Maryland’s Brain Injury Waiver: Services, Licensing, and Provider Preparation

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

Maryland providers considering services for adults with brain injuries have a potential route to expand their population served and Medicaid-funded service offerings. The Brain Injury Waiver supports eligible adults in community settings, with services that address independence, daily functioning, employment, and health needs.

For Residential Service Agency (RSA) and Assisted Living operators, preparation starts with understanding the additional qualifications. An existing RSA or Assisted Living license does not automatically authorize Brain Injury Waiver services.

What is the Brain Injury Waiver?

Maryland’s Behavioral Health Administration (BHA) operates the waiver for Medicaid. It helps eligible adults receive services at home and in the community as an alternative to institutional care. Applicants must meet medical, financial, and technical eligibility criteria, including requirements concerning their injury and institutional setting. A brain injury diagnosis alone does not establish eligibility. MDH program overview.

Although several provider licenses fall under regulations associated with the Developmental Disabilities Administration (DDA), the Brain Injury Waiver is administered by BHA. This distinction matters when planning approvals and contacting the state.

The five Brain Injury Waiver services

1. Individual Support Services

Support in the participant’s home or community teaches practical strategies for difficulties with memory, attention, planning, judgment, or impulse control after brain injury. The goal is to help the person initiate and complete activities more independently and, where possible, reduce the support needed over time. Individual Support Services requirements.

2. Day Habilitation

A structured program outside the participant’s residence develops or restores daily-living, social, and adaptive skills. Services focus on maintaining or improving function and include program meals and transportation. Activities should support specific goals; ordinary social recreation alone does not meet the service definition. Day Habilitation requirements.

3. Supported Employment

Employment supports help participants obtain and maintain paid work in integrated community settings. Services include job-related skill development, training, and ongoing support appropriate to the person’s needs, together with transportation or transportation coordination. The program pays for eligible supports rather than an employer subsidy or the participant’s wages. Supported Employment requirements.

4. Residential Habilitation

A community residential program helps participants develop or regain daily-living, social, and adaptive skills. Support may extend to 24 hours a day, based on the approved plan of care. Providers also coordinate relevant clinical and rehabilitation services. Room and board are outside the waiver’s service payment. Residential service requirements, residential provider requirements.

5. Medical Day Care

Medically supervised daytime services support adults who need health maintenance and restorative care to continue community living. This service operates in an appropriately licensed medical day care setting and has its own medical day care requirements. Its health-service model differs from day habilitation’s primary focus on functional skill development. Medical Day Care under the waiver, medical day care definitions.

Understand the licensing and CARF requirements

Most Brain Injury Waiver programs require a specific underlying service license or approval. Separately, most providers must demonstrate brain injury expertise through an experience-based route or qualifying CARF accreditation. These are separate requirements: CARF accreditation does not replace a required service license.

The service-specific licensing routes are summarized below. Confirm the appropriate application route with BHA and the Office of Health Care Quality (OHCQ) for your proposed program. COMAR 10.09.46.06.

Waiver service	Required service license or approval
Residential Habilitation	OHCQ community residential program licensure under COMAR 10.22.08.
Day Habilitation	OHCQ licensure under COMAR 10.22.07 for vocational and day services.
Supported Employment	OHCQ licensure under COMAR 10.22.07, or approval under the mental health vocational program route in COMAR 10.21.28.
Individual Support Services	OHCQ licensure under COMAR 10.22.06 for family and individual support services.
Medical Day Care	Medical day care licensure under COMAR 10.12.04 and compliance with COMAR 10.09.07.

The brain injury qualification requirement

For providers subject to the waiver’s general participation requirements, the experience route requires all three of the following:

• A history of serving people with brain injuries for at least the past two years.
  

• Specialized programming appropriate to that population.
  

• Access to licensed healthcare professionals with brain injury experience to supervise, train, or consult with staff.
  

Alternatively, a provider may meet this qualification requirement through CARF accreditation for brain injury services. General accreditation should not be assumed to satisfy the requirement. BHA approval and the other applicable participation conditions still apply. COMAR 10.09.46.05.

Medical Day Care is expressly exempt from those general conditions and follows its own licensing and program requirements. Medical Day Care exception.

This means a new applicant may need a longer development process if it lacks the required license, agency experience, or qualifying accreditation. The qualification review should happen before committing to an opening date.

What can providers do now?

Choose the service you want to offer, review the licensing route, and gather evidence of relevant agency experience and staff qualifications. Develop the operating model, staffing plan, service procedures, and financial assumptions together. Maryland’s provider addendum recommends attending BHA’s Brain Injury Waiver information session before enrollment. Provider application guidance.

MPRIME is scheduled to launch October 13, 2026. ePREP access ends October 1; download needed records by 5 p.m. September 30. Preparing now can advance your readiness, while actual submission depends on portal availability and completion of the applicable prerequisites. MDH transition notice.

What ClearPath’s $4,500-per-service package includes

ClearPath works with providers on:

• Policy and procedure development 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 to prepare for agency meetings and any required provider interview or review.
  

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

Our team has attended multiple MPRIME training sessions and is currently assisting several clients who arepursuing Maryland waiver programs.

The consulting fee is $4,500 for each selected waiver service. It excludes CARF or other accreditation assistance and separate DDA licensing assistance. If you need those services, ClearPath will quote them as additional engagements. Government and accreditor fees, along with startup and operating expenses, are separate.

We help you prepare and manage the application process. The state and any accrediting organization make the approval decisions, and provider approval does not guarantee referrals or revenue.

Discuss your program with ClearPath. Call (404) 482-0611 or visit clearpathconsultinggroup.com. Share your current licenses, service area, brain injury experience, accreditation status, and the services you would like to develop.