A Georgia Medicaid 1915(c) waiver pays for care at home instead of a nursing facility, but unlike regular Medicaid it is capped and waitlisted, so you can qualify and still wait for a slot. That one rule, set by federal law, is behind the planning lists, the level-of-care tests, and the income limits Georgia families keep running into. This guide explains how Georgia's four waivers (EDWP, which delivers the CCSP and SOURCE service models, plus ICWP, NOW, and COMP) work, who qualifies, and what to do while you wait.,

In This Guide

How a Georgia Medicaid 1915(c) waiver works, and why you can qualify and still wait

A Georgia Medicaid 1915(c) waiver lets the state spend Medicaid dollars on care at home or in the community for someone who would otherwise need the level of care provided in a hospital, a nursing facility (NF), or an intermediate care facility for individuals with intellectual disabilities (ICF/IID). The authority comes from Section 1915(c) of the Social Security Act, at 42 U.S.C. 1396n(c).

Every 1915(c) waiver rests on three federal tests, and each one shapes what a family experiences. First, cost neutrality: the state must assure that the average per-person cost under the waiver will not exceed 100 percent of what that care would have cost in an institution. Second, level of care: each person must be independently evaluated as needing the institutional level of care the waiver replaces, with a reevaluation at least once a year. Third, limited enrollment: the waiver application specifies a maximum number of unduplicated participants per waiver year, which caps the size of the program, and the only federal floor is that the Secretary of Health and Human Services may not hold that number below 200.

That third test is why you can be fully eligible and still wait. Regular Medicaid is an entitlement, so if you meet the rules you cannot be turned away. A waiver is different by design: the state sets a maximum number of slots, and when they are full, qualified applicants go on a planning list. Eligibility and a slot are two separate things. The waiting list is a capacity-and-budget decision the cap permits, not a judgment that you do not need the care.

Who qualifies for a Georgia Medicaid 1915(c) waiver: income, assets, and level of care

Qualifying for any Georgia waiver means clearing three gates: functional (do you need institutional level of care), financial (income and assets), and categorical (age, disability, or diagnosis for that specific waiver).

The functional gate is nursing-facility level of care, or NFLOC. There is no single federal definition; federal law has each state set its own assessment tool and threshold. Across states, the evaluation weighs the same three things: help needed with activities of daily living (bathing, dressing, toileting, transferring, eating, and moving around), skilled-nursing or medical needs, and cognitive or behavioral impairment. The same gateway applies to nursing-facility Medicaid and to the 1915(c) waivers that substitute for that care.

The financial gate uses the institutional special income rule. Georgia calls its version the Medicaid CAP and applies it across its long-term-care classes of assistance, EDWP, ICWP, and NOW/COMP among them. Georgia's own DFCS financial-limits appendix (effective July 2026) prints the cap at $2,982 a month for an individual and $5,964 for a couple, which is 300 percent of the $994 SSI federal benefit rate for 2026. Georgia's aged, blind, and disabled resource limit tracks the SSI standard separately: $2,000 in countable resources for an individual, $3,000 for a couple. That income ceiling is far more generous than regular Medicaid, which is the point of the waiver.

Being over the cap is not a dead end, and this is the step families most often miss. Georgia policy lets an applicant whose gross income is at or above the Medicaid CAP establish a Qualified Income Trust, commonly called a Miller trust, and deposit income into it to shelter all or part of that income from the eligibility income test. The trust must be irrevocable, hold only the applicant's own income, and name the Department of Community Health as remainder beneficiary up to what Medicaid paid for the applicant's care. Without one, an applicant at or above the cap is income ineligible for every long-term-care class of assistance until the trust exists, and is budgeted as Medically Needy instead.

If you are married, the spousal impoverishment rules under Section 1924 (42 U.S.C. 1396r-5) are what keep the spouse who stays at home from being left with nothing. In 2026 the community spouse resource allowance runs from a federal minimum of $32,532 to a maximum of $162,660, and the monthly maintenance needs allowance from $2,705.00 to a maximum of $4,066.50; states elect a standard inside those ranges, and the amount a particular couple ends up with also turns on their own resources and income. Our Georgia guide linked above walks through how that calculation runs on a Georgia case.

