Does Medicaid Pay for Assisted Living in Georgia?

Assisted living facilities provide support for daily activities, but their costs can be substantial. Many families consider government programs to manage these expenses, making it important to understand how public assistance contributes to long-term care in Georgia.

Medicaid and Assisted Living in Georgia

Medicaid in Georgia does not cover the full cost of room and board in an assisted living facility. The state’s Medicaid program focuses on covering the medical and personal care services an individual requires.

Financial aid for care services is provided through Home and Community-Based Services (HCBS) waiver programs, such as the Community Care Services Program (CCSP) and the Service Options Using Resources in a Community Environment (SOURCE). These waivers allow individuals who meet nursing home level of care criteria to receive services in a community setting, including assisted living facilities.

These waiver programs prevent or delay institutionalization by providing care in less restrictive environments. CCSP and SOURCE services focus on personal care and health support, not residential costs. While Medicaid reduces the financial burden of care, the individual or family remains responsible for housing and meal expenses.

Eligibility Requirements for Waiver Programs

Qualification for Georgia’s HCBS waiver programs involves meeting both financial and functional criteria.

Financial eligibility includes income and asset limits; for a single applicant in 2025, the monthly income limit is $2,901, and the countable asset limit is $2,000. For married couples applying, the combined income limit for CCSP is $5,802 per month, with a combined asset limit of $3,000. If only one spouse applies, the applicant’s income limit remains $2,901 per month, and the non-applicant spouse’s income is not counted.

Rules apply to married couples to prevent spousal impoverishment. The non-applicant spouse may retain a portion of the couple’s combined assets, up to a Community Spouse Resource Allowance (CSRA) of $157,920 in 2025. If the non-applicant spouse’s income falls below a certain threshold, they may be allocated a Monthly Maintenance Needs Allowance (MMNA) of up to $3,948 per month in 2025 from the applicant spouse’s income.

If an applicant’s gross monthly income exceeds the cap, a Qualified Income Trust (QIT) can be utilized. This tool allows income above the Medicaid limit to be deposited into the trust, not counting against eligibility. Funds in a QIT must be spent down monthly for approved medical or care-related expenses. This strategy helps individuals with higher incomes qualify for Medicaid long-term care services.

Functional or medical eligibility requires a determination that the applicant needs a “nursing home level of care.” This assessment verifies the individual has significant care needs that would necessitate placement in a nursing facility. The evaluation focuses on the individual’s ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

ADLs include self-care tasks such as bathing, dressing, eating, transferring, and toileting. IADLs encompass more complex activities necessary for independent living, including meal preparation, managing medications, and light housekeeping. A state-approved medical professional or agency conducts this evaluation, and both financial and functional criteria must be met for waiver program approval.

Applying for the Waiver

Applying for Georgia’s CCSP or SOURCE waiver programs involves contacting a local agency, such as the Area Agency on Aging (AAA) or the Aging & Disability Resource Connection (ADRC). These agencies provide guidance and conduct initial screenings to determine eligibility.

After initial contact, applicants receive instructions on how to complete the application forms. Documents like bank statements and medical records are necessary for eligibility determination.

Following application submission, an in-home assessment or interview is scheduled. This allows a care coordinator or assessor to verify the applicant’s medical and functional needs. The assessment contributes to the development of an individualized care plan.

Some waiver programs may have waiting lists due to limited funding or available slots. Meeting eligibility criteria is essential, but immediate services are not always guaranteed. Applicants are notified of the decision regarding their application, and appeal process information is provided if services are denied.

Services Covered by the Waiver

Georgia’s CCSP and SOURCE waiver programs cover services to support individuals in assisted living settings, excluding room and board costs. These waivers focus on providing personal care and health-related support to help individuals maintain independence and avoid institutionalization.

Common services covered include personal care assistance with daily activities like bathing, dressing, and grooming. Medication management assistance is also provided. Case management services are a core component, coordinating care and helping navigate support options.

The waivers may also cover limited skilled nursing services, depending on assessed medical needs. Other supportive services include adult day health services, providing supervised care and activities, and respite care, offering temporary relief for primary caregivers. Non-emergency transportation to medical appointments may also be covered.

Services not covered by these waivers, beyond room and board, include specialized medical equipment or non-medical personal expenses. The combination of services an approved individual receives is tailored to their needs, based on a comprehensive assessment and individualized care plan.