Category: SCII State Profiles Tags: Maryland, Disability Policy, Community Integration, Olmstead, HCBS, Subminimum Wage, Disability Rights, SCII 2026, State Profile, Independent Living, Competitive Integrated Employment, Policy Analysis, Disability Employment
Introduction
Maryland ranks third in the 2026 State Community Integration Index, distinguished by a singular achievement that places it in a category shared by only a handful of states in the country: the full elimination of subminimum wage employment under Section 14(c) of the Fair Labor Standards Act, completed on October 1, 2020 — making Maryland the second state in the nation to reach this milestone. What makes Maryland’s ranking particularly significant is not just the policy itself but the evidence that followed it. A 2024 study examining the effects of Maryland’s phased subminimum wage elimination found measurable increases in both employment and labor force participation among workers with disabilities after the repeal — the first peer-reviewed research to document post-elimination workforce gains at a state level (Disability Scoop, 2024) [1]. Maryland’s third-place ranking reflects a state that has not only enacted bold reform but has produced the evidence base that makes the case for that reform nationally.
2026 SCII Score Card
| Composite Score | 79 / 100 |
| National Rank | #3 of 15 (Pilot Phase) |
| Tier | 🟢 Tier 1 — Leading |
| Active DOJ Olmstead Action | No |
| Olmstead Plan Status | Current; cross-system coordination documented |
| Judicial Posture | Neutral (+0) |
| Data Current As Of | May 2026 |
Domain Scores
| Domain | Score | Notes |
|---|---|---|
| Institutional Population Burden | 15 / 20 | Moderate institutional population; managed nursing facility under-65 census |
| HCBS Infrastructure | 15 / 20 | Strong waiver infrastructure; moderate waitlists; Community First Choice option utilized |
| Olmstead Compliance | 13 / 15 | Substantive compliance with formal plan; no enforcement action; cross-agency coordination documented |
| Criminal Justice Diversion | 11 / 15 | Active mental health court network; 988 implementation in progress statewide |
| Housing & Economic Self-Determination | 14 / 15 | Full 14(c) elimination October 1, 2020; documented employment gains post-elimination |
| Voice, Oversight & Civil Rights | 11 / 15 | Disability Rights Maryland active; strong ILC presence; state Human Rights Act covers disability |
Critical Population Counts
| Setting | Count | Source |
|---|---|---|
| Nursing facility residents under 65 | Moderate; below national high-burden states | CMS Nursing Home Compare, 2024 [2] |
| State psychiatric hospital census | Managed; community mental health primary pathway | SAMHSA URS, 2024 [3] |
| ICF/IID residents | Moderate; active transition programs | CMS HCBS Data, 2024 [4] |
| Estimated incarcerated adults with serious mental illness | Moderate; mental health courts active | Bureau of Justice Statistics, 2024 [5] |
| Chronically homeless adults with disabilities | Moderate per capita | HUD AHAR, 2024 [6] |
Three Strengths
1. Full Elimination of Subminimum Wage with Documented Workforce Gains Maryland’s 2016 law triggered a four-year phased elimination of subminimum wage employment, reaching full elimination on October 1, 2020. Critically, the post-elimination period has produced research that directly addresses the primary objection to 14(c) reform — that workers with disabilities will be worse off without the subminimum wage option. A 2024 study examining Maryland and New Hampshire found that both states saw increases in employment and labor force participation among workers with disabilities following repeal (Disability Scoop, 2024) [1]. Maryland’s data is now the strongest peer-reviewed evidence available in support of subminimum wage elimination and should be a central reference in every state-level advocacy effort on this issue.
2. Strong HCBS Infrastructure with Community First Choice Maryland utilizes the Community First Choice state plan option, providing attendant care and community support services with enhanced federal matching funds. This financing mechanism gives Maryland a structural advantage in HCBS delivery that enables the state to serve a broader population than its waiver enrollment alone would suggest. Cross-system coordination between the Developmental Disabilities Administration, the Behavioral Health Administration, and the Medical Assistance program reflects an administrative commitment to integrated service delivery (Kaiser Family Foundation, 2025) [7].
