Maryland’s Autism Waiver: Nine Services Your Agency Can Explore

By ClearPath Human Services Consulting Group, LLC | Updated September 11, 2026

If you operate a Maryland Residential Service Agency (RSA) or Assisted Living business, expanding into services for children and young people with autism may be part of your growth plan. Maryland’s Autism Waiver offers several distinct service opportunities, each with its own qualifications and operating requirements.

The first step is choosing a service your organization can deliver well and determining what additional preparation it needs. An existing license provides business experience, but it does not automatically authorize Autism Waiver services.

What is the Autism Waiver?

The Autism Waiver supports eligible children and youth with autism in their homes and communities as an alternative to institutional care. Maryland’s Department of Health (MDH) and State Department of Education (MSDE) administer the program together. Participants must meet the waiver’s eligibility requirements; an autism diagnosis alone does not establish enrollment. MSDE program overview.

For approved providers, the waiver can support an additional Medicaid-funded service line. Revenue depends on enrollment, participant choice, authorized services, and compliant service delivery and billing. Provider approval does not assign clients to your agency.

The nine Autism Waiver services

Maryland identifies nine service options when the regular and intensive levels of Therapeutic Integration and Residential Habilitation are counted separately.

1. Intensive Individual Support Services (IISS)

Individualized, one-to-one support helps a participant develop communication, social, behavioral, and daily-living skills. Workers implement an individualized treatment plan in the home or community, with qualified professional supervision. The service emphasizes practical skills and successful community living. IISS requirements.

2. Respite Care

Short-term, one-to-one supervision and assistance with daily activities give the participant’s usual family caregivers relief. Services may occur at home, in the community, or in certain approved respite or camp settings. Respite is unavailable to participants receiving residential habilitation. Respite requirements.

3. Regular Therapeutic Integration

A structured therapeutic program outside the participant’s residence uses activities such as music, art, movement, and socialization groups to work toward individualized goals. Its purpose includes developing social skills, managing behavior, and improving participation. Activities must have a therapeutic purpose beyond ordinary recreation. Therapeutic Integration requirements.

4. Intensive Therapeutic Integration

This service has a similar therapeutic focus but provides a direct care worker for each participant who needs one-to-one intervention. Providers must plan for the greater staffing commitment and individualized support involved. Intensive Therapeutic Integration requirements.

5. Family Consultation

A qualified professional teaches and coaches the participant’s family in strategies that support communication, behavior, safety, daily routines, and independence. The service focuses on helping the family support the participant; agency employee training and IEP advocacy are outside this benefit. Family Consultation requirements.

6. Adult Life Planning

Available to participants age 14 and older, this service helps families plan for the supports needed after the participant leaves the Autism Waiver. Planning focuses on transition to appropriate adult services and community resources. Adult Life Planning requirements.

7. Environmental Accessibility Adaptations

Approved, medically necessary changes to a participant’s home support safety and independence. Examples include protective padding and certain safety alarms. Adaptations require authorization and applicable building approvals; general remodeling and improvements to residential habilitation facilities are excluded. Environmental Accessibility Adaptations requirements.

8. Regular Residential Habilitation

A licensed community residence provides a therapeutic living environment for participants who cannot currently live at home. Services build daily-living, social, and adaptive skills and support transition toward an appropriate future living arrangement. Medicaid payment for this service excludes room and board. Residential Habilitation requirements.

9. Intensive Residential Habilitation

This is the more intensive residential option for participants whose approved needs include awake overnight staffing and at least four hours of one-to-one staffing. The participant’s needs and the multidisciplinary team’s authorization determine the intensity level. Residential intensity requirements.

Participants also receive service coordination through their local education agency. This function is separate from the nine service options described above. MSDE service overview.

What should an existing provider assess first?

Start with your proposed service, leadership experience, staff qualifications, supervision arrangements, service area, and operating budget. Residential services need particular attention to the approved licensing route and setting. An Assisted Living license by itself does not establish eligibility to operate Autism Waiver residential habilitation. Residential provider requirements.

The Autism Waiver provider process includes required MSDE initial provider training, supporting materials, and a structured interview to assess the applicant’s knowledge and capacity. Agency leaders must be prepared to explain how their program will actually operate. Medicaid enrollment is another required part of the process. MDH/MSDE provider application guidance.

Applicants must follow MSDE’s current instructions for applicant-prepared materials and permitted consulting assistance. ClearPath’s role supports your team’s preparation and understanding; your organization remains responsible for demonstrating its qualifications and implementing its program.

Why begin preparing during the MPRIME transition?

Maryland is replacing ePREP with MPRIME. Its September 16 notice schedules launch for October 13, 2026, with ePREP access ending October 1. Save needed ePREP records by 5 p.m. September 30. MDH transition notice.

Use the preparation period to select services, review qualifications, develop your operating documents, and identify outstanding training or licensing requirements. Portal availability is one milestone; the agency must also complete the applicable MSDE and Medicaid requirements. Legacy application documents may still mention ePREP, so follow the current enrollment instructions when submitting.

How ClearPath helps

Our consulting fee is $4,500 per selected waiver service. We work with your team on:

• Agency-specific policies, procedures, and administrative forms for program operations.
  

• A Quality Assurance Plan and a Program Service Plan with implementation procedures for each selected service.
  

• A business plan, three-year financial projections, and a marketing plan.
  

• Dedicated consulting and preparation for the Autism Waiver structured interview.
  

• Guided application assistance, MPRIME submission support when prerequisites are met, and monitoring through certification and enrollment review.

  
  

Our team has attended multiple MPRIME trainings and is currently helping several clients prepare for Maryland waiver programs. We tailor our support to your selected services and the reviewing agencies’ requirements.

Accreditation assistance and separate DDA licensing assistance are excluded from the $4,500 fee and quoted separately if needed. Government or accreditor fees and the costs of staffing, premises, insurance, and operating the program are separate. Approval and review timing remain with the responsible agencies.

Ready to explore your agency’s options? Contact ClearPath at (404) 482-0611 or visit clearpathconsultinggroup.com. Tell us your current license type, county, and the Autism Waiver services that interest you.