Georgia runs a Medicaid Buy-In, Georgia Medicaid for Workers with Disabilities, that lets working adults keep full Medicaid above the usual income limit by paying a premium. It is one of five routes built into federal law that let a person with a disability qualify for, or keep, Georgia Medicaid when the ordinary income-and-asset test would shut them out. The other four are the Katie Beckett (TEFRA) option for children, the Pickle Amendment for people knocked off Supplemental Security Income (SSI) by Social Security cost-of-living raises, Disabled Adult Child (DAC) Medicaid for adults disabled before age 22, and Section 1619(b) for SSI recipients who go back to work.

Two are optional and Georgia adopted them (Katie Beckett TEFRA and the Buy-In); three are mandatory federal protections Georgia must apply (Pickle, DAC, and 1619(b)). Georgia runs the state-side pieces through the Georgia Department of Community Health (DCH) and the Georgia Division of Family and Children Services (DFCS); the Social Security Administration (SSA) handles the federal determinations. No single statute lists all five, so families usually learn about them one at a time, if at all.

In This Guide

Georgia's five Medicaid pathways at a glance

Pathway Who it serves Administered by Premium Federal status
Katie Beckett (TEFRA) Children with a severe disability, through the month they turn 19 DCH and DFCS None Optional (Georgia adopted)
Georgia Medicaid for Workers with Disabilities (GMWD) Working adults aged 16 to 64 with a disability DFCS Monthly premium (age and income) Optional (Georgia adopted)
Pickle Amendment People who lost SSI because of Social Security cost-of-living raises DFCS None Mandatory
Disabled Adult Child (DAC) Adults disabled before age 22 who lose SSI when DAC benefits start DFCS None Mandatory
Section 1619(b) Working SSI recipients earning above the SSI cash-benefit limit SSA (Georgia accepts the finding) None Mandatory

All five rely on the federal SSI definition of disability at 42 U.S.C. 1382c(a)(3): a medically determinable physical or mental impairment expected to last at least 12 continuous months or result in death, which for an adult must keep them from substantial gainful activity and for a child under 18 must instead cause marked and severe functional limitations. That childhood standard, not the adult work test, is what a Katie Beckett applicant has to meet. Georgia's aged, blind, and disabled (ABD) Medicaid is SSI-linked: its financial limits are the federal SSI standards, so the 2026 SSI Federal Benefit Rate (the ABD income limit, counted net of the $20 general exclusion) is $994 a month for an individual and $1,491 for a couple, with a countable resource limit of $2,000 (individual) or $3,000 (couple).

Katie Beckett (TEFRA) option

The Katie Beckett option, authorized by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), lets Georgia cover a child with a severe disability on the child's own income and resources, with the parents' not deemed (counted) to the child.

In Georgia, the Katie Beckett (TEFRA) Deeming Waiver is a class of assistance for children 18 and younger; eligibility does not extend past the month the child turns 19. A child qualifies by meeting all five of these conditions:

  • Age. The child is 18 or younger.
  • Institutional level of care. The child is chronically impaired enough to be a suitable candidate for institutional care (a nursing facility, hospital, or ICF for the intellectually disabled).
  • Financial ineligibility for SSI. The child is ineligible for SSI in a private living arrangement on the child's own income and resources or those deemed from the parents.
  • Level-of-care criteria met.
  • All other basic and financial criteria met.

Cost-effectiveness is decided separately: on Forms DMA 704 and DMA 708, DFCS compares the physician's estimated monthly cost of home care against the institution's monthly Medicaid billing rate, and denies the application if home care costs more. Georgia Pediatric Program services and costs, skilled nursing included, are left out of that comparison, and the caseworker never completes the DMA 704 for a family. If the doctor leaves part of it blank, chasing it down is on you.

A child who qualifies is covered as a household of one, on the same income and resource limits as an SSI-related adult. Coverage is full Medicaid, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), Medicaid's comprehensive benefit for enrollees under age 21 that covers all medically necessary services to correct or ameliorate a condition. Medically complex children can also get private-duty nursing through the Georgia Pediatric Program (GAPP).

Coverage does not stop at 18. In the month after the child turns 18, DFCS advises the family to apply for SSI, but nothing changes on the case whatever SSA decides: Katie Beckett stays open through the month the child turns 19 and closes the month after, once DFCS has run a Continuing Medicaid Determination against every other class of assistance, waivers and Aged, Blind and Disabled Medically Needy included.

To apply, families submit Forms DMA 6A (Physician's Recommendation for Pediatric Care), DMA 706 (Medical Necessity and Level of Care Statement), and DMA 704. The level-of-care packet, including the DMA 705 routing form, goes to Alliant Health Solutions, which makes that determination. A doctor's signature on the DMA 6A or DMA 706 is good for only 90 days, so a packet assembled slowly can go stale before it is filed. Start an application with the Centralized Katie Beckett Medicaid Team (678-248-7449), any local DFCS office by mail, telephone, or fax, or online at Georgia Gateway; once it is entered, the family is emailed access to the Katie Beckett member portal. Federal rules cap Georgia at 90 days to decide a disability-based Medicaid application, and bar the agency from treating that period as a waiting time or denying an application because it missed the deadline.

Georgia Medicaid for Workers with Disabilities (the Buy-In)

Georgia Medicaid for Workers with Disabilities (GMWD) is Georgia's Medicaid Buy-In, in effect since March 2008. It lets working adults with disabilities qualify for full Medicaid at income levels above the regular ABD limit by paying a premium, so that earning more does not force a choice between a paycheck and coverage. DFCS policy 2149 states its criteria as "all of the following," so meeting six of the seven is not enough. To qualify in 2026, a person must:

  • Be at least 16 but under 65 years of age.
  • Have a disability that meets SSA's standards.
  • Have disability income between $600 and $699 a month.
  • Be employed and receiving compensation.
  • Be a Georgia resident.
  • Have countable income under the Medicaid Cap of 300 percent of the federal poverty level.
  • Have countable resources under $4,000 for an individual or $6,000 for a couple.

