When Medicaid in Georgia Will Pay for a Nursing Home, Assisted Living, or Home Health Care

In Georgia, Medicaid is a very common source of funding for long-term care. About 70% of nursing home residents in Georgia use Medicaid to pay for their nursing home care.

Without Medicaid, long-term care like nursing homes, assisted living facilities, and home health care is unaffordable for most people. In 2024, the average monthly cost of a private room in a nursing home in Georgia was approximately $8,616 (about $283 per day), or over $103,000 per year.

Private health insurance policies generally don't cover long-term care, and very few people purchase private long-term care insurance policies. Medicare coverage for long-term care services is limited. As a result, Medicaid picks up the tab for many Georgians who need long-term institutional care or home care.

There are several ways to become eligible for Medicaid in Georgia, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.

Income Limit for Georgia's Medicaid Program

People who are 65 or older, disabled, or blind can qualify for Medicaid if they meet specific income and asset limits. Georgia's Aged, Blind, and Disabled (ABD) Medicaid program serves those residents.

If you receive Supplemental Security Income (SSI), you automatically qualify for ABD Medicaid in Georgia. If you're 65 or older, blind, or disabled and need long-term care in a nursing home or in the community but aren't receiving SSI, then your monthly income must be less than $2,829 (in 2024) to qualify for ABD Medicaid.

If your income is above the limit, you can still qualify for Medicaid in two other ways. First, you can put your extra income each month into a special bank account set up under the terms of a Qualified Income Trust (QIT), also called an Income Only Trust or Miller Trust. Using a QIT might work for you if your income exceeds Georgia's ABD limit, but isn't enough for you to pay for a nursing home.

The second way to qualify for Medicaid if you're over the income limit is through Georgia's Medically Needy Program. In the Medically Needy Program, you can use your monthly medical bills to "spend down" your income and qualify for Medicaid. The program is available to adults who are:

• • 65 and older
  • blind, or
  • disabled.

In 2024, the income limit for the ABD Medically Needy Program is $317 per month for a single person. That $317 is the most income you can have left after paying your monthly medical expenses. Once you show your expenses are enough to take your income below the limit, you'll qualify for Medicaid coverage for the rest of that month.

To apply for ABD Medicaid or the Medically Needy Program, contact your local office of the Georgia Division of Family and Children Services (DFCS) or online at gateway.ga.gov.

Resource Limit for Georgia's Medicaid Program

To qualify for Medicaid in Georgia, you must have less than $2,000 in "resources" if you're single. Resources are assets like money and property. The resource limit is the same regardless of whether you're:

• in a nursing home
• receiving community care, or
• living independently.

A couple can have $3,000 in resources and still qualify. If they're qualifying under the Medically Needy Program, they can have up to $4,000 in resources.

There are special "community spouse" rules that allow a spouse who is remaining in the "community" (at home or with relatives rather than in a long-term care setting) to keep more assets and income when the other spouse is in a long-term care institution.

Georgia follows federal rules regarding the Medicaid resource limit and when your home is exempt. (Ga. Code § 49-4-6(a).) As of 2024, your home is exempt unless you have more than $713,000 in equity in it.

Under federal and Georgia laws, your household goods are exempt from being counted as resources. In addition, Georgia won't count one car as part of your resources, regardless of its value.

When a Nursing Home Is Medically Necessary

Medicaid will pay for a nursing home only when it's medically necessary. (42 U.S.C. § 483.112.) To meet this standard, you must show that you have a physical or mental impairment, or a combination of the two, that requires continued nursing care under the supervision of a doctor. This is called needing a "nursing home level of care."

In Georgia, before you're admitted to a nursing home, you'll get a Pre-Admission Screening and Resident Review (PASRR). The screening assesses whether you meet the nursing home level of care standard and also whether a particular facility can meet your needs.

The severity of your impairment will determine what type of facility you need. For example, if you require round-the-clock nursing care, you'll need a skilled nursing facility (SNF). But if you have an impairment that prevents you from taking care of yourself but doesn't require round-the-clock care, you might only need an intermediate care facility. You must meet at least the intermediate level of care for Georgia Medicaid to pay for a nursing home.

Medicaid for Georgians Needing Assisted Living or Home Health Care

Many Georgians eligible for nursing home placement would prefer to live in a less restrictive setting, like assisted living facilities (ALF), or in their own homes with some services like home health care.

Assisted living facilities are generally less expensive and less medically intensive than nursing homes. Home health care includes a wide variety of services, like:

• skilled nursing
• therapy
• medication management
• help with bathing or getting around, and
• personal care aide services, like meal preparation or cleaning.

If you receive ABD Medicaid, the program will pay for some home care services, but only if the services are:

• prescribed by your doctor as part of a plan of care for a particular problem, and
• directed at curing or rehabilitating you.

Georgia Medicaid limits the number of home health visits you can receive each year.

