Georgia Medicaid Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Georgia Medicaid Long Term Care for seniors, which is administered by the state’s Department of Community Health and will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.
Georgia Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Georgia Medicaid will cover the cost of long-term care in a nursing home for financially limited Georgia residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
- Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
- Skilled nursing care
- Physician’s visits
- Prescription medication
- Medication management
- Mental health counseling
- Social activities
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Georgia Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $70/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Georgia Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
Home and Community Based Services (HCBS) Waivers
Home and Community Based Services (HCBS) Waivers will pay for long-term care goods and services that help financially limited Georgia seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long term care services for Georgia residents who live in their home, the home of a loved one or an assisted living personal care home. Georgia residents can also receive some HCBS Waiver benefits while in adult day care. While Georgia’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.
The HCBS Waiver relevant to Georgia seniors is the Elderly and Disabled Waiver, which funds two programs that can provide long-term care services and supports – the Community Cares Services Program (CCSP) and the Service Options Using Resources in a Community Environment (SOURCE). The programs are similar and described in more detail below, but SOURCE is for Georgia residents who also qualify for Supplemental Security Income (SSI).
Unlike Nursing Home Medicaid, the Elderly and Disabled Waiver is not an entitlement. Instead, it has a limited number of enrollment spots (45,373 per year as of 2023). Once those spots are full, additional applicants will be placed on a waitlist. During the Elderly and Disabled Waiver application process, Georgia residents will be screened over the phone by an Area Agency on Aging to determine their eligibility and urgency of need, which will affect their placement on the waitlist. Once the applicant reaches the top of the waitlist, they will undergo an in-home assessment to confirm their level of care need (they must require a Nursing Facility Level of Care to be eligible) and help in the creation of their care plan.
1. Community Cares Services Program (CCSP)
The Community Cares Services Program (CCSP) provides long-term care services and supports to elderly or disabled Georgia Medicaid beneficiaries who have some functional impairment, a care need that isn’t being met and require a Nursing Facility Level of Care (NFLOC) but instead live in the community. Georgia uses the Determination of Need Functional Assessment-Revised to determine if a care need is being unmet, and it uses the Minimum Date Set Home Care tool to determine if the applicant has functional impairment and requires a NFLOC. A physician must also confirm the applicant’s need for a NFLOC. For Georgia’s Elderly and Disabled Waiver programs, including CCSP, living in the community can mean living in their home, the home of a loved one or an assisted living personal care home, although CCSP will not pay for room and board in a personal care home. Program participants can also receive CCSP benefits in adult day care.
Each CCSP participant will receive an individualized benefits plan based on their needs and circumstances. Benefits can include adult day care, 24/7 supervision, in-home skilled nursing and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, preparing meals, housework, money management).
The state can provide a licensed caregiver to provide personal care assistance to CCSP participants, but they can also self-direct those services by choosing a caregiver of their choice. This can not be a relative, unless the CCSP participant lives in such a rural area that a relative is the only choice. Even then, spouses can not be hired as CCSP caregivers.
2. Service Options Using Resources in a Community Environment (SOURCE)
The Service Options Using Resources in a Community Environment (SOURCE) program provides long-term care services and case management for elderly and disabled Georgia Medicaid beneficiaries who are functionally impaired, require a Nursing Facility of Level of Care (NFLOC), live in the community and qualify for Supplemental Security Income (SSI). Living “in the community” for this program can mean living at home, the home of a loved one or an assisted living personal care home. To qualify for SSI, Georgia residents must meet an income limit and an asset limit. For a single applicant in 2024, the SSI income limit is $943/month and the asset limit is $2,000. For a married applicant in 2023, the income limit for a couple is $1,415/month and the asset limit is $3,000. SOURCE Program participants who live in a personal care home, however, must use most of their SSI income to help offset the cost of living in the facility.
The SOURCE program coordinates medical care and home and community based long-term care services into one plan. The long-term care benefits will be provided depending on each beneficiary’s needs and can include adult day care, 24/7 supervision, in-home nursing and therapies (physical, occupational, speech) and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, preparing meals, housework, money management).
The state can assign a licensed caregiver to provide personal care assistance to SOURCE participants, but they can also self-direct those services by choosing a caregiver of their choice. This can not be a relative, unless the SOURCE participant lives in such a rural area that a relative is the only choice. Even then, spouses can not be hired as SOURCE caregivers.
Aged, Blind, and Disabled Medicaid
Georgia’s Aged, Blind, and Disabled (ABD) Medicaid provides basic healthcare coverage and long-term care services and supports to financially limited Georgia residents who are aged (65 and older), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed to receive healthcare coverage. Long-term care benefits via ABD Medicaid, however, are provided based on need and availability.
ABD Long Term Care Benefits
Eligible Georgia seniors who show a medical need for long-term care services can receive some of those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Georgia seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.
Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and non-medical personal needs into one comprehensive plan and delivery system for ABD Medicaid recipients who require a Nursing Facility Level of Care, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. Although Georgia does not have a PACE program of its own as of 2024, all five of its neighboring states have programs. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.