That third criterion is narrow enough to catch people out. Check it against your own award letter.

That doubled resource limit is the program's central advantage: $4,000 and $6,000 against the standard SSI and ABD limits of $2,000 and $3,000, so a worker can keep more savings and still qualify., GMWD participants may owe a monthly premium, set by the person's age and total countable income; DFCS publishes no dollar schedule, and premiums are paid to PSI, Inc. one month ahead of the coverage month.

Apply through DFCS and ask for Georgia Medicaid for Workers with Disabilities by name, since a worker may not raise it. Bring a disability determination (an SSA award letter or a state determination), employment and income verification, and the standard application. The Georgia Vocational Rehabilitation Agency and SSA's Ticket to Work help workers plan around the Buy-In.

Pickle Amendment

The Pickle Amendment (section 503 of Public Law 94-566, enacted 1976) is a mandatory protection for people who lost SSI only because Social Security cost-of-living adjustments (COLAs) raised their other income. Under 42 CFR 435.135, a state that covers SSI recipients must also cover a person who receives Social Security (OASDI), was eligible for and receiving SSI but became ineligible for it after April 1977, and would still be SSI-eligible if every COLA received since SSI was lost were subtracted back out of the current Social Security check.

The mechanism matters because COLAs compound: 2.8 percent in 2026, after 2.5 in 2025, 3.2 in 2024, and 8.7 in 2023. Over years those raises push a Social Security benefit past the SSI limit (the $994 monthly Federal Benefit Rate for an individual in 2026), and the person loses SSI and, without Pickle, Medicaid too.

Pickle is widely underused because workers may not flag it. If you or a family member lost SSI in the past and was later denied Medicaid for income, ask DFCS to run a Pickle calculation. A test failed once is worth re-running: the frozen Social Security figure never rises while the Federal Benefit Rate does, so someone who does not qualify this year can qualify in a later one. If an earlier denial was wrong, federal law lets Medicaid pay for covered services going back to the third month before the month of application, so a corrected case can carry retroactive coverage. For applications filed on or after January 1, 2027, that window narrows to two months.

Disabled Adult Child (DAC) Medicaid

Disabled Adult Child (DAC) Medicaid, authorized by Section 1634(c) of the Social Security Act (42 U.S.C. 1383c(c)), is a mandatory protection for an adult who became disabled before age 22 and loses SSI because they become entitled to Social Security child's insurance benefits on a parent's earnings record. The statute is mandatory ("shall be treated"): the person keeps Medicaid so long as they would still be eligible for it with the DAC benefit set aside. That also fixes the protection's limit: a separate disqualification, such as other income, excess resources, or medical improvement, ends it.

The trigger is usually a parent's retirement, disability, or death: the adult child becomes entitled to a DAC benefit calculated from the parent's earnings, often higher than the SSI Federal Benefit Rate of $994 a month, so SSI ends. What decides the case is when the disability began, not the diagnosis: any impairment that started before age 22 and meets SSA's standard can qualify, including Down syndrome, intellectual disability, autism, and cerebral palsy. Federal law assigns that "would still qualify without the DAC benefit" call to the state agency, not SSA, so it is DFCS that makes it at the time of the SSI termination. If it is missed, ask DFCS to apply DAC Medicaid and reference the SSI termination notice. The internal route detail for Georgia is in our guide to Disabled Adult Child Medicaid in Georgia.

Section 1619(b)

Section 1619(b) of the Social Security Act keeps Medicaid for an SSI recipient who goes to work and earns enough to stop the SSI cash payment but still meets SSI's disability and resource rules. SSA continues to treat the person as receiving SSI for Medicaid when they were eligible for SSI in a prior month, still have the qualifying impairment, still meet the resource limit, need Medicaid to keep working, and have earnings under the state threshold.

For Georgia in 2026, that ceiling is the Section 1619(b) Charted Threshold Amount of $41,927 in gross annual earned income. Only earnings count toward it, and clearing it is not by itself the whole test; the other four requirements still apply. A worker whose actual Medicaid costs run high (Home and Community-Based Services, say, or specialty drugs) can ask SSA for an individualized threshold above $41,927; a worker with no such costs cannot. The SSI cash payment stops earlier, at the 2026 break-even point of $24,876 in gross annual earnings. Neither figure is the Substantial Gainful Activity level of $1,690 a month, which SSA uses to decide whether a non-blind applicant is disabled at all; the blind SGA amount of $2,830 applies to Social Security disability, not SSI.

SSA, not the state, makes the 1619(b) finding, and retaining SSI recipient status preserves Medicaid in the states that follow the SSI criteria; Georgia's ABD Medicaid runs on those standards., Georgia-specific detail is in our guide to Georgia Medicaid Section 1619(b).

Where Georgia counts income and resources more generously

Georgia does not apply the plain SSI baseline everywhere: Katie Beckett counts the child alone, and the Buy-In allows $4,000 and $6,000. A separate route, the Aged, Blind and Disabled Medically Needy class, lets a person whose income exceeds the ABD limit subtract incurred medical expenses to reach eligibility. It is a last resort (DFCS rules out every other ABD class first), and not always a spend-down: someone already at or under the Medically Needy Income Level, with resources inside the AMN limit, is "de facto eligible" and owes none. Spend-down cures only excess income, never excess resources, which must still be inside the AMN limit. It is one of the classes Georgia has to consider before a Katie Beckett case closes.

Choosing the right Georgia Medicaