Written By:
RBT
Introduction
If your child has been diagnosed with autism spectrum disorder (ASD), you have probably heard other parents mention “the Waiver” in a support group or at an IEP meeting. It is one of the most valuable resources available to Maryland families, and also one of the most misunderstood. The name alone raises questions: Waived from what? Who qualifies? Does it replace private insurance or work alongside it?
At Admire ABA, we talk to families about the Autism Waiver almost every week, usually because they are trying to figure out whether it is worth the paperwork and the wait. The short answer is yes, for most families it is. The longer answer is what this guide is for.
We will walk through what the Maryland Autism Waiver actually is, who is eligible, what it pays for, how the registry and application process work, and how it fits alongside services like in-home ABA therapy, parent training, and early intervention. Our goal is to give you a clear, accurate roadmap so you can make an informed decision for your family.
What Is the Maryland Autism Waiver?
The Maryland Autism Waiver (AW) is a Medicaid home and community-based services program that allows children and young adults with ASD to receive long-term, therapeutic support in their homes and communities instead of in an institutional setting. It is administered jointly by the Maryland Department of Health (MDH), which oversees the Medicaid program, and the Maryland State Department of Education (MSDE), which handles day-to-day implementation through local school systems. The Autism Waiver is designed to provide community-based, long-term, person-centered therapeutic services and support to eligible children and youth with Autism Spectrum Disorder to enable home and community living as an alternative to institutional care.
The program traces back to a 1998 legislative proposal, and Maryland received federal approval for the waiver from the Centers for Medicare and Medicaid Services in September 2000. It operates under a federal authority known as a Section 1915(c) waiver, which lets states use Medicaid funds for community-based care rather than requiring a child to be placed in an institution to receive comparable support.
In practical terms, the Autism Waiver “waives” the usual Medicaid rule that a person must be receiving care in a facility to access certain intensive services. Instead, those services come to your child, at home, at school, or in the community.
How the Waiver Differs From Regular Medicaid or Private Insurance
Regular Medicaid and most private insurance plans cover medical necessity based on diagnosis and treatment need, without regard to household setting. The Autism Waiver is different in two important ways. First, it is specifically structured around keeping a child at home and in the community rather than in an institutional level of care. Second, it opens the door to services that general Medicaid and commercial plans typically do not cover on their own, such as respite care, environmental home modifications, and structured after-school therapeutic programming.
Once enrolled, a participant also qualifies for full Medical Assistance benefits, including health insurance, prescription coverage, dental care, physician and hospital care, home health, laboratory services, disposable medical supplies, durable medical equipment, and mental health services. For many families, that full-benefit access is just as significant as the waiver-specific services themselves.
Who Is Eligible for the Maryland Autism Waiver?
Eligibility for the Autism Waiver is evaluated across three categories: medical, technical, and financial. A child must meet all three to qualify, and eligibility is reviewed annually to confirm the family still meets each requirement.
Medical Eligibility
To meet the medical criteria, a child must:
- Have a diagnosis of Autism Spectrum Disorder. Most sources indicate this diagnosis should be current, generally documented within the last three years, using an evidence-based evaluation tool.
- Meet eligibility requirements for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) institutional level of care. This does not mean your child needs to have ever lived in an institution. It is a clinical benchmark used to determine that the intensity of support your child needs is comparable to what an institutional setting would provide, which is what justifies using the waiver in the first place.
Technical Eligibility
Technical eligibility relates to your child’s age, residency, and educational plan:
- Be between the ages of 1 and the end of the school semester in which they turn 21 years old.
- Reside in Maryland.
- Have an Individualized Educational Program (IEP) or Individualized Family Service Plan (IFSP) with at least 15 hours per week of special education and/or related services.
This IEP/IFSP requirement is one families sometimes overlook. Because MSDE administers the day-to-day operation of the waiver, your child’s educational plan is not just a school document. It is part of the eligibility record, which is why your local school system’s Autism Waiver Coordinator plays such an active role throughout the process.
