, then wait for an invitation to apply. This is why experienced families get on the registry years before they expect to need it — there is no cost to being on the list, and no obligation if your plans change.

There is one significant exception worth knowing: if your loved one is already in a nursing facility and Medicaid has paid for their care for at least 30 days, they may apply with no wait at all. Ask the facility’s social worker about this. It is one of the few paths that moves quickly, and it is frequently the route families use to transition a parent out of a nursing home and into a smaller assisted living home.

If Medicaid denies the application because income is too high, ask about Maryland’s Increased Community Services Program, which exists specifically for that situation. And note that not every assisted living community is licensed to accept the waiver — confirm before you fall in love with a place. An elder law attorney is genuinely worth the consultation fee here: they can structure assets legally, protect a community spouse, and keep Medicaid’s five-year lookback from disqualifying an otherwise eligible applicant.

VA Aid & Attendance: The Most Underused Benefit

If your parent or grandparent served during a wartime period, Aid & Attendance may be the single most overlooked source of money for assisted living. It is an increase to the VA pension for veterans and surviving spouses who need help with daily activities such as bathing, dressing, medication management, or transferring. Many families never apply simply because no one told them it existed.

How the money actually works. The VA sets a Maximum Annual Pension Rate (MAPR) — a ceiling, not a check. Your actual payment is the difference between the MAPR and your countable income for VA purposes. Unreimbursed medical expenses, which for most families in assisted living includes a large share of the monthly fee, are deducted from that income. This is why a family whose income looks “too high” on paper often qualifies anyway once the cost of care is counted.

For the rate year running December 1, 2025 through November 30, 2026, the maximum Aid & Attendance rates are:

• Veteran with no dependents: $29,093 per year — about $2,424 per month
• Veteran with one dependent (typically a spouse): $34,488 per year — about $2,874 per month
• Surviving spouse with no dependents: $18,697 per year — about $1,558 per month

There is also a net worth limit of $163,699 for this rate year, covering assets plus income. Your primary residence, your car, and basic home furnishings do not count toward it. The VA applies a three-year lookback to asset transfers, with a penalty period of up to five years for transfers below fair market value — so do not move money around before talking to an accredited representative.

Service requirements are more nuanced than most articles suggest. The often-quoted “90 days with one day during wartime” applies only to those who started active duty before September 8, 1980. Enlisted personnel who started after September 7, 1980 generally need 24 months of service or the full period they were called up. The veteran also must be at least 65, or permanently and totally disabled, or in a nursing home for long-term care, or receiving SSDI or SSI. And the discharge requirement is that it was not dishonorable — a common misconception is that only an honorable discharge qualifies, which discourages families who might well be eligible.

Recognized wartime periods include World War II, the Korean conflict, the Vietnam era, and the Gulf War period, which began August 2, 1990 and remains open — meaning post-9/11 service can qualify. Vietnam-era dates differ depending on whether the veteran served in-country. Check the current rules and rate tables directly at va.gov/pension/eligibility, and get free help from a VA-accredited representative rather than paying anyone who offers to file on your behalf for a fee.

The Senior Assisted Living Subsidy (SALS)

Maryland runs a state-funded subsidy — historically called the Senior Assisted Living Group Home Subsidy, now generally the Senior Assisted Living Subsidy or SALS — that helps low and moderate-income older adults pay for assisted living in homes licensed by the Maryland Department of Health. It is administered county by county through your local Area Agency on Aging, which means the name, the intake process, and the availability all differ depending on where you live.

Statewide, the financial test is net monthly income no higher than 60% of the state median, with assets no greater than $20,064 for an individual or $26,400 for a couple. Applicants must be at least 62 and need help with activities of daily living. Notice how much more generous those asset limits are than Medicaid’s — a senior with $18,000 in savings is far over the waiver limit but still within reach of SALS.

Montgomery County: the program changed on July 1, 2026

If you are searching for Montgomery County’s Senior Assisted Living Subsidy, you may land on outdated pages. As of July 1, 2026, the county folded this assistance into the Supporting Older Adults with Resources (SOAR) Aging Program, run by the Department of Health and Human Services. SOAR provides care coordination plus partial financial assistance toward monthly assisted living fees at licensed Montgomery County facilities.

• Who qualifies: Montgomery County residents, 62 or older, U.S. citizens or qualifying non-citizens, who need help with activities of daily living
• Income and assets (as of July 1, 2026): individual — up to $4,358 per month and $20,064 in assets; couple — up to $4,983 per month and $26,400 in assets
• How to start: call the Aging and Disability Resource Unit at 240-777-3000 for a Level One screen
• Assessment: a county Community Health Nurse completes a functional assessment in person, at no cost to you

Be realistic about timing. Applications are reviewed in the order received, and eligible applicants go onto a waiting list because funding is capped. The county states plainly that SOAR is not an emergency placement or emergency funding program. If you need a placement next month, this is not your bridge — but it is very much worth starting now if you are planning ahead.