Eligibility Criteria For Georgia Medicaid Long Term Care Programs
To be eligible for Georgia Medicaid Long Term Care, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid and what program they’re applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
Georgia Medicaid Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Georgia residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for Georgia Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Georgia Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the cost of nursing home care. They are only allowed to keep $70/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Georgia Medicaid is $3,000 combined, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in Georgia is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. This is determined through a state assessment and reports from the applicant’s doctors and other relevant healthcare professionals. Georgia uses the Minimum Data Set Home Care tool to determine if the applicant requires a NFLOC. This tool takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as cognitive ability.
Georgia Home and Community Based Services (HCBS) Waivers Eligibility Criteria
Financial Requirements
Georgia residents have to meet asset and income limits in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for Georgia’s Elderly and Disabled Waiver, which funds both the Community Cares Services Program (CCSP) and the Service Options Using Resources in a Community Environment (SOURCE) program, is $2,000, which means the applicant must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for the Elderly and Disabled Waiver is different for the two programs. For a single CCSP applicant, the 2023 income limit is $2,829/month. For a single SOURCE applicant, it’s $943/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2024 asset limit for both programs funded by the Elderly and Disabled Waiver is $3,000 combined. The 2024 income limit for married applicants with both spouses applying for CCSP is a combined $5,658/month, but for SOURCE it’s a combined $1,415/month. For a married applicant with just one spouse applying for CCSP, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. But for a married applicant with just one spouse applying to SOURCE, the 2024 asset limit is $3,000 combined. The income limit for a married applicant with just one spouse applying to CCSP is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted. But for a married applicant with just one spouse applying to SOURCE, the 2024 income limit is a combined $1,415/month.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers in Georgia is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. Georgia uses the Minimum Data Set Home Care tool to determine if the applicant requires NFLOC. This tool takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as cognitive ability. For the SOURCE program, an applicant must have an unmet need for care. To determine if they do, Georgia uses a Determination of Functional Assessment-Revised, which also takes into consideration the applicant’s ability to complete the Activities of Daily Living and the Instrumental Activities of Daily Living.
Georgia Aged, Blind, and Disabled Medicaid Eligibility Criteria
Financial Requirements
Georgia residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $943/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2024 asset limit for Georgia ABD Medicaid is $3,000 combined, and the income limit is $1,415/month combined. This applies to married couples with both spouses applying or with just one spouse applying.
Functional Requirements
The only functional requirements to receive basic healthcare coverage through Georgia ABD Medicaid are being aged (65 or over), blind, or disabled. For ABD Medicaid applicants who require long-term care services and supports, Georgia Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of benefits the applicant needs and the state will cover.
How Georgia Medicaid Treats the Home for Eligibility Purposes
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
- If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
- If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
- If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status.
Georgia Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Georgia and how you can protect your home from it, click here.
Applying For Georgia Medicaid Long Term Care Programs
The first step in applying for a Georgia Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one want to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Georgia Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Georgia Medicaid applicant. These documents will be needed for the official Georgia Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Georgia residents can apply for Medicaid online through Georgia Gateway. They can also contact their county office for the Division of Family and Children Services (DCFS), or call DCFS at 1-877-423-4746.
Applicants for the Community Care Services Program (CCSP) should contact their local Area Agency on Aging for a telephone screening to see if they meet the eligibility criteria. If they do, the applicant will be placed on a waiting list for an in-home functional assessment. Click here to find a list of Georgia Area Agencies on Aging.
Applicants for Services Options Using Resources in Community Environments (SOURCE) should contact Georgia’s Aging & Disability Network at 1-866-552-4464, or contact their local Aging And Disability Resource Connection.
For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Choosing a Georgia Medicaid Nursing Home
After being approved for Nursing Home Medicaid through Georgia Medicaid, your or your loved one needs to choose which Medicaid-accepting nursing home best meets yours needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any open spaces. Finding the right nursing home can be a chore, especially if you are looking in a specific location.
Georgia has about 360 nursing homes. There are approximately 60 that accept Medicaid in the Atlanta region, including the cities of Sandy Springs, Roswell and Johns Creek. And there are another dozen nursing homes that accept Medicaid in Athens. Choices thin out in other areas of the state, but there are clusters of nursing homes around cities – roughly 20 near Augusta, about 15 around Savannah, and 10 near Columbus.
Residents in some Georgia communities regularly cross state lines for personal or business reasons, including healthcare. Medicaid coverage, however, can not cross state lines. So, someone who Georgia Nursing Home Medicaid will not be covered in a nursing home in Chattanooga, Tenn., or Tallahassee, Fla., even those facilities are closer or more convenient to the Georgia resident’s home.
Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by health inspections, quality measures, staffing and overall rating, which can be a helpful place to start. The healthcare professionals who work with you can be a great source of information. You can also find more information about nursing homes by contacting your local Area Agency on Aging.
After doing your research, you or someone close to you should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence provide transportation? Does it offer social activities? Are there private spaces for when you have visitors? What are the meals like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
Data collected by CMS shows that Georgia nursing homes averaged 16.5 health deficiencies that led to citations from 2019-2022, which is less than the national average of 25.7 during that same three-year time period. Georgia nursing homes also averaged fewer fire deficiencies than the national average, 7.5 compared to 13.5.