Financial Eligibility
The Autism Waiver also has income and asset limits tied to Medical Assistance rules. A child’s monthly income may not exceed 300% of SSI benefits, and countable assets may not exceed $2,000 or $2,500, depending on the eligibility category. Importantly, this is based on the child’s own income and assets, not the household’s, which is why many families who would not otherwise qualify for Medicaid based on parental income are still able to access the waiver.
In our experience working with families across Maryland, this financial detail is often the biggest surprise. Parents assume their own income disqualifies them, and are relieved to learn the waiver looks at the child’s finances instead.
What Services Does the Autism Waiver Cover?
Provider agencies participating in the Autism Waiver are approved to offer anywhere from one to all nine AW services, and may serve as few as five individuals or well over one hundred, depending on their capacity. The core services include:
Intensive Individual Support Services (IISS)
One-on-one, goal-directed assistance built around the specific interventions and supports identified in your child’s plan. This is often where families see the most day-to-day overlap with ABA-based skill building, since IISS staff work directly on the behavioral and life skills goals your treatment team has identified.
Therapeutic Integration (Regular or Intensive)
A structured program during after-school hours, weekends, and non-school days that provides therapeutic services for children and adolescents who have difficulty with socialization, isolation, hyperactivity, impulse control, or related behavioral challenges. Some children access this through a center-based program rather than at home.
Respite Care
Short-term supervision and daily living assistance provided when a child’s usual caregivers are absent or need relief. Respite can happen at home, in the community, or in some cases through an approved overnight camp, and it is one of the most requested waiver services simply because caregiver burnout is real and this is one of the few funding sources built specifically to address it.
Family Consultation
Structured coaching and training to help parents and caregivers manage behaviors, build life skills, and reinforce strategies used elsewhere in your child’s treatment plan.
Adult Life Planning
Family-centered planning that helps caregivers begin thinking about the transition into adult community services, including support with decision-making as the participant approaches adulthood.
Environmental Accessibility Adaptations
Funding toward physical modifications to the home that are necessary for the child’s health, safety, and independence.
Residential Habilitation
Structured, community-based residential support for children who are temporarily unable to live at home due to the intensity of their support needs, to develop life skills and eventually transition back home.
Service Coordination
Every Autism Waiver participant also receives service coordination, or targeted case management, through their local school system, which acts as the connective tissue between the family, the school, and the waiver’s other services.
In our sessions with families who are newly approved, we often spend the first few weeks simply helping them map which of these nine services their child actually needs versus which ones sound helpful in theory. Not every family needs every service, and building a plan around your child’s actual routine tends to work far better than trying to use all of them at once.
How the Registry and Application Process Work
Unlike some Medicaid programs, the Autism Waiver does not currently have enough funded slots to serve every eligible child immediately. Access is managed through a statewide registry.
- Join the registry. Families contact the Autism Waiver Registry directly to be placed on the list. As of this writing, the registry can be reached at 866-417-3480.
- Wait for a vacancy notification. Families are eligible to formally apply only when a vacancy occurs, and the AW Registry contacts them. Because the number of available slots is limited by CMS approval and state funding, and because both change from year to year, we strongly encourage families to confirm current wait times directly with the registry or their school’s Autism Waiver Coordinator rather than relying on any figure published online, including this one.
- Complete the eligibility determination. Once notified, your family will work through the medical, technical, and financial documentation described above.
- Begin services with an approved provider. There are more than 60 Autism Waiver provider agencies across the state, and families choose an agency to deliver the services in their approved plan.
The waiver is governed by COMAR chapter 10.09.56, and if you ever want to verify a detail with your school directly, ask to speak with the school’s Autism Waiver Coordinator, or contact MSDE’s Autism Waiver office at (866) 417-3480.
