Maryland is making a big bet that stable housing can keep people healthier and out of the hospital. The state is sharply expanding a Medicaid-backed program that pairs housing support with intensive case management for residents who are homeless or at risk of losing their homes. The move will more than double the program’s annual capacity and extend services into counties that previously were not on the map. State health officials say the goal is straightforward: keep medically vulnerable residents housed and cut back on costly emergency and inpatient care.
According to the Maryland Department of Health, the Assistance in Community Integration Services (ACIS) program will add 1,070 participant spaces, boosting allocated annual slots from 620 to 1,690, an increase of more than 170%. As part of the expansion, Calvert, Carroll, Garrett, Harford, and Howard counties will launch ACIS for the first time, while Baltimore City, Montgomery County, and Prince George’s County will grow their existing programs; Cecil County will hold steady at its current enrollment level. ACIS, which began as a pilot in 2017, provides tenancy-based case management and housing supports alongside coordinated medical and behavioral health care.
Evaluation Shows Strong Housing Outcomes
An annual review by The Hilltop Institute covering calendar years 2019-2023 found that more than 76% of ACIS participants achieved stable housing, and nearly 80% of those went on to secure permanent housing. The analysis also reported fewer inpatient admissions and a drop in the share of participants with four or more emergency department visits after enrollment. State officials say those numbers make a strong case for scaling up the program.
Who Qualifies and What Services Look Like
ACIS targets Medicaid beneficiaries who are experiencing housing insecurity or are at risk of homelessness and who also meet specific health criteria, such as having two or more chronic conditions or frequently relying on the emergency room. Service rules describe tenancy-based case management that helps participants find housing, meet their obligations as tenants, and coordinate medical, behavioral health and community services to support long-term stability, according to COMAR.
Funding, Approvals and Growth
Budget documents show the program became a state-funded Medicaid benefit in calendar year 2025 after the Moore-Miller administration included $5.4 million in general funds to expand ACIS. Analysis from the Maryland General Assembly also notes that federal approval under the HealthChoice Section 1115 demonstration cleared the way to expand authorized participant spaces, a step authorized by the Centers for Medicare & Medicaid Services.
Local Rollout and What’s Next
Local health departments and other government agencies were invited to apply for ACIS participant spaces earlier this year, with letters of intent required as part of the application process, according to outreach materials for prospective providers. Updates from LifeSpan Network and the City of Baltimore say the expansion will allow hospitals, housing authorities and nonprofits to coordinate more referrals to tenancy supports and health services.
Advocates caution that even a large expansion of ACIS will not fix Maryland’s broader housing shortage, but state and local officials say the program can still play a significant role in reducing emergency care use and helping people stabilize their lives. For more information on eligibility and local enrollment, see the Maryland Department of Health ACIS page.
