Most Maryland parents hear about “the waiver” within a week of their child’s autism diagnosis. Usually from another parent in a waiting room. Rarely with the full picture attached.
The Maryland Autism Waiver is a Medicaid-funded Home and Community-Based Services program that lets eligible children with autism receive specialized in-home and community support, plus full Medical Assistance benefits, regardless of family income. You apply by calling the registry at 1-866-417-3480. The waiver is currently full, with Baltimore County Public Schools reporting an approximately eight-year waiting period. Getting on the list early matters more than almost any other paperwork step a Maryland family will take.
Here’s how the process actually works, what services come with it, and what to do while you wait.
What the Maryland Autism Waiver Actually Is
The waiver was authorized under House Bill 99 in 1998 and approved by the Centers for Medicare and Medicaid Services under Section 1915(c) of the Social Security Act. Translation: it’s a federal Medicaid carve-out that lets children who would otherwise need institutional-level care stay at home and in their community.
It’s administered jointly by the Maryland State Department of Education (MSDE) and the Maryland Department of Health. MSDE handles eligibility and case management through your local school system.
This is not the same thing as standard Medicaid coverage for ABA therapy. The waiver is a separate, supplemental program with its own slot count, its own rules, and its own wait.
Step 1: Call the Registry
There’s only one front door, and it’s a phone number.
Call 1-866-417-3480. A Maryland Department of Health vendor will run a brief intake screening based on what you self-report. If your child meets the initial technical criteria, your name is added to the registry and MSDE is notified.
What you’ll need on hand:
- Your child’s autism spectrum disorder diagnosis (or pending evaluation)
- Maryland residency confirmation
- Basic contact and demographic information
Add your child the moment a diagnosis is in motion. Even if you’re not ready to use the services now, you can decline them later. You can’t speed up a list you never joined.
Step 2: Meet the Eligibility Rules
According to the Maryland State Department of Education’s published criteria, your child must:
- Be a Maryland resident
- Have a current ASD diagnosis (DSM-5) or educational classification of Autism
- Be ages 1 through the end of the school year they turn 21
- Have an IFSP (under age 3) or an IEP with at least 15 hours per week of special education and related services
- Meet ICF-IID institutional level of care criteria
- Meet financial eligibility: countable assets cannot exceed $2,000–$2,500, depending on category
That last rule trips families up constantly. Income is counted on the child’s name only, not the parents’. But any cash, savings bond, or gift in the child’s name above $2,000 can disqualify them. The state looks back five years on assets. Tell well-meaning relatives to redirect financial gifts into a Maryland ABLE account or a special needs trust instead. More on Maryland-specific resources in our guide to ABA therapy coverage in Maryland.
Step 3: Move From Registry to Waitlist
The registry isn’t the waitlist. It’s the line for the waitlist.
Once MSDE verifies technical eligibility, your child moves from the registry to the official waitlist. You’ll get a confirmation letter. Then you wait. According to the Maryland Department of Health, the program is governed by COMAR chapter 10.09.56 and is capped at a federally negotiated slot count. As of recent published estimates, more than 6,000 Maryland children are waiting for autism waiver services.
When your slot opens, you receive an Invitation to Apply. From that point, you have 45 days to respond and continue the formal eligibility process through your local education agency.
Step 4: Understand What the Waiver Covers
The waiver pays for services standard Medicaid often won’t. According to MSDE’s official fact sheet, covered services include:
- Intensive Individual Support Services (IISS) — one-on-one habilitation in the home or community
- Therapeutic Integration — structured after-school and weekend programs
- Respite Care — short-term relief care for families
- Family Consultation and Training
- Environmental Accessibility Adaptations — home safety modifications
- Adult Life Planning — transition support
- Residential Habilitation — out-of-home placement when needed
- Service Coordination — provided through your local school system
Waiver enrollment also unlocks full Medical Assistance benefits for the child: physician care, prescriptions, dental, mental health services, durable medical equipment, and more. That secondary benefit is often the most financially significant part for middle-income families who otherwise wouldn’t qualify for Medicaid.
How the Waiver Interacts With Private Insurance and Medicaid
Here’s where many families get tangled.
You do not need the waiver to access ABA therapy. Under Maryland’s insurance parity law and the federal EPSDT mandate, both private insurance and standard Maryland Medicaid already cover medically necessary ABA for children under 21. The Maryland Insurance Administration requires state-regulated plans to cover ABA as a habilitative service, and Medicaid covers it through EPSDT with no annual session cap.
The waiver layers on top of those. It fills gaps insurance won’t touch, such as overnight respite, home modifications, and intensive in-home support outside of structured therapy hours.
Real-world scenario: A family in Anne Arundel County receives an autism diagnosis for their 3-year-old. Their CareFirst plan covers ABA at $20 copay per session. They start in-home ABA in Maryland within 60 days. The same day, they call 1-866-417-3480 and join the registry. Their child receives therapy now through insurance. Years later, when a waiver slot opens, they gain access to respite care, family training, and full Medicaid as a secondary payer, eliminating most remaining out-of-pocket costs.
That layered strategy is what most experienced Maryland families end up using.
What to Do While You Wait
The Maryland Department of Health and Pathfinders for Autism both point families toward two interim programs:
- Community First Choice (CFC) — personal assistance services for Medicaid-eligible children
- Low Intensity Support Services (LISS) — small annual grants for things like therapy supplies, camps, and respite
You should also keep the file moving. Update the registry whenever your address or phone changes. Submit a fresh evaluation periodically so the ASD diagnosis stays current. And keep your child’s assets under the $2,000 ceiling.
Many families pair the wait with active ABA care. Our team of BCBAs and RBTs often helps Maryland parents stack waiver registration, insurance authorization, and school-based services so no support category sits idle.
Eight years is a long time to wait, but it’s not eight years of doing nothing. Most Maryland families combine waiver registration with insurance-funded ABA, school services, and interim Medicaid programs. The order matters and the paperwork stacks. Get in touch with our team and we’ll walk through where your family sits in the system, what to file this month, and what therapy can start before that registry letter ever lands in your mailbox.
FREQUENTLY ASKED QUESTIONS
Q: How do I apply for the Maryland Autism Waiver?
A: Call the Autism Waiver Registry at 1-866-417-3480. A short phone intake adds your child to the registry, and MSDE verifies full eligibility from there.
Q: How long is the Maryland Autism Waiver waitlist?
A: Baltimore County Public Schools and Pathfinders for Autism currently report an approximate eight-year wait, though timing varies by slot availability and your child’s age at registration.
Q: What services does the Maryland Autism Waiver cover?
A: Intensive Individual Support Services, respite care, therapeutic integration, family consultation, environmental adaptations, adult life planning, and full Medical Assistance benefits.
Q: Can my child get ABA therapy without the Maryland Autism Waiver?
A: Yes. Maryland Medicaid covers ABA through EPSDT, and state-regulated private insurance plans must cover ABA as a habilitative service for children with an ASD diagnosis.
Q: What is the income limit for the Maryland Autism Waiver?
A: The waiver counts only the child’s income and assets, not the parents’. The child’s countable assets must stay under $2,000 to $2,500 depending on eligibility category.
Sources:
https://health.maryland.gov/mmcp/ltss/Pages/autism-waiver.aspx
https://marylandpublicschools.org/programs/pages/special-education/autismfactsheet.aspx
https://www.bcps.org/cms/One.aspx?portalId=31979921&pageId=70861636