Howard County

Howard County still administers SALS under its own name through the Office on Aging and Independence. The same statewide financial limits apply — 60% of state median income, $20,064 in assets for an individual or $26,400 for a couple — and the applicant must be 62 or older and entering or living in an assisted living program that holds a service agreement with the county. Grant funding is limited and there is currently a waiting list. Apply through Maryland Access Point in Howard County at 410-313-1234. Howard County publishes a subsidy of up to $1,000 per month, which is the number to weigh against the gap you are trying to close.

One practical note: the subsidy only works at communities that have a service agreement with the county. Always ask a prospective home directly whether they participate before you assume the subsidy will travel with you.

Long-Term Care Insurance

If your loved one purchased a long-term care insurance policy in their 50s or 60s, this is the moment that policy pays off. Long-term care policies commonly cover somewhere in the range of $150 to $400 per day, depending on when the policy was written and what was purchased for two to six years of care, often with an inflation rider that grows the daily benefit over time. Most policies cover assisted living, memory care, and in-home care — not just nursing homes — though the specific definitions vary by policy and the year it was issued.

Two policy details deserve attention before admission: the elimination period and the benefit trigger. The elimination period (usually 30, 60, or 90 days) is a deductible measured in days — the family pays out of pocket before the insurer starts reimbursing. The benefit trigger defines when the policy activates, usually the inability to perform two of six activities of daily living or a diagnosis of cognitive impairment. Have the community’s nurse or your loved one’s primary care physician document deficits on the insurer’s required form — informal language slows the claim.

Some families also have hybrid life insurance / LTC policies that pass unused benefits to heirs as a death benefit if care is never needed. If you are unsure whether a policy exists, check old binders, safe deposit boxes, and previous employer benefit summaries — many policies were sold through employers in the 1990s and early 2000s and have been forgotten.

Bridge Loans for Assisted Living

A bridge loan is a short-term loan — typically 6 to 12 months — designed to cover assisted living costs while the family waits for another funding source to come through. The most common scenarios: a home is on the market but has not yet sold, a VA Aid & Attendance application is in the months-long review queue, or a long-term care insurance claim is still being processed. Specialty lenders such as Elderlife Financial Services and a handful of regional Maryland banks underwrite these loans specifically for senior care, often with no prepayment penalty and lines of credit shared among multiple adult children.

Bridge loans are not the right tool for permanent funding. Interest rates are higher than a conventional mortgage, and the family is still responsible for repayment if the underlying funding source falls through. Use them when the timeline is short, the exit strategy is documented, and the alternative is delaying care.

Home Equity: Sale, Reverse Mortgage, and Bridge-and-Sell

The family home is usually the largest asset families have, and there are several Maryland-friendly ways to convert it into assisted living funding.

Outright sale is the cleanest option when both spouses are moving to a community or when there is no spouse remaining at home. Proceeds become liquid private-pay funds.Timelines vary with the market, so get a current read from a local agent before you count on a sale date.

Reverse mortgage (HECM) suits couples where one spouse needs assisted living and the other stays in the home. It converts equity into monthly payments, a lump sum, or a line of credit — funding care without forcing the home spouse to relocate. The federally insured HECM program is available to homeowners 62 and older.

Bridge-and-sell combines both: the family draws a short bridge loan to fund admission today, then lists and sells the home within 90 days to retire the loan. Maryland senior real estate specialists (look for the SRES designation) coordinate staging, listing, and downsizing during what is already a stressful transition.

How These Options Compare

The right funding mix depends on the family’s assets, the veteran’s eligibility, the timeline, and how long care is expected to be needed. Here is how the major options compare at a glance:

Funding Source	Best For	Typical Monthly Value	Speed to Approval
Private Pay	Families with retirement income, savings, or strong cash flow	Full monthly cost	Immediate
Maryland Community Options Waiver	Low-income seniors with limited assets	$2,500–$4,500	60–120 days, plus registry wait
VA Aid & Attendance	Wartime veterans and surviving spouses	Up to $2,424 (veteran), $2,874 (veteran with dependent) or $1,558 (surviving spouse), reduced by countable income	4–9 months (paid retroactively)
Long-Term Care Insurance	Anyone with an active policy	$4,500–$12,000	30–90 day elimination period
Bridge Loan	Temporary gap while another source comes through	Up to monthly rate	1–3 weeks
Home Sale / Reverse Mortgage	Homeowners with significant equity	Varies	30–60 days

Combining Funding Sources: What Real Maryland Families Actually Do

Most families do not pay for assisted living from a single bucket. The common combinations we see at our boutique assisted living homes include:

• Social Security + pension + LTC insurance. Together these often cover 100% of a boutique home’s monthly rate for several years.
• VA Aid & Attendance + private pay + eventual home sale. A wartime veteran’s monthly benefit reduces out-of-pocket costs immediately while the family takes its time selling the home.
• Bridge loan + Community Options Waiver application. Families who cannot afford private pay file the waiver application immediately, fund admission with a short bridge loan, and transition to the waiver once approved.
• Reverse mortgage + Social Security. A surviving spouse uses the home’s equity to fund a small, family-style community without having to sell the home outright.

