On June 30, one day before Maryland's Developmental Disabilities Administration was set to cut what it pays self-directed care staff, the state told families the cuts were on hold. Providers had already told staff, weeks earlier, that their pay was about to drop by roughly a third starting July 1, and some caregivers quit before the cut ever took effect. "People have lost staff," said Shari Dexter, co-founder of Concerned Citizens of Self-Direction Maryland. "We've had reports where the participant's team...people have said 'I can't do it at this rate.'"

The wage cut is paused, but the budget shortfall that produced it and the deadlines that now replace it are not.

What Was Supposed to Happen July 1

Maryland's DDA runs the state's Medicaid waiver for people with intellectual and developmental disabilities. This year's budget cut $126 million in state funding to the agency, more than $250 million once federal matching dollars are counted. The plan called for cutting self-directed care wages by roughly a third, eliminating pay bumps for certain staffing situations, and requiring small vendors who work under self-direction to become licensed DDA providers, a process the state gave them 60 days to complete despite it typically taking months. Maryland's budget deal locked those cuts in back in March. What changed this week is the timeline for putting them into effect.

What's Delayed, and Until When

The state didn't cancel the cuts. It rescheduled the pieces that weren't ready.

Wage cuts: On hold until the federal Centers for Medicare and Medicaid Services approves Maryland's waiver amendment. Until then, participants can keep paying caregivers at their June 30 rate.

Vendor licensing: Pushed from July 1 to August 15. Small self-directed vendors still need to become licensed DDA providers, just with six extra weeks to do it.

New budget methodology: The formula that determines how much each participant's self-directed budget can hold moves to January 1, 2027. Families keep their current budget structure until then.

Family caregiver hour limits: Now start October 1, with emergency exceptions written into the waiver for households facing a staffing disruption.

Laura Howell, CEO of the Maryland Association of Community Services, said the delay means the state won't realize the $22 million in general fund savings it had counted on for this budget year, and that lawmakers haven't said how they'll cover the difference. Del. Lauren Arikan called the underlying policy "really backwards thinking" that undermines the independence self-direction is supposed to protect. Michelle DeFeo, co-leader of Concerned Citizens of Self-Direction Maryland, described the past week as a "roller coaster of emotions" with the state "constantly pivoting."

Why This Is Happening at All

Maryland's waiver operates under a federal requirement that home and community-based care costs stay within range of what institutional care would cost the state. Self-directed enrollment grew from 1,618 families in 2021 to 3,632 in 2024, and the agency's spending grew with it. The state says it exceeded its cost ceiling, and these cuts are the correction. The math behind them didn't change on June 30, only the calendar for enforcing them did.

What to Do Before August 15

If you use a small vendor for self-directed services, licensing them as a DDA provider now protects your budget from a scramble in mid-August. Ask your service coordinator for the licensing checklist this week rather than waiting for a reminder, since the application involves background checks and documentation that take time to assemble.

What to Do Before October 1

If a family member works as a paid caregiver under your self-directed plan and their hours are close to what a limit might restrict, ask your service coordinator now how the emergency exception process works and what it requires to qualify. Waiting until October to learn the process means learning it during a staffing gap instead of before one.

What to Confirm This Week

Ask your service coordinator to confirm, in an email you can reference later, that your caregiver's current wage rate is frozen at the June 30 level.

If your caregiver already gave notice based on the earlier pay-cut notification, tell your service coordinator immediately. The freeze may be enough to bring them back, but only if someone tells them the cut isn't happening yet.

Where to Track What Happens Next

The Arc Maryland and Disability Rights Maryland are both tracking the CMS waiver decision and will flag it publicly once it lands, since that single approval determines whether wage cuts happen this year or not at all.

• The Arc Maryland: 410-571-9320, thearc.org/maryland
• Disability Rights Maryland: 410-727-6352, disabilityrightsmd.org

The delay bought time, not resolution. The families who come out ahead over the next few months are the ones who use this window to lock down the specifics, licensing paperwork, wage confirmations, exception requests, rather than treating July 1 as the day the story ended.