Georgia's four Medicaid 1915(c) waivers at a glance

Georgia operates four active 1915(c) waivers, each targeting a specific population and gated by the institutional level of care it replaces: EDWP (the Elderly and Disabled Waiver Program) serves older adults and adults with physical disabilities at nursing-facility level of care through its two service models, CCSP and SOURCE, which are not separate waivers (run by DCH); ICWP serves a limited number of adults who apply between the ages of 21 and 64, on either a nursing-facility or a hospital level of care, for severe physical disabilities or traumatic brain injury (DCH); and NOW and COMP serve people with intellectual and developmental disabilities at ICF/IID level of care (administered by DCH, which delegates day-to-day operation to DBHDD through six regional field offices). For the full side-by-side comparison and a profile of each program, see our Georgia Medicaid HCBS waivers directory.

The NOW and COMP waivers share one planning list, and it is long. About 7,900 Georgians were on it in September 2025. Roughly 4,900 of them were 22 or older, and 43 percent of those adults (about 2,100 people) had already been waiting at least six years; on average, people on the list had been waiting nearly five years. DBHDD typically prioritizes the people with the greatest unmet needs, and those whose circumstances are more urgent under DBHDD's criteria may be served first, so a place on the list is not a place in line: prioritization is based on need rather than on how long you have waited.

Children are on that list as well as adults, and a 1915(c) waiver is not the only way Georgia Medicaid reaches a child who is waiting. Our guide to Georgia Medicaid school-based services covers the care the program pays for at school, including the therapies written into a child's IEP, which runs on separate authority from a waiver.

Two other Georgia pathways serve home-based care but are not 1915(c) waivers. Katie Beckett (TEFRA) is a class of assistance under Georgia's Medicaid state plan rather than a waiver: it waives the deeming of a parent's income and resources so a child 18 years of age or younger who needs an institutional level of care can qualify for Medicaid on the child's own income and resources while living at home. Turning 18 does not end that coverage. Under current DFCS policy the child is advised to apply for SSI in the month after turning 18, but whether or not the family provides proof of that application, and whether Social Security approves it or finds the child not disabled, no action is taken to change eligibility: the Katie Beckett class of assistance stays open through the month the child turns 19 and closes the month after. Georgia also runs Money Follows the Person, a demonstration DCH implemented on September 1, 2008 with DBHDD and the Division of Aging Services, which transitions people out of institutions and into the community using the state's waiver programs.

Your rights once you are on a waiver

Waiver services are furnished under a written plan of care, and the level-of-care finding that put you on the waiver is reevaluated at least once a year. That annual reevaluation is not a formality: it is the point at which a change in your condition, or in what your family can still manage, belongs in the record. Ask your case manager or support coordinator for a copy of your current plan and for the date of your next reevaluation, and say so in writing if the plan no longer matches what you need.

You may also be able to direct your own services. Federal self-direction comes in two forms: employer authority, where you recruit, hire, train, schedule, supervise, and fire the workers who furnish your services, and budget authority, where you control an individual budget and use it to purchase the supports in your plan. It can be built into a 1915(c) waiver, but it is a state election rather than a federal guarantee, so ask your case manager or support coordinator whether your specific waiver offers it.

Electronic visit verification and what it means for your care

If your waiver includes personal care or home health, the worker will clock each visit through electronic visit verification, or EVV. Section 12006 of the 21st Century Cures Act requires states to capture six data elements for each visit: the type of service, the person receiving it, the date, the location, the person providing it, and the times the visit starts and ends.

The personal care requirement took effect January 1, 2020 (with up to a one-year good-faith extension for states that needed it), and the home health requirement took effect January 1, 2023. A state that does not comply faces an incremental reduction in its federal medical assistance matching funds, which is why every state, Georgia included, has to have an EVV system in place for these services.

The federal HCBS Access Rule: an 80 percent pay floor by 2030

A second federal rule is aimed at the pay of the people who do that hands-on work. The CMS Ensuring Access to Medicaid Services final rule (CMS-2442-F), published May 10, 2024 and codified for 1915(c) waivers at 42 CFR 441.302(k), created what CMS calls the HCBS payment adequacy requirement, better known as the 80/20 rule: states must ensure that each provider of homemaker, home health aide, or personal care services spends 80 percent of the total payments it receives for those services on total compensation for direct care workers. Some costs, including travel, training, and personal protective equipment, are carved out of that calculation, states may set a separate performance level for providers they define as small, and states may grant hardship exemptions through a transparent public process.

