What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers.
Waiver Description
Georgia Medicaid’s Community Care Services Program (CCSP) operates under the Elderly and Disabled Waiver. CCSP is a program designed to help frail older adults remain living in their own homes or communities and to receive services in those locations as an alternative to nursing homes. Sometimes referred to as a nursing home diversion program, this type of program helps the state keep nursing home costs low and is generally preferred by families.
The state of Georgia allows participants in this waiver program a degree of freedom to direct the services that they want. This is sometimes referred to as “Cash and Counseling.” This means individuals are empowered to choose their own personal caregivers.
In most states, this “consumer direction” of services is interpreted as having the ability to hire family members as paid caregivers. But, in Georgia, the rules are different. While it is legally possible to hire family members, in practice, this is exceedingly rare. Only in situations in which a participant lives in a rural area or has a unique condition where it is difficult to find a home care provider can relatives be hired. Spouses cannot be hired to provide care. Persons should not pursue this program if their sole goal is to achieve compensation for a family member providing care.
In July 2016, CCSP was moved from the Division of Aging Services in the Department of Human Services to the Department of Community Health. The Department of Community Health also operates the SOURCE Waiver, which also operates under Georgia’s Elderly and Disabled Medicaid Waiver. This reorganization does not impact the delivery of services and is only an internal change.
The CCSP Program often has a waiting list and individuals are prioritized based on their levels of impairment and unmet needs.
Eligibility Guidelines
General Requirements
To qualify for CCSP, individuals must be Georgia residents who first qualify for Georgia Medicaid. There are also functional and financial eligibility requirements that must be met. Functionally, applicants must have physical limitations and require the level of care provided in a nursing home. Documentation from a doctor indicating this is the case must be provided. CCSP recognizes Alzheimer’s disease and related dementias as conditions that limits one physically.
Financial Requirements
Income Limits
Georgia has the same income limits for individuals receiving care in nursing homes as those receiving care in the community — on Home and Community Based Services (HCBS) waivers. For 2024, this monthly gross income limit is $2,829. For married applicants with both parties applying for CCSP, the income limit for each spouse remains the same as for a single applicant, for a total of $5,658.
An exception to the income limit also exists when one spouse of a married couple is not applying for Medicaid. A certain amount of the applicant’s income can be shifted to the non-applicant spouse to provide them with a livable income. As of 2024, this spousal income allowance can be as much as $3,853.50 a month. This is also called a monthly maintenance needs allowance. If the non-applicant spouse already has monthly income equal to, or above, this figure, a transfer of income is not permitted from the applicant spouse.
Asset Limits
In 2024, the value of an individual’s resources or assets must be less than $2,000. Couples with both spouses applying can retain up to $3,000. If only one spouse applies, the non-applicant spouse can have up to $154,140 in assets (this is called a community spouse resource allowance). Plus, the individual applicant can have assets up to $2,000.
The asset limit excludes the applicant’s primary vehicle and the value of their home equity interest up to $713,000, given the applicant or their spouse lives in the home. In addition, there is a $10,000 burial exclusion for applicants and their spouses. This means each spouse can have up to $10,000 in a burial account and it is not counted toward Medicaid’s asset limit.
Over the Financial Limits?
Persons with income or assets in excess of Medicaid limits or couples with only one spouse applying for Medicaid should consult with a professional Medicaid planner in advance of applying. Free assistance is available.
Benefits and Services
The CCSP program provides a variety of services and supports to individuals in their homes or in non-nursing home residential care. Services are determined on a case-by-case basis and can include any of the ones mentioned below. Program participants are given the flexibility (within limits) to select from whom they receive these care services. Providers must be qualified and willing to accept the Medicaid payment rates.
- Adult Day Health Care – may include speech, physical, and occupational therapy
- Alternative Living Services / Assisted Living Services
- Case Management
- Home Delivered Meals
- Home Health Care – includes skilled nursing
- In Home and Out-of-Home Respite Care
- Personal Emergency Response Services – 24-hours per day / 7-days per week
- Personal Support Services – housecleaning, shopping for essentials, assistance with meal preparation, and assistance with day-to-day activities, such as bathing, mobility, using the bathroom, etc.
- Self-Directed Personal Support Services – allows eligible applicants the flexibility to hire and manage the worker of their choosing
- Financial Management Services – provides employment assistance for program beneficiaries self-directing their own personal care
How to Apply / Learn More
More information about the CCSP waiver is available on this downloadable fact sheet. To apply for this program, individuals should contact their local Area Agency on Aging. One can also call Georgia Cares at 866-552-4464. For those not already enrolled in Georgia Medicaid, once the AAA has screened the applicant, and there are available slots for new participants, the applicant must complete the Medicaid application through the Department of Human Services’ Division of Family and Children Services.
