For a long time, getting daily living supports meant giving up certain choices — like where you lived, who supported you, and how your daily life was structured. Services and housing were tightly linked: if you wanted to use Maryland’s Developmental Disabilities HCBS Medicaid Waiver, you had to move into a group home or provider-run facility to get it.
That changed with the HCBS Final Rule. This rule made it clear that housing and support must be separate. It gives people the right to choose where they live and to get services at home, not just in institutions.
For adults with autism, this opens up new options: living in your own apartment, receiving support only when needed, and building a more independent life on your own terms.
What is HCBS?
Home and Community-Based Services (HCBS) is a Medicaid program that funds support services for people with disabilities in community settings. Instead of requiring someone to move into a facility to receive help, HCBS brings the support to wherever they live: their own apartment, a family home, or shared housing of their choice.
It’s designed to help people live more independently while staying connected to their communities. The goal isn’t to fit people into a system; it’s to build support around what matters to the individual.
A central part of the HCBS “Final Rule” is separating housing from services. In practice, this means someone can keep their apartment if they change service providers; they can choose who supports them, how, and when. It gives people more freedom, more control, and more stability.
Who uses HCBS in Maryland?
Many participants in Elevate Spectrum’s programs use HCBS waivers to fund their services. In Maryland, the most common ones are:
Each waiver supports different needs. Some people need just a few hours of help per week, while others may benefit from daily coaching or backup support. Services are tailored to each person’s situation.
It’s worth noting that Maryland has long waiting lists for some waivers. Planning ahead can make a big difference, especially if you’re preparing to transition out of school or move toward independent living.
What HCBS covers (and what it doesn’t)
HCBS doesn’t pay for all housing costs – it doesn’t cover rent, mortgage, or utilities. In Maryland, it covers services delivered in or around the home. That can include:
- Support staff to help with daily routines and independent living skills
- Remote coaching or backup support (like Smart Living remote support)
- Help with cooking, cleaning, and budgeting
- Case management and coordination
- Assistive technology
- Transportation to work or community activities
- Job coaching and employment supports
- Housing supports, which can help make housing more affordable
For example, in a Smart Living apartment, participants use vouchers, SSI/SSDI (Supplemental Security Income and Social Security Disability Insurance), or family help to pay for housing. The HCBS waiver covers the remote coaching, safety tech, and support planning that make this kind of setup possible.
The philosophy behind HCBS
Traditional systems were built around convenience for providers. If someone needed help, they were placed into a facility where staff controlled their schedule, meals, and decisions. HCBS shifts the focus to the individual.
Instead of assuming a “program” will work for everyone, services are designed through a person-centered planning process. That means:
- The participant sets their own goals
- Services are built around what they need to reach those goals
- They decide who supports them and how
The HCBS model is all about real integration. That goes beyond simply living in a regular neighborhood — it means having real opportunities to build relationships, work, contribute, and grow. Participants make choices about their daily life: what to eat, when to sleep, and who to spend time with.
This approach aligns closely with how Elevate Spectrum works. Whether someone is preparing for their first job or moving into their own apartment for the first time, support is tailored to build confidence and encourage independence.
The role of Medicaid in HCBS
Medicaid, not Medicare, is what funds HCBS. Medicaid waiver programs allow states to offer support services in flexible ways that aren’t covered by traditional Medicaid.
To access HCBS services in Maryland, participants usually apply through the Developmental Disabilities Administration (DDA). This includes a full eligibility process, plus enrollment into the appropriate waiver. It can take time, so it helps to start early and explore your options before a big transition like moving out or graduating high school.
HCBS settings requirements in Maryland
To qualify as HCBS-compliant, Maryland housing and support settings must meet specific rules. These are designed to protect participants’ rights and ensure services promote independence, not control.
Settings must:
- Be integrated into the community
- Support access to jobs, transportation, and activities
- Allow participants to choose how they spend their day and who they spend it with
- Respect privacy and autonomy
- Provide legal protections like a lease agreement
Supports should promote growth, not dependence. That means making room for risk-taking, decision-making, and learning new skills instead of doing everything “for” someone.
Moving forward with HCBS
Understanding how HCBS works can open new doors. Instead of having to choose between a group home and staying in the family home forever, there’s a flexible middle ground where independence and support go hand in hand.
Because housing and services are separate, participants can move forward at their own pace. Someone might start with Supported Living while living at home, explore Housing Supports, and eventually transition into a Smart Living apartment as their forever home.
HCBS also recognizes that families often remain an important part of the support circle. Services can complement, not replace, the role of parents, siblings, or advocates.
Want to learn how HCBS-funded services could support your next steps? Book a call with our team to talk through your options and create a plan that works for you.