The timing matters as much as the number, and it is the part most families get wrong. States do not have to comply with 42 CFR 441.302(k) until six years after July 9, 2024, which is July 9, 2030; for HCBS delivered through managed care, it is the first rating period on or after that date. The same rule's HCBS incident-management requirements land earlier, three years after July 9, 2024, with one reporting element at five years. So the 80 percent floor is something to watch rather than something to expect on your current plan of care, and a federal requirement this far out can still be amended before it arrives. If your waiver includes personal care, homemaker, or home health aide services, ask your provider agency what it pays its direct care workers now, because that is the number the rule will eventually measure.

How 1915(c) compares to Georgia's other HCBS options

A 1915(c) waiver is one of several federal doors to home-based care, and which door you are under changes whether you can be capped and waitlisted. A waiver requires institutional level of care and may be capped, which is what creates the planning lists.

The state-plan options work differently, and the important thing for a Georgia family to know is that Georgia's own home-care programs do not run on them. Section 1915(i) lets a state cover HCBS through a state plan amendment instead of a waiver, without the waiver's institutional level-of-care test; only a minority of states operate an approved 1915(i) benefit, and Georgia is not among the states documented as operating one, delivering its HCBS programs under 1915(c) authority instead. Section 1915(k), Community First Choice, is an optional state plan attendant-care benefit that a state must furnish statewide to everyone eligible, with no enrollment cap or waiting list, and with a 6 percentage point boost to its federal match. It is optional, though, and not every state elects it. Georgia's four active HCBS programs are all 1915(c) waivers, so the capped and waitlisted route is the one to plan around; confirm with DCH before counting on a state plan alternative.

How to apply, and what to do if you are denied

Where you apply depends on which waiver fits your situation: applications for EDWP, under either its CCSP or its SOURCE model, go through Georgia's Aging and Disability Resource Connection (ADRC) offices, not through a central state number; ICWP is administered by the Georgia Department of Community Health (DCH); for NOW or COMP, apply through the Georgia Collaborative ASO's Individual IDD Connects portal, creating an account and uploading the required documents there. DBHDD prefers the online route because paper applications have to be retyped into the portal, but you may instead fax or mail a paper application to a DBHDD Regional Field Office, and that office will help you if you call and ask. Regional Field Office Intake and Evaluation staff review each application, and applicants found pre-eligible go on the shared NOW/COMP planning list.,, Every path then runs through the same two gates: a functional assessment confirming institutional level of care (nursing-facility, hospital, or ICF/IID), and a financial review against Georgia's Medicaid CAP of $2,982 a month for an individual in 2026, which is 300 percent of the SSI federal benefit rate, with countable resources at or below $2,000 (or, if your income is over the cap, a Qualified Income Trust).,, The step-by-step application walkthrough, with documents to gather and what to expect at each stage, lives in our HCBS waivers directory and our guide to how to apply for Georgia Medicaid.

If your application is denied, or your waiver services are cut, federal law guarantees you a fair hearing before the state agency: 42 CFR 431.220 requires the agency to grant a hearing to anyone who believes it acted erroneously or denied a claim for eligibility or for covered services. Watch the date on the notice, because keeping your services during the appeal depends on it. Under 42 CFR 431.230(a), if the agency sent the required advance notice and you request the hearing before the date the action takes effect, it may not reduce or terminate your services until a decision is issued. A request filed after that date does not trigger continuation, though 42 CFR 431.231 lets the agency reinstate services if you request the hearing no more than 10 days after the date of action. If the agency's action is ultimately upheld, it may recoup the cost of the services furnished solely by reason of that continuation. Georgia hearings are held by the Office of State Administrative Hearings (OSAH), reachable at (404) 657-2800 or 1-877-809-0007. Free legal help is available through Georgia's legal-aid and disability-rights organizations.

Your next step To join the NOW/COMP planning list, start an Individual IDD Connects account with the Georgia Collaborative ASO and upload your documents there, or fax or mail a paper application to your DBHDD Regional Field Office. For EDWP (CCSP or SOURCE), start with an Aging and Disability Resource Connection (ADRC) office; ICWP runs through DCH.

Frequently Asked Questions

What is a Georgia Medicaid 1915(c) waiver?

It is a Medicaid benefit, authorized by Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), that pays for care at home or in the community for someone who would otherwise need a hospital, nursing facility, or ICF/IID. Georgia runs four of them: EDWP (whose CCSP and SOURCE models are delivery arms of the single waiver), ICWP, NOW, and COMP. Without this authority, Medicaid would generally only pay for institutional care.

