Georgia Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Georgia Medicaid Long Term Care for seniors. This is different from regular Medicaid, which is for low-income people of all ages. In Georgia, Medicaid is administered by the state’s Department of Community Health. Medicaid will help pay for long term care for Georgia residents in a nursing home, in their home and in an assisted living personal care home through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.

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 eligible Georgia residents through its Nursing Home / Institutional Medicaid. This includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with Activities of Daily Living (eating, bathing, moving, dressing and using the bathroom).

Some of the things that Georgia Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.

Nursing Home Medicaid is an entitlement. This means that eligible Georgia residents who apply are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved.

Any Georgia Medicaid beneficiary who receives Nursing Home Medicaid coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $90 / month, as of 2023. This can be spent on any personal item – clothes, snacks, books, haircuts, cell phones, etc. It cannot be spent on any item that Medicaid covers, including hygiene basics like a toothbrush, soap, deodorant, razors and incontinence supplies, unless the Medicaid beneficiary wants a specific brand that is not covered by Georgia Medicaid. In this case, they could spend their personal needs allowance on the item.

Home and Community Based Service (HCBS) Waivers

Home and Community Based Service (HCBS) Waivers will pay for long term care goods and services that help Georgia Medicaid recipients 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.

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for an HCBS Waiver program in Georgia, they are not guaranteed by law to receive the benefits.

Georgia’s Elderly and Disabled Waiver funds two programs for Georgia Medicaid beneficiaries – the Community Cares Services Program (CCSP) and the Service Options Using Resources in a Community Environment (SOURCE). The programs are similar, but SOURCE is for Georgia residents who also qualify for Supplemental Security Income (SSI).

There are a limited number of enrollment spots for the the Elderly and Disabled Waiver, and once those spots are full any additional eligible applicants will be placed on a waiting list. Currently, the Elderly and Disabled Waiver is approved for a maximum of 34,826 program participants per year. During the application process for the Elderly and Disabled Waiver, 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 waiting list. Once the applicant reaches the top of the waiting list, they will undergo an in-home assessment to confirm their level of care need (they must require a NFLOC to be eligible) and help create a 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 have 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 2023, the SSI income limit is $914 / month and the asset limit is $2,000. For a married applicant in 2023, the income limit for a couple is $1,371 / month and the asset limit is $3,000.

SOURCE Program participants who live in a personal care home, however, must use most (about 80% in 2022) 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 services into one plan. The service 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 provide 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 / Regular Medicaid

Georgia’s Aged Blind and Disabled (ABD) Medicaid provides healthcare and personal service benefits to low-income Georgia residents who are aged (65 and older) or disabled and live “in the community.” Living “in the community” can mean living in their home, the home of a loved one or a personal care home. While ABD Medicaid will cover services in all of those settings, it will not cover room and board costs. 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 low-income people of all ages.

ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.

1) Standard ABD Benefits
In addition to medical care, ABD Medicaid benefits can include non-medical services and supports such as in-home personal care, adult day care, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long term care benefits they need and will receive.

2) 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, including Medicare benefits for those who are “dual eligible.” Although Georgia does not have a PACE program of its own as of 2023, all five of its neighboring states have programs. PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. There are PACE programs in Florida, Tennessee and South Carolina that are either right on Georgia state lines or within two hours drive. While individuals can not transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in their new state as soon as they relocate without any waiting period. More.

Eligibility Criteria For Georgia Medicaid’s 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 are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (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 2023, 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 red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / 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, Nursing Home Medicaid recipients are only allowed to keep $90 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.

For married applicants with both spouses applying, the 2023 asset limit for Nursing Home Medicaid through Georgia Medicaid is $3,000 combined, and the income limit is $2,742 / month per spouse for a total of $5,484 / month combined. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.

Georgia Nursing Home Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Georgia Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

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 can only be provided in 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 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 Service (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 2023, 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 red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities.

The 2023 income limit for the Elderly and Disabled Waiver is different for the two programs. For a single CCSP applicant, the 2023 income limit is $2,742 / month. For a single SOURCE applicant, it’s $914 / 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 2023 asset limit for both programs funded by the Elderly and Disabled Waiver is $3,000 combined. The 2023 income limit for married applicants with both spouses applying for CCSP is $5,484 / month combined, but for SOURCE it’s $1,371 / month. For a married applicant with just one spouse applying for CCSP, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, but for a married applicant with just one spouse applying to SOURCE the 2023 asset limit is $3,000 combined. The income limit for a married applicant with just one spouse applying to CCSP is $2,742 / 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 2023 income limit is $1,371 / month combined.

Home and Community Based Service Waiver applicants in Georgia are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Georgia Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

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 2023, 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 red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $914 / 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, the 2023 asset limit for Georgia ABD Medicaid is $3,000 combined between the two applicants/spouses, and the income limit is a combined $1,371 / month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.

While Georgia has a “look-back” period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no “look-back” period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The functional requirements for Georgia’s Aged, Blind, and Disabled (ABD) Medicaid are being disabled, blind or aged (65 or over). For ABD Medicaid applicants who require in-home 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 services the applicant needs and the state will cover.

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 / Institutional Medicaid, Home and Community Based Service (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 include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.

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, and if so, the applicant will be placed on a waiting list for an in-home functional assessment. This Georgia Department of Human Services site has Area Agency on Aging locations and contact information, or applicants can call 1-888-669-7195.

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.

Choosing a Georgia Medicaid Nursing Home

After an applicant has been approved for Nursing Home Medicaid through Georgia Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Nursing Home Medicaid is an entitlement, Georgia Medicaid will only cover stays and care in approved nursing homes. Georgia residents can find and compare nursing homes using the state’s Find a Facility site. They can also use Nursing Home / Institutional Medicaid, which is a federal government website that has information about more than 15,000 nursing homes across the country. All of the nursing homes on this site are either Medicaid- or Medicare-approved.