The federal review of Maryland's cost-cutting Medicaid waiver amendment for people with developmental disabilities has been extended. In an Oct. 1, 2026, update to its Community Pathways Waiver amendment page, the state's Developmental Disabilities Administration said it received a request for additional information from the Centers for Medicare & Medicaid Services on Sept. 25. Maryland submitted the amendment on July 1.

The administration says it has sent CMS the information and expects the agency to finish its review within 90 days. Changes in the amendment will not take effect until CMS approves it.

Why the clock restarted

Under federal rules, a waiver amendment is considered approved unless CMS denies it or asks for more information within 90 days of receiving it. When CMS asks, a new 90-day period begins on the day it receives the state's answer, under 42 CFR 430.25(f)(3). The Sept. 25 request came on day 86 of the first window, which we noted in July would run to about the end of September. The administration did not say when it sent its response, but the new deadline cannot fall earlier than Dec. 24, 90 days after the request arrived.

The amendment had listed Oct. 1, 2026, as its proposed effective date. That date has now passed without approval.

What stays on hold

  • Provider rates. For the Community Provider-Managed model, rates stay at June 30, 2026, levels until CMS approves the amendment. The budget measures behind it include a 2% rate cut for community providers and a lower funding level for certain support services.
  • Self-directed wages. The new reasonable and customary wage standards for self-directed services are on hold, and allowable wages stay at June 30, 2026, levels. Participants who want to change a worker's pay are told to contact their Financial Management and Counseling Services vendor.

The administration says it will hold regional listening sessions and technical assistance webinars on what changes, when it takes effect and what people need to do. It received 846 unique comments during the amendment's public comment period, April 29 to May 28, 2026.

Why this matters for providers and DSPs

The request buys agencies and self-directing families more time at June 30 pay and rate levels, likely into at least late December. It does not cancel anything. The cuts will arrive once CMS approves the amendment, possibly with changes made in response to the federal questions, so providers should keep budgeting for the 2% reduction and watch the DDA page for the approval and the start date it sets. For direct support workers whose pay was set to fall, current wages are protected only until then.