Maryland's Medicaid program is called Medical Assistance. For home care agencies, the operating reality comes down to two facts and one critical distinction. First: CPAS is an entitlement with no waitlist — your most consistent pipeline. Second: the CO Waiver has 24,000 people waiting, with 700 invited per month — plan accordingly. And Maryland uses LTSSMaryland for EVV — its own state-built system, not HHAeXchange or Sandata. If you're used to other states, almost everything works differently here.
Maryland's home care market is shaped by the relationship between two programs with very different access dynamics. Understanding them before you build your referral strategy will save you from building expectations around a pipeline that doesn't flow the way you think.
CPAS provides personal care assistance — bathing, dressing, grooming, meal preparation, light housekeeping, and related ADL support — to Medicaid-eligible individuals of any age. It does not require nursing facility level of care eligibility. It does not cap enrollment.
If someone is Medicaid-eligible and needs personal care assistance, they get it through CPAS. That's what makes CPAS your primary pipeline. It's the program where referrals are relatively predictable and the administrative burden is manageable compared to the waiver world.
Formerly called MAPC (Medical Assistance Personal Care). Services include personal assistance, supports planning, and nurse monitoring as specified in Code of Maryland Regulations 10.09.20.
The CO Waiver serves adults 18 and older who need nursing facility level of care — a higher clinical threshold than CPAS. It funds a broader range of HCBS services. It also has a formal Service Registry waitlist. As of January 31, 2025, 24,015 individuals are registered. Approximately 700 are invited to apply each month.
The wait for most registrants is measured in years. The CO Waiver prioritizes residents currently in nursing homes seeking community transitions. For agencies, this means CO Waiver referrals are infrequent and somewhat unpredictable — they arrive when someone's registry position finally moves, not on a steady schedule.
Build your agency around CPAS. Accept CO Waiver referrals when they come. Don't forecast based on CO Waiver volume.
If you've operated in other Medicaid states, you're used to HHAeXchange or Sandata. Maryland uses neither. LTSSMaryland is the Maryland Department of Health's purpose-built EVV system, managed through the LTSSMaryland Provider Portal.
Two EVV methods are available: The IVR (Interactive Voice Response) call-in system — caregivers call a toll-free number to record service start and end times. And the LTSSMaryland EVV mobile app (available on iOS App Store and Google Play) — caregivers use their smartphones to clock in and out with GPS location capture.
Both methods satisfy Maryland's 21st Century Cures Act EVV requirements. Both capture the six required data elements: type of service, individual receiving service, date, location, individual providing service, and start/end times. Matched clock-in/clock-out pairs trigger automated billing submission for CPAS and CO Waiver services through the portal.
To register: Email [email protected] for LTSSMaryland Provider Portal access. Portal registration is required before you can use either the IVR or mobile app pathways.
The LTSSMaryland portal also provides real-time alerts when EVV records are incomplete, when eligibility changes affect a client's coverage, and when billing exceptions require manual review. Billing staff should monitor the portal actively rather than waiting for denial explanations on the remittance advice — the portal surfaces problems before they become billing holes.
Manual time entry is available for missed clock-ins or clock-outs. Use it for corrections, not as a routine alternative to real-time EVV capture. High rates of manual entry attract audit attention — they signal that caregivers are not using the system at the point of care.
Maryland's HealthChoice program is the Medicaid managed care organization structure covering the large majority of Medical Assistance participants. Approximately 86% of Maryland Medicaid members are enrolled in a HealthChoice MCO. For home care agencies, this means that for most CPAS and CO Waiver participants you serve, claims go to the member's MCO — not directly to MDH.
| Member Coverage | Where Claims Go | Eligibility Verification | Critical Note |
|---|---|---|---|
| HealthChoice MCO member (~86%) | Member's specific HealthChoice MCO | EVS: 1-866-710-1447. Identify the plan before billing. | Each MCO has its own claims submission format, prior authorization process, and timely filing window. Verify with each contracted MCO. |
| Fee-for-service Medical Assistance (~14%) | MDH directly via Medical Assistance billing system | EVS: 1-866-710-1447. Confirm FFS status. | CPAS and CO Waiver FFS members use the LTSSMaryland billing integration — EVV-linked automated billing submission when records are complete. |
| REM Program members | HealthChoice MCO or FFS depending on enrollment | Through HealthChoice MCO or FFS pathway | Rare and Expensive Conditions (REM) program members have specialized care management. Verify through the MCO or DHMH for service coordination details. |
Check eligibility before every billing cycle, not just at intake. Maryland Medicaid eligibility can change month to month — HealthChoice MCO assignment can change when a member switches plans during open enrollment periods. Billing a claim to the wrong MCO because of a plan change creates denials that require re-submission to the correct plan within its timely filing window. The EVS at 1-866-710-1447 provides current enrollment and MCO assignment.