3. Active Mental Health Court Network Maryland has developed one of the more comprehensive mental health court networks in the Mid-Atlantic region, providing a structured diversion pathway for individuals with serious mental illness who would otherwise enter or remain in the criminal justice system. Mental health courts operate across multiple jurisdictions, offering treatment-based alternatives to incarceration with individualized supervision and community support (National Center for State Courts, 2024) [8].
Three Critical Gaps
1. Persistent HCBS Waitlist Challenges Despite strong waiver infrastructure, Maryland maintains waitlists for developmental disability services that represent a meaningful gap between demand and community capacity. Individuals waiting for waiver services face the same risks as those in higher-burden states — informal caregiving exhaustion, crisis escalation, and in some cases institutional placement — even if Maryland’s waitlists are shorter than those in Tier 3 and Tier 4 states (Kaiser Family Foundation, 2025) [7].
2. Nursing Facility Population Among Working-Age Adults Maryland’s nursing facility population includes a segment of working-age adults with disabilities whose placement reflects community capacity gaps rather than clinical necessity. This population represents an ongoing Olmstead obligation — individuals who, with adequate community supports, could and should be living outside institutional settings (Centers for Medicare & Medicaid Services, 2024) [2].
3. Geographic Disparities in Service Access Maryland’s service infrastructure is concentrated in the Baltimore metropolitan area and the Washington DC suburbs. Rural counties on the Eastern Shore and in Western Maryland face HCBS provider shortages, transportation barriers, and limited access to supported employment services that are not reflected in the state’s aggregate score. A state that performs well on average may be producing those averages by serving urban populations well while rural residents with disabilities face conditions more consistent with a lower-tier state (Maryland Department of Health, 2024) [9].
Key Insight
Maryland’s most important contribution to the national disability policy conversation is not its ranking — it is its evidence. When advocates argue for subminimum wage elimination, opponents consistently raise the concern that workers with disabilities will be harmed by losing employment options. Maryland’s post-elimination data answers that argument with research rather than assertion. Employment went up. Labor force participation went up. The workers who were supposed to be protected by subminimum wage were, in fact, better served by its elimination (Disability Scoop, 2024) [1]. This finding has implications far beyond Maryland. It is the evidentiary foundation for every state-level campaign to eliminate 14(c), and it arrives at a moment when the federal government has withdrawn its own proposed rule to phase out subminimum wage nationally. In the absence of federal leadership on this issue, Maryland’s data is what the advocacy movement has to work with — and it is more than enough to make the case (U.S. Government Accountability Office, 2024) [10].
References
[1] Disability Scoop. (2024, December 19). After ending subminimum wage, states see workforce gains. https://www.disabilityscoop.com/2024/12/19/after-ending-subminimum-wage-states-see-workforce-gains/31228/
[2] Centers for Medicare & Medicaid Services. (2024). Nursing home compare. U.S. Department of Health and Human Services. https://www.medicare.gov/care-compare
[3] Substance Abuse and Mental Health Services Administration. (2024). Uniform reporting system. U.S. Department of Health and Human Services. https://www.samhsa.gov/data/report/uniform-reporting-system-urs-table
[4] Centers for Medicare & Medicaid Services. (2024). Home and community-based services data. U.S. Department of Health and Human Services. https://www.medicaid.gov/medicaid/home-community-based-services/index.html
[5] Bureau of Justice Statistics. (2024). Prisoners in 2023. U.S. Department of Justice. https://bjs.ojp.gov/library/publications/prisoners-2023
[6] U.S. Department of Housing and Urban Development. (2024). The 2024 annual homeless assessment report (AHAR) to Congress. HUD USER. https://www.huduser.gov/portal/sites/default/files/pdf/2024-AHAR-Part-1.pdf
[7] Kaiser Family Foundation. (2025). A look at waiting lists for Medicaid home- and community-based services from 2016 to 2025. KFF. https://www.kff.org/medicaid/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2025/
[8] National Center for State Courts. (2024). Mental health courts. https://www.ncsc.org/topics/alternative-dockets/problem-solving-courts/mental-health-courts
[9] Maryland Department of Health. (2024). Developmental disabilities administration services. https://health.maryland.gov/dda/pages/home.aspx
[10] U.S. Government Accountability Office. (2024). Some states are eliminating subminimum wages for people with disabilities — what does that mean for workers? https://www.gao.gov/blog/some-states-are-eliminating-subminimum-wages-people-disabilities-what-does-mean-workers
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