Maryland's Dysfunctional Medicaid System Sued in Court
Maryland’s Medicaid program has long been plagued with problems. For years, families and advocates have complained that the state’s eligibility systems are confusing, unreliable, and prone to sudden mistakes that cut off health coverage without warning. Now, those complaints are in court.
In a lawsuit filed September 24, 2025, in
Montgomery County Circuit Court, Medicaid recipients and advocacy groups including The Arc Montgomery County accuse the Maryland Department of Health of violating federal and state law by wrongfully disenrolling people from Medicaid health coverage. The lawsuit was first reported in Maryland Matters, and you can read the full complaint here (PDF).
The complaint alleges that Maryland’s Medicaid eligibility system:
- Wrongly terminates benefits for eligible individuals.
- Sends notices to outdated addresses,
preventing people from learning about redetermination deadlines.
- Provides confusing or incomplete explanations of why coverage was terminated.
- Forces recipients into lengthy appeals, during which many go without health care.
The plaintiffs argue that these practices violate due process rights under the U.S. Constitution and federal Medicaid law, which requires that states provide clear notice and an opportunity to be heard before cutting off benefits.
Health
Coverage Medicaid vs. Long-Term Care Medicaid
It’s important to emphasize that this lawsuit focuses on health-coverage Medicaid — the insurance side of Medicaid that pays for doctor visits, hospitalizations, prescriptions, and other medical services.
By contrast, most of my prior coverage has focused on long-term care Medicaid — the part of the program that pays for nursing homes and, in some cases, home-based or community-based care. See, for
example:
Maryland Medicaid Waivers Have a Waitlist of 21,000 Names: Is That Ever Going to Change?
Medicaid-Covered Home Health Care in Maryland: Reality or Illusion?
These are related but distinct problems:
- If you are wrongly cut off from health Medicaid, you could lose access to your doctors and medications.
- If you need long-term care Medicaid, you face waitlists, minimal in-home services, and a system that often leaves families to fend for themselves.
The common thread is clear:
Maryland’s Medicaid systems — both health coverage and long-term care — are unreliable, error-prone, and often harmful to the very people they are supposed to protect.
The Maryland Service Registry: Why It Matters
For Maryland residents who may one day need long-term care, one of the most important proactive steps is to get on the state’s Medicaid waiver service registry, also known as the waiver waiting list.
This registry is maintained by
the state and managed through Maryland Access Point (MAP), which serves as the gateway for seniors and individuals with disabilities seeking long-term care services. Here’s how it works:
What it is: The registry is a first-come, first-served list for Maryland’s Home and Community-Based Services (HCBS) waivers. These waivers are supposed to help people receive care at home or in assisted living rather than being forced into nursing
homes.
Why it matters: Maryland has historically had a backlog of over 21,000 names on this list. Many individuals on the waiting list wind up in a nursing home or dead while waiting to be "invited" to apply, but Maryland only sends out about 700 invitations per year, and only to people on the waiting list. So if you are not on the registry when you eventually need care, you will likely have no chance of getting services at
all.
How to sign up: You can apply through your local Maryland Access Point office. Details are available on the Maryland Access Point website. The process typically requires basic demographic information, a description of your care needs, and ongoing updates to keep your application active.
Key tip: If you live in Maryland and do not plan to move, and if you have just been diagnosed
with dementia or any type of neurodegenerative disease, or even if you are healthy, seriously consider putting yourself on the registry now. Waiting until you need care will almost certainly be too late.
The lawsuit about health-coverage Medicaid eligibility highlights just how fragile Maryland’s Medicaid systems are. The registry backlog highlights the same problem on the long-term care side. Families cannot assume that Maryland Medicaid will be there when they need
it.
Planning Options: Not Just One Path
Many people think “planning ahead” is the only way to protect themselves. Planning early is often powerful and often the best strategy — but it is not the only option. Families have multiple avenues depending on their timing and circumstances:
Advance Planning Options
Living Trust Plus® Medicaid Asset Protection Trust: This tool allows families to protect their assets five years in advance of needing nursing
home Medicaid (or three years in advance for Veterans Aid and Attendance benefits).
Interstate Planning: If you have flexibility, consider where you live. Both DC and Virginia have more reliable, better-managed Medicaid programs for in-home long-term care. Simply put: if you are moving or choosing where to retire in the DMV area, don’t choose Maryland.
Crisis Planning (Level 4)
Even if you didn’t plan ahead, all hope
is not lost. At the Farr Law Firm, a major area we specialize in is what we call Level 4 Planning, which is a combination of Life Care Planning, Medicaid Asset Protection, and sometimes Veterans Asset Protection.
What it is: A crisis strategy to obtain Medicaid for someone who needs nursing home
care now or soon.
What it covers: In Maryland, crisis planning is only effective for nursing home Medicaid — not for home-based care. In Virginia and DC, it works for both nursing home Medicaid and for home-based Medicaid.
Why it works: Through use of a combination of over two dozen Medicaid-compliant asset protection strategies, it is possible to qualify someone for nursing home coverage while still
protecting significant assets for the spouse or family.
Hybrid Planning
Some families start advance planning but still need crisis help. Others relocate to DC or Virginia after joining the Maryland registry. Each case is unique, and part of our role is to help families navigate the best path for their specific needs.
The Bigger Picture
This lawsuit may force Maryland to improve its eligibility systems. But long-term care Medicaid remains plagued by
waitlists, inadequate services, and broken promises.
What does that mean for you?
If you rely on Maryland Medicaid health coverage, this lawsuit could eventually improve protections against wrongful terminations. But don’t expect quick fixes.
If you expect to need long-term care, this lawsuit should serve as yet another warning: the system is unreliable, and families who fail to plan will be left exposed.
Final Thoughts
The Montgomery
County lawsuit shines a spotlight on Maryland’s failing Medicaid eligibility system. While the case itself focuses on health coverage, it validates what long-term care families already know:
Maryland Medicaid is dysfunctional across the board.
Whether you are planning in advance, facing a crisis, or weighing a move across state lines, there are ways to protect yourself and your loved ones. But relying on Maryland Medicaid for in home care is
not a plan.
Contact us today to learn more about how we can help you prepare — whether through advance asset protection, crisis Medicaid planning, or strategic relocation advice.
Don’t wait for a crisis. Educate yourself, talk with those you trust, and work with a knowledgeable attorney here at the Farr Law Firm to make your decisions official.
Ready for more insights? Find in-depth articles covering Elder Law, Estate
Planning, Medicaid Planning, Incapacity Planning, Asset Protection, Advance Directives, and much more — plus resources to help you get started — on the Everything Elder Law Blog. For real-world stories from families who very happy they planned ahead, just read our Google Reviews.
Related news:
Maryland's largest provider for Medicaid enrollees gets its accreditation suspended | AP News
‘Big Beautiful Bill’ will strip Medicaid from 175,000 Marylanders - The Washington Post