Agencies providing personal care services under CPAS or CO Waiver must hold a Residential Service Agency (RSA) license from the MDH Office of Health Care Quality (OHCQ). RSA licensing has two levels — Level 1 and Level 2 — covering different service types and staff qualification requirements.
The RSA license must be active, current, and in the agency's legal name matching the Medicaid enrollment record before services can be reimbursed. Contact OHCQ at 410-402-8100 for licensing requirements and applications. The RSA license is required for Medicaid enrollment — enrollment cannot be completed without an active license.
Enroll as a Medical Assistance provider through MDH's provider enrollment process to receive a Medicaid provider number. This is the state enrollment step — necessary but not sufficient for billing HealthChoice MCO members.
To bill HealthChoice MCOs (which cover 86% of members), complete separate credentialing with each HealthChoice plan. Each plan has its own application, documentation requirements, and processing timeline. Verify the current HealthChoice MCO roster and credentialing contacts through MDH's HealthChoice program webpage.
CPAS (Community Personal Assistance Services) is a state plan entitlement — no waitlist, no enrollment cap. Anyone Medicaid-eligible who needs personal care assistance qualifies and receives services. It doesn't require nursing facility level of care. The Community Options (CO) Waiver covers individuals 18+ who do need nursing facility level of care, but its enrollment is capped at approximately 6,300 slots per year with a Service Registry of 24,015 people as of January 2025. About 700 people per month are invited to apply — meaning the practical wait is years. Most Maryland home care agency business comes through CPAS, not CO Waiver.
Maryland built its own EVV system — LTSSMaryland — which is entirely separate from HHAeXchange and Sandata. It uses two capture methods: caregivers call an IVR (Interactive Voice Response) phone number to clock in and clock out, or use the LTSSMaryland EVV mobile app on their smartphone. Matched records trigger automated billing submission for CPAS and CO Waiver services. Register for portal access by emailing [email protected]. The system is competent and works well once your team is trained on it — the main adjustment is unlearning the assumptions about how HHAeXchange works, because the workflows are different.
Call the Maryland Eligibility Verification System (EVS) at 1-866-710-1447. It provides current enrollment status and MCO assignment. Check at intake and at the start of each billing month — HealthChoice plan assignments can change when members exercise their right to switch plans during enrollment periods. Billing to an MCO that a member has switched away from will result in a denial, and you'll need to re-submit to the correct plan within its timely filing window. If you're unsure about the timely filing window for a specific HealthChoice plan, contact that plan's provider services department directly.
Maryland's RSA (Residential Service Agency) license has two levels under MDH OHCQ. The specific level depends on the types of services your agency provides and the qualifications of your clinical staff. Contact OHCQ at 410-402-8100 for current licensing requirements and to determine which RSA level applies to your service model. The RSA license must be active and current before Medicaid provider enrollment can be completed — enrollment requires a valid RSA license number. Once enrolled, maintain the license in good standing and verify the name on the license matches your enrollment record exactly.
Maryland agencies managing LTSSMaryland EVV through a system unlike any other state, billing split between HealthChoice MCOs (86%) and FFS (14%) with MCO assignment changes requiring active tracking, and CPAS entitlement billing alongside rare CO Waiver cases are managing workflows that don't look like any other state's playbook. CareBravo delivers scheduling, LTSSMaryland-integrated EVV compliance, billing across both HealthChoice MCO and FFS pathways with eligibility verification built in, and authorization tracking as completed work — so the office isn't manually checking the EVS and re-routing MCO claims every time a member changes plans.
The no-waitlist CPAS structure is a genuine operational advantage in Maryland. But LTSSMaryland's IVR/app-based EVV, the HealthChoice MCO billing split, and the CO Waiver's unpredictable referral rhythm all require Maryland-specific knowledge to navigate well. The CareDrain Diagnostic shows what current operational gaps are costing your agency monthly — before you plan your growth in a state where the infrastructure is different from everywhere else.