The Maryland Autism Waiver Explained: Registry, Eligibility, and the Wait

A phone call is the entire application. Not a form. Not a portal. Not a packet of school records. Maryland families start the process by dialing a registry line, and the date of that call is the single thing that matters most for years afterward.

Here is the short version. The Maryland autism waiver is a Medicaid home and community-based services program for children with an autism diagnosis, ages 1 through the end of the school year in which they turn 21. It funds supports that standard Medicaid does not, including respite care, one-on-one behavioral support in the community, structured after-school programming, family training, and home modifications. Two state agencies run it together. Slots are capped by the federal government, demand far exceeds supply, and families join the registry by calling 866-417-3480.

The waiver is also one door among several, which is why families already receiving ABA therapy across Maryland sometimes discover the waiver answers a question they were not actually asking. Knowing which door leads where will save you years.

What Is the Maryland Autism Waiver?

A Medicaid waiver for autism is a federal carve-out. Under Section 1915(c) of the Social Security Act, a state can waive certain Medicaid rules so children who would otherwise qualify for institutional care can stay home instead.

Maryland's version has a specific origin. Delegate John Hurson introduced House Bill 99 in the 1998 legislative session. The General Assembly passed it, the Maryland Department of Health applied to the Centers for Medicare and Medicaid Services that August, CMS approved it on September 1, 2000, and the first children enrolled in 2001. The program is governed by COMAR chapter 10.09.56.

The structure is unusual. Most Medicaid waivers run entirely through a health agency. This one is a partnership. The Maryland State Department of Education operates it through local education agencies, which is why your child's service coordinator works out of the school system rather than a clinic. The Department of Health handles Medicaid administration and oversight. Families comparing this against privately funded in-home and school-based ABA programs often find the school-system involvement surprising.

Who Qualifies for the Maryland Autism Waiver Program

A child has to clear three separate tests. Missing any one of them ends the application. The state groups them as medical, technical and financial rules.

Medical. A current autism spectrum disorder diagnosis or an educational classification of autism. A determination that the child needs an Intermediate Care Facility for Individuals with Intellectual Disabilities level of care. A finding that the child can be safely supported at home with waiver services.

Technical. Age 1 through the end of the school semester in which the child turns 21. Maryland residency. An IFSP for ages 1 to 5, an IEP in an early childhood or kindergarten setting for ages 3 to 5, or an IEP with 15 or more hours per week of special education and related services and/or 1:1 adult support from first grade onward. No concurrent enrollment in another waiver. Community-based costs must not exceed institutional costs.

That 15-hour threshold trips up more families than anything else. A solid diagnosis paired with a light IEP will not clear technical eligibility.

Financial. Here the waiver does something most programs do not. Eligibility rests on the applicant's income and assets only. Parent income is not counted. Monthly income cannot exceed 300% of the SSI benefit rate, and countable assets cannot exceed $2,000 or $2,500 depending on the eligibility category.

The practical consequence catches families off guard. A well-meaning grandparent who leaves money directly to a child can disqualify that child. Parents who have already worked through SSI eligibility rules tend to know this. Everyone else should hear it early.

What the Waiver Pays For, and the One Thing It Does Not

Seven services, delivered by agencies that must be enrolled Medicaid providers. Statewide there are more than 60 approved waiver provider agencies.

• Intensive Individual Support Services — one-on-one support in home and community settings, built around an individualized treatment plan
• Respite care — short-term supervision so primary caregivers can step away
• Therapeutic Integration — structured programming during after-school hours, weekends, and non-school days
• Family Consultation — training and consultation for the family
• Environmental Accessibility Adaptations — funding toward home modifications for health and safety
• Residential Habilitation — community placement for children who cannot currently live at home, with the goal of returning home
• Adult Life Planning — planning for the transition into adult disability services

Enrollment also opens full Medical Assistance benefits: health coverage, prescriptions, dental, hospital care, durable medical equipment, and mental health services.

Now the omission. ABA therapy is not on that list. Read it again if you need to.

ABA runs on a separate Maryland Medicaid track. Under the federal EPSDT benefit, states must cover medically necessary treatment for enrolled children under 21, and Maryland's ABA provider manual spells out the diagnosis and prior authorization requirements. A family waiting years for a waiver slot in order to start ABA is waiting for the wrong thing.

That does not make the waiver services filler. Towson University researchers Karen Goldrich Eskow, Gregory Chasson, and Jean Ann Summers matched 130 Maryland families receiving waiver services against 130 families still sitting on the registry. The waiver group reported greater improvement in independent living skills and family quality of life over the prior year, and more frequent Intensive Individual Support Services and Therapeutic Integration predicted improvement across several domains.

Inside the Maryland Autism Waiver Waiting List

Maryland uses three stages, and the terms are not interchangeable.