Why can I qualify and still be on a waiting list?

Because a 1915(c) waiver is not an entitlement. Federal law lets Georgia cap the number of people each waiver serves (the only floor is that the Secretary of Health and Human Services may not hold the approved number below 200), so when the slots are full, qualified applicants wait. Regular Medicaid, by contrast, cannot make an eligible person wait.

What income and assets can I have and still qualify?

Waivers use the institutional special income rule. Georgia's Medicaid CAP for 2026 is $2,982 a month for an individual and $5,964 for a couple, which is 300 percent of the SSI federal benefit rate, with countable resources at or below $2,000 for an individual and $3,000 for a couple.,

What if my income is over Georgia's cap?

You are not automatically out. Georgia lets an applicant at or above the Medicaid CAP set up a Qualified Income Trust, or Miller trust, and deposit income into it so that income is not counted in the eligibility test. The trust has to be irrevocable, hold only your own income, and name the Department of Community Health as remainder beneficiary up to what Medicaid paid for your care. Until one exists, an applicant at or above the cap is income ineligible for every Georgia long-term-care class of assistance and is budgeted as Medically Needy instead.

Can my spouse keep our income and savings if I go on a waiver?

Partly, and the amount depends on where your state sits inside the federal ranges. The spousal impoverishment standards under 42 U.S.C. 1396r-5 set a community spouse resource allowance of $32,532 to $162,660 for 2026 and a monthly maintenance needs allowance of $2,705.00 to $4,066.50; states elect a standard within those ranges, and what a given couple keeps also turns on their own resources and income. Our Georgia spousal impoverishment guide covers how the calculation runs here.

How long is the wait for NOW or COMP?

It is often years. About 7,900 Georgians were on the shared NOW/COMP planning list in September 2025, and among the roughly 4,900 who were 22 or older, 43 percent (about 2,100 people) had already waited at least six years. On average, people on the list had been waiting nearly five years. DBHDD typically serves the people with the greatest unmet needs first, and those whose circumstances it classifies as more urgent may be served ahead of others, so time on the list is not what moves you up.

Can I hire and manage my own caregiver under a Georgia waiver?

Sometimes, through self-direction, but it is a state election rather than something every waiver offers. Where it is available, it takes one of two forms: employer authority, where you hire, schedule, supervise, and manage your own workers, or budget authority, where you control an individual budget for the supports in your plan. Ask your case manager or support coordinator whether self-direction is available for your specific waiver, and see our guide to self-directed services in Georgia.

Learn More

MedicaidGeorgia Medicaid hubGeorgia Medicaid 2026: income and asset limits, the EDWP waiver (CCSP and SOURCE), Pathways to Coverage, Miller Trusts, estate recovery, and how to apply. MedicaidGeorgia Medicaid long-term careGeorgia Medicaid long-term care in 2026: nursing facility coverage, four HCBS waivers (EDWP with CCSP and SOURCE, ICWP, NOW, COMP), PACE, and how to apply. MedicaidGeorgia CCSP, an EDWP service modelGeorgia CCSP Waiver 2026: who qualifies for the Community Care Services Program, what it covers, and how to apply through your Area Agency on Aging. MedicaidGeorgia SOURCE, an EDWP service modelHow the Georgia SOURCE waiver works in 2026: a delivery model inside the 1915(c) Elderly and Disabled Waiver Program, eligibility, sites, and how to apply. MedicaidGeorgia Miller trusts (Qualified Income Trusts)Georgia Medicaid Miller Trust (Qualified Income Trust) in 2026: who needs one above the $2,982 income limit, how to set it up, and the monthly funding rules. MedicaidGeorgia ICWP waiverGeorgia's Independent Care Waiver Program (ICWP) funds home care for adults 21-64 with severe physical disabilities or TBI. Eligibility, services, how to apply. MedicaidGeorgia NOW and COMP waiversHow Georgia's NOW and COMP waivers serve people with I/DD: eligibility, the ~7,900-person Planning List, services covered, and how to apply through DBHDD. MedicaidGeorgia Medicaid 1915(i) HCBS State Plan OptionGeorgia's Medicaid home care runs under Section 1915(c) waiver authority, not the Section 1915(i) HCBS state plan option. Here is what that means for you.

Find personalized help choosing and applying for a Georgia Medicaid HCBS waiver at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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