A Few Things Families Should Know Before Applying
Getting a call from the registry can happen faster or slower than expected, and there is no way to predict it precisely. What we tell parents is this: use the waiting period productively. Keep your child’s ASD diagnosis current, make sure the IEP or IFSP accurately reflects their actual service hours, and keep your paperwork organized so that when the registry calls, you are not scrambling to gather documents under a deadline.
We have also seen families assume the waiver is an all-or-nothing decision that replaces their other therapy services. It is not. The Autism Waiver is designed to work alongside services your child may already be receiving, including in-home ABA therapy, parent training, early intervention, and diagnostic services, rather than instead of them.
How the Autism Waiver Fits Alongside ABA Therapy
One question we hear constantly is whether families still need private ABA therapy once they are approved for the Autism Waiver. In most cases, yes, and here is why.
The Autism Waiver’s services, like IISS and Therapeutic Integration, focus on structured support and skill practice in specific settings and time blocks. ABA therapy, by contrast, is a clinical treatment built around an individualized, data-driven behavior plan developed by a Board Certified Behavior Analyst. Many of the families we work with use their private insurance or Medicaid ABA benefit for clinical therapy, in-home sessions, and parent training, while relying on the Autism Waiver for the wraparound supports insurance typically does not fund: respite care, environmental home modifications, and adult life planning as their teen approaches the transition years.
We have seen this combination work particularly well for families balancing early intervention ABA with a packed school and therapy schedule. The waiver’s respite and family consultation services give parents breathing room, while the clinical ABA work continues to drive measurable progress on communication, social, and daily living goals.
Conclusion
The Maryland Autism Waiver can be a genuine turning point for families managing the day-to-day realities of raising a child with autism, but it works best as one part of a broader plan rather than a stand-alone solution. Understanding the eligibility categories, knowing what the nine covered services actually do, and getting on the registry early all make the process less overwhelming when your family’s turn comes.
If you are weighing your options, or already receiving ABA services and wondering how the waiver might fit alongside your current plan, our team is glad to talk through it with you. At Admire ABA, we support families across Maryland, including in Baltimore, Aspen Hill in Montgomery County, and Laurel in Prince George’s County, with in-home ABA therapy, parent training, daycare-based ABA, weekend ABA, early intervention services, and diagnostic evaluations.
Contact us today to schedule a conversation about your child’s services and how programs like the Autism Waiver may complement the care they are already receiving.
Frequently Asked Questions
Does the Maryland Autism Waiver cover ABA therapy directly?
The Autism Waiver itself does not fund ABA therapy as a covered service. ABA therapy is typically accessed through Medicaid’s separate ABA benefit or through private insurance. Families often use both programs together: the Autism Waiver for services like respite care and family consultation, and Medicaid or private insurance for clinical ABA treatment.
How long is the wait for the Maryland Autism Waiver?
Wait times vary from year to year based on the number of state-funded slots and how many children are already on the registry, so there is no fixed timeline that applies to every family. The most reliable way to get a current estimate is to call the Autism Waiver Registry directly or ask your school’s Autism Waiver Coordinator, since both can speak to where your family stands.
Can my child be on the Autism Waiver Registry while also receiving private insurance-funded ABA therapy?
Yes. Being on the registry, or even being enrolled in the waiver, does not prevent your child from receiving ABA therapy, speech therapy, occupational therapy, or other services through private insurance in the meantime. Many families pursue both paths simultaneously so their child is not without support while waiting for a waiver vacancy.
SOURCES:
- https://health.maryland.gov/mmcp/ltss/Pages/autism-waiver.aspx
- https://elevates.marylandpublicschools.org/autism-waiver/
- https://marylandpublicschools.org/programs/pages/special-education/autismfactsheet.aspx
- https://autismsocietymd.org/resources/maryland-autism-waiver/
- https://pathfindersforautism.org/articles/maryland-services/sign-up-for-the-autism-waiver-registry/
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MD
- https://www.montgomerycountymd.gov/department-health-human-services/disability-services-programs/maryland-medicaid-waivers