• Registry — everyone who has called 866-417-3480 to express interest
• Waitlist — registrants screened as appearing to meet preliminary technical eligibility
• Wave — waitlisted families invited to formally apply when funded slots open

State reporting under the End the Wait Act, passed as Chapter 464 of 2022, shows how the funnel narrows. In fiscal year 2024, MSDE moved 1,100 individuals into a wave and 2,913 onto the waitlist, and removed 1,370 who did not meet preliminary technical eligibility. The registry dropped from 6,705 on June 30, 2023 to 2,769 a year later, a reduction of roughly 59%.

Capacity is the other half. Senate Bill 622 added 1,350 slots and CMS approved a ceiling of 2,950 participants for FY 2024. The program served 1,937 that year. Slots existed on paper that no provider network could fill. The Hilltop Institute, a nonpartisan research organization at the University of Maryland, Baltimore County, built the modeling behind these targets.

Once an invitation arrives, the clock speeds up. Families work with an assigned service coordinator to complete the financial eligibility application within 45 days.

What This Looks Like for One Maryland Family

Consider a composite of a situation Maryland families run into constantly.

A Baltimore County parent gets an autism diagnosis for her four-year-old in March. A friend tells her to call the registry, so she does, and a representative confirms her son's name is on the list. The wait could stretch for years.

She assumes therapy is on hold until then. It is not.

Her son already has Medical Assistance coverage, and the EPSDT benefit entitles Medicaid-enrolled children under 21 to medically necessary services. His IEP includes 18 hours a week of special education, so he likely clears technical eligibility whenever his wave arrives. Meanwhile his pediatric neurologist completes a comprehensive diagnostic evaluation and refers him for ABA. Prior authorization goes through. He starts therapy roughly ten weeks after diagnosis.

Six years later, if his waiver invitation comes, the respite hours and therapeutic integration will be genuinely useful additions. They were never the prerequisite.

What to Do While You Wait

1. Call the registry now. The date of the call anchors your position. A child who does not yet meet the 15-hour IEP threshold can still be registered.
2. Verify Medical Assistance enrollment. Both waiver services and EPSDT services require it.
3. Get the diagnostic paperwork clean. Prior authorization depends on a comprehensive diagnostic evaluation by a qualified health care professional.
4. Strengthen the IEP. Documented service hours feed directly into technical eligibility screening.
5. Look at interim programs. Community First Choice provides personal assistance services for Medicaid-eligible individuals living in the community, independent of the waiver.
6. Answer the screening calls. MSDE staff contact registrants to verify health and demographic information. Unreachable families get removed.
7. Keep the child's assets under the limit. Gifts, inheritances, and accounts in the child's name all count.

None of this requires a waiver slot. All of it improves your position when one opens. Nationally, research published in Medical Care by Douglas Leslie and colleagues found that HCBS waivers meaningfully reduced unmet health care needs among children with autism, with the largest gains among children who would not otherwise qualify for Medicaid. Maryland's problem is not whether the program works. It is how long the line is. Several no-cost ABA pathways exist while you stand in it.

Registry position and therapy access are two separate problems, and only one of them has to wait. Put the call in today so the clock starts. Then work out what your child can already use this month.

Send us a note and we will walk the Maryland Medicaid side of it with you, from what EPSDT authorization requires to what the waiver would eventually add on top. Start with a quick message and we will take it from there.

Frequently Asked Questions

What is the autism waiver in Maryland?

It is a Medicaid home and community-based services program that funds supports like respite care, one-on-one community support, and home modifications for children with autism, ages 1 through 21. The Maryland State Department of Education and the Maryland Department of Health run it jointly.

How do I apply for the Maryland autism waiver?

Call the Autism Waiver Registry at 866-417-3480 to have your child's name added. You cannot apply directly; the state invites families to apply when a funded slot opens.

How long is the Maryland autism waiver waiting list?

Waits commonly run for years because participation is capped by federally approved slots. Maryland reduced its registry by roughly 59% during fiscal year 2024, but enrollment that year still reached only 1,937 of 2,950 approved slots.

Does the Maryland autism waiver cover ABA therapy?

No. ABA is covered separately through Maryland Medicaid's EPSDT benefit for enrolled participants under 21, with a qualifying diagnosis and prior authorization.

Does parent income count for the Maryland autism waiver?

No. Financial eligibility rests on the child's own income and assets, with income capped at 300% of the SSI benefit rate and countable assets capped at $2,000 or $2,500.

Sources:

• https://marylandpublicschools.org/programs/pages/special-education/autismfactsheet.aspx
• https://health.maryland.gov/mmcp/ltss/Pages/autism-waiver.aspx
• https://health.maryland.gov/mmcp/epsdt/ABA/Documents/ABA-Provider-Manual.pdf
• https://pubmed.ncbi.nlm.nih.gov/25183656/
• https://health.maryland.gov/mmcp/Documents/JCRs/2024/endthewaitJCRfinal10-24.pdf
• https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment
• https://health.maryland.gov/mmcp/ltss/Pages/community-first-choice.aspx
• https://pubmed.ncbi.nlm.nih.gov/27547947/