The biggest mistake we see is waiting until private-pay funds are nearly exhausted before exploring other options. VA benefits take months. The Medicaid waiver registry can take longer. Long-term care insurers move at their own pace. Beginning the parallel paperwork six to twelve months before money becomes tight makes the eventual transition far smoother.

Frequently Asked Questions

Does Medicare pay for assisted living in Maryland?

No. Medicare covers short-term skilled nursing care after a qualifying hospital stay (up to 100 days, with cost-sharing after day 20), but it does not pay for long-term residential assisted living. The Maryland Community Options Waiver is the Medicaid program that does cover assisted living for qualifying seniors.

How can I pay for assisted living if my parent has no money?

The most direct path is the Maryland Community Options Waiver, which is designed for low-income seniors with limited assets. If your parent is a wartime veteran or the surviving spouse of one, VA Aid & Attendance can be combined with the waiver. Families in this situation should also explore subsidized senior housing programs and the state’s Senior Assisted Living Subsidy (in Montgomery County, the SOAR Aging Program). Start with the Maryland Access Point or your county’s Department of Aging.

Is there assisted living for low-income seniors in Montgomery County?

Yes. The Community Options Waiver funds eligible low-income seniors in licensed community-based assisted living homes across Montgomery County. Not every community accepts the waiver, so families should specifically ask each community whether they are a Medicaid waiver provider before touring. Boutique homes, county-funded subsidized housing, and a handful of nonprofit communities also offer reduced-rate options.

Can I qualify for both VA Aid & Attendance and the Medicaid waiver?

In many cases, yes — but the interaction is complex. VA Aid & Attendance counts as income for Medicaid eligibility purposes, which can push some applicants over the income cap. An elder law attorney who works with both VA and Medicaid families can structure the application order to preserve eligibility for both. The right sequence is genuinely fact-specific — Aid & Attendance counts as income for Medicaid purposes, so the order that works for one family can backfire for another. This is the point at which to sit down with an elder law attorney rather than follow a rule of thumb.

How long does it take to get approved for the Maryland Community Options Waiver?

Two separate clocks matter here, and families often only hear about the second one. First, you must get onto the Community Options Waiver registry by calling Maryland Access Point at 844-627-5465, then wait for an invitation to apply — that wait can run well beyond a year depending on demand and funding. Only once you are invited does the application itself get processed, which generally takes a few months from a complete submission. The major exception: if your loved one is already in a nursing facility and Medicaid has covered at least 30 days of care, they can apply immediately with no registry wait. Get on the registry as early as you can — it costs nothing and carries no obligation.

What is the difference between the Maryland Community Options Waiver and standard Medicaid?

Standard Maryland Medicaid covers medical care and nursing-home placement for eligible residents. The Community Options Waiver is a Medicaid program specifically authorized to fund community-based long-term services, including assisted living — keeping seniors in residential settings rather than nursing homes when that is the right level of care. Both programs share core eligibility rules, but the waiver has additional requirements (the nursing-facility level-of-care assessment) and the registry process.

Can a family member be paid to provide care instead of paying a community?

Some Medicaid programs in Maryland allow family caregivers to be compensated through self-directed services, particularly for in-home care. Once a senior moves into a licensed community, that compensation path closes, but in-home services and respite care can still be arranged through Brookeville House’s in-home services program while families plan the transition.

Related reading

• How can I pay for assisted living with no money? — options when savings and assets are already gone
• The levels of assisted living in Maryland — how care levels are assessed and what each one costs
• Assisted living in Montgomery County, MD — licensing, staffing ratios, and what to look for on a tour
• Assisted living near Laurel, MD and near Gaithersburg, MD

Figures in this guide were verified against VA.gov, the Maryland Department of Health, the Maryland Department of Aging, and county aging offices in July 2026. Benefit rates, income limits, and asset limits change at least annually — VA pension rates reset every December 1, and Maryland subsidy guidelines are revised each July. Always confirm current figures with the agency before making a decision. This article is general information, not financial or legal advice.

Plan With Brookeville House

Brookeville House welcomes families from across Montgomery and Howard County — including Bethesda, Silver Spring, Columbia, and Laurel — and we work directly with families on funding plans before admission. We can talk through your specific situation, refer you to vetted elder law attorneys and VA-accredited representatives, and help you understand exactly what a boutique home costs and how families typically pay for it. For a detailed breakdown of rates and what is included, see our cost guide, or visit our homepage to explore everything Brookeville House offers. To schedule a free consultation or tour at any of our three homes, call (301) 363-9688 or book a tour online.