Georgia's Long-Term Care Waiver Programs

Georgia operates several Medicaid waiver programs that pay for assisted living facilities and home health care services for low-income Georgians. To qualify for any of the waiver programs Georgia offers to cover long-term care costs, you must meet the intermediate nursing home level of care. You must be able to show:

• you qualify for placement in a nursing home (need nursing home level care), and
• without the services provided by the waiver program, you'd need to move into a nursing home.

Georgia's Elderly and Disabled Waiver Program

Georgia's Elderly and Disabled Waiver Program (EDWP) (formerly the Community Care Services Program or CCSP) provides in-home and community-based services to residents over 65 and those with disabilities. EDWP-covered services can include:

• skilled nursing services
• therapy services
• home-delivered meals
• housekeeping and chore help
• personal care, like help bathing or getting around, and
• respite care for your family members.

To qualify, you must be at least 65 or disabled and have a physical impairment that causes limitations. If qualified, you'll receive a needs assessment and a care plan outlining the type of services you'll receive.

The EDWP also can pay for alternative living services (ALS), which provide 24-hour supervision, personal care, nursing supervision, and health-related support services in state-licensed personal care homes. To apply, contact your local Area Agency on Aging or call the state-wide Area Agency on Aging office toll-free at 866-552-4464.

SOURCE and CCSP Through Your Local ADRC Office

Georgia also operates a couple of home and community-based waiver service programs as part of the EDWP through the 12 Area Agencies on Aging (AAAs) across the state. Both waiver programs serve Medicaid recipients who meet the nursing home level of care standard.

The Service Options Using Resources in a Community Environment (SOURCE) and Community Care Services Program (CCSP ) waivers offer:

• case management services with primary care physicians
• payments for services offered in an assisted living home
• home health care
• personal care
• delivered meals, and
• emergency response services.

To qualify for SOURCE or CCSP, you must be over 65 and disabled. For SOURCE, you must also be eligible for SSI. To apply for CCSP, you must be eligible for Medicaid (or likely eligible). Get more information or apply for the waiver by contacting your local Georgia Aging and Disability Resource Connection (ADRC) office.

Georgia's Independent Care Waiver Program for Those Under 65

Georgia's Independent Care Waiver Program (ICWP) offers services for adults between 21 and 64 years old who have a severe physical impairment or a traumatic brain injury. The waiver covers services designed to help recipients move out of—or avoid moving into—a nursing home, including:

• personal support
• home health services, including skilled nursing
• occupational therapy and counseling
• specialized medical equipment and supplies
• emergency response systems
• home modifications, and
• transportation

To qualify, you must be eligible for Medicaid nursing home benefits. For more information or to apply for the waiver, contact the Alliant Georgia Medical Care Foundation (GMCF) by calling 888-669-7195 or 800-982-0411 or online at www.gmcf.org. You'll need to complete a pre-application telephone screening, submit an application, and then have an in-person assessment. Qualified applicants get waiver services as funding becomes available.

Georgia's New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP)

Finally, Georgia has two waiver programs serving state residents with intellectual and developmental disabilities. The New Options Waiver (NOW) program and the Comprehensive Supports Waiver Program (COMP) provide support that allows recipients to live outside institutional facilities. The specially designed services available through NOW and COMP include:

• pre-vocational training and supported employment
• physical, occupational, and speech therapy
• specialized medical equipment
• home and vehicle adaptation
• residential services (like group homes and crisis respite homes)
• behavior support services, and
• mobile crisis dispatch.

Get more information or apply for NOW and COMP services through the Georgia Department of Behavioral Health and Developmental Disabilities or by contacting your regional DBHDD field office.

De-Institutionalization of Medicaid Recipients in Georgia

Georgia has a "Money Follows the Person" (MFP) grant from the Centers for Medicare and Medicaid Services that helps older people move out of institutions and into less restrictive settings. To qualify for help moving out of an institution, all the following must be true:

• you're at least 65 or have a physical or developmental disability
• you live in a hospital, nursing home, or other long-term care facility (for at least 60 days)
• Medicaid has been paying for your care, and
• you continue to meet the institutional level of care standard.

MFP provides funding for things like moving expenses and transportation costs. The program can cover the cost of modifications to your home or vehicle, medical supplies, and other services intended to help you live more independently.

Get more information online from Georgia Medicaid. You can apply for MFP by contacting the state MFP office at [email protected] or by calling 404-651-9961.

Supportive Services for Georgians Who Don't Qualify for Medicaid

If you're a senior (over 65) and you don't qualify for Medicaid or meet the nursing home level of care requirement, you might still qualify for some home health services. Georgia's Area Agencies on Aging operate the Non-Medicaid Home and Community-Based Services program, which offers a wide variety of services like meal delivery, help with chores, and personal care assistance. To apply, contact your local Area Agency on Aging.