Georgia Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Georgia provides long-term care resources to seniors through its Division of Aging Services, under the Department of Human Services (DHS), and through the Department of Community Health (DCH). The Division of Aging Services offers non-Medicaid Home and Community Based Services (HCBS) to residents over 60, including in-home services, caregiver programs, and nutrition and wellness support. This program is required under the Older Americans Act, and is administered regionally. In order to see if these Home and Community Based Services are available in your area, it is necessary to contact your local Area Agency on Aging.

In addition to the non-Medicaid services provided by the DHS, Georgia has recently moved the administration of its assisted living and in-home care programs for Medicaid-eligible seniors to the Department of Community Health. Georgia offers multiple alternatives to nursing home care through the Medicaid home-and-community based (HCBS) waiver program. Just like Medicaid for nursing homes, the applicant must meet certain financial and non-financial requirements for eligibility. Georgia offers two waiver programs for seniors who wish to receive long-term care outside of a nursing home facility.

Medicaid Waiver Programs For Assisted Living and In-home Care

Georgia Elderly & Disabled Medicaid Waiver (HCBS Elderly & Disabled Waiver)

The Georgia Elderly & Disabled HCBS Medicaid Waiver (E&D Waiver) assists individuals who are older or disabled and functionally impaired to continue to live in the community with appropriate supports. The E&D Waiver provides seniors with a range of options, including assisted living and various in home care services. The care provided is equivalent to that of a nursing home facility, but allows eligible seniors to live in their own home or assisted living community. There is a total enrollment cap on E&D Waiver beneficiaries of 34,492 in 2017.

In Georgia, the E&D Waiver is implemented by the Department of Community Health and offers two programs, the: 1) Community Care Services Program (CCSP) 2) Service Options Using Resources in a Community Environment (SOURCE).

Community Care Services Program (CCSP)

Introduction: The CCSP program provides a range of services (see below), and is regionally managed by Georgia’s 12 Area Agencies on Aging to administer the program and provide case management services. The program serves older and/or functionally disabled consumers, their families, and caregivers in achieving safe, self-reliant lives. The CCSP program helped 13,205 Georgians stay in their communities and receive care in 2015.

Services

The following services are provided by this program: Adult Day Health Care, Alternative Living Services, Emergency Response Service, Home Delivered Meals, Home Delivered Services provided as an extension of State Plan approved home health therapies and nursing, Personal Support Services, and Skilled Nursing Services not otherwise delivered by home health agencies.

Eligibility

Generally, CCSP participants must meet the same medical, functional and financial eligibility criteria as for placement in a nursing facility under Medicaid and be approved by a physician.

  1. Health Criteria: Must meet the State’s requirement for Nursing Home Level of Care as approved by a physician, meaning the applicant’s doctor must sign-off on the applicant’s need for the services provided by CCSP.
  2. Financial Criteria: Georgia has the same limits for people over 65 as those receiving Medicaid assistance for nursing home care. This means there is an income limit and resource limit. In 2017, the income limit for an individual is $2,205 per month. The resources that the applicant is allowed to keep must not be above $2,000 for an individual or $3,000 if the applicant is married and both spouses are participants. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust), can allow them to access the benefits by funneling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care. Georgia also has a “medically needy” Medicaid eligibility category which allows the applicant to deduct medical and other related expenses from their income in order to reach the income limit. If the CCSP Medicaid applicant has a spouse who is neither in CCSP nor in an institution, the assets of the spouse MUST be considered in the eligibility determination, known as the Community Spouse Resource Allowance (CSRA). In 2017, the maximum allowable CSRA is $120,900.

Practical Considerations

In applying for the CCSP program, it is helpful to understand some of the practical issues that are in play. From the point of view of eligibility, the CCSP program is unique in that is must have a doctor’s signature accompany your health assessment. From the financial standpoint, if you are not already Medicaid-eligible, Georgia allows a Miller Trust to lower your income to meet the income limits.

Conclusion

The CCSP program is a good option for seniors who already know what they are looking for in their long-term care. An applicant who meets the Medicaid financial eligibility and has their own doctor is a great candidate for this program. The viability of this program is highly dependent on the waitlist in the applicant’s area, as the Medicaid financial eligibility rules allow for planning through the use of a trust and transfers of assets.

Service Options Using Resources in a Community Environment (SOURCE)

Introduction

The SOURCE program serves the frail elderly and disabled senior population by providing Medicaid enrolled seniors to receive care in their homes rather than in a nursing facility. The program provides both primary medical care and case management with approved long-term health services. The SOURCE waiver program is used by approximately 19,000 elderly and disabled beneficiaries statewide.

Services

The SOURCE program provides individual-level services in addition to the HCBS Medicaid waiver“core” services, such as: service coordination (help with managing care needs and services), personal support (assistance with daily living activities, i.e. bathing, dressing, meals and housekeeping), home health services (nursing, home health aide, and occupational, physical and speech therapy), emergency response systems, respite care (caregiver relief).

SOURCE program participants also receive more individualized care and are assigned a case manager. This primary point of contact performs an assessment after enrollment, and then creates customized “care path” for the SOURCE beneficiary. Care paths are sets of standardized outcomes for each level of care, with customized plans for each person to achieve those outcomes. The case manager works closely with the participant's primary care doctor, and other treatment providers to ensure quality of care. Additionally, case managers serve as a regular point of contact, and perform monthly and quarterly visits to re-assess the needs of the participant, specifically tailoring services to meet each individual’s situation.

Eligibility

All SOURCE clients must be eligible for Medicaid and meet nursing home level of care.

  1. Health: Must meet the State’s requirement for Nursing Home Level of Care, as determined through initial assessment.
  2. Financial: Georgia has the same limits as those receiving Medicaid assistance for nursing home care for the SOURCE Program. This means there is an income limit and resource limit. In 2017, the income limit for an individual is $2,205 per month. The resources that the applicant is allowed to keep must not be above $2,000 for an individual or $3,000 if the applicant is married and both spouses are participants. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust), can allow them to access the benefits by funneling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care. Georgia also has a“medically needy” Medicaid eligibility category which allows the applicant to deduct medical and other related expenses from their income in order to reach the income limit. If the SOURCE Medicaid applicant has a spouse who is neither in SOURCE nor in an institution, the assets of the spouse MUST be considered in the eligibility determination, known as the Community Spouse Resource Allowance (CSRA). In 2017, the maximum allowable CSRA is $120,900.

Practical Considerations

When considering the SOURCE program, it is important to know that it provides a more robust level of care, and offers a more personalized approach. It differs from the CCSP program in that it does not require a doctor’s signature, but rather an in-person assessment by a case manager to determine if the applicant meets the health criteria for eligibility. From the financial standpoint, if you are not already Medicaid-eligible, Georgia allows a Miller Trust to lower your income to meet the income limits.

Conclusion

The SOURCE program is a good option for seniors who need different levels of care and a more managed approach to their long-term health care. The program uses its own case manager and doctors to provide services, and has two different levels of care that will determine the path the applicant takes. The viability of this program is highly dependent on the waitlist in the applicant’s area, as the Medicaid financial eligibility rules allow for planning through the use of a trust and transfers of assets. For more information, you can call (404) 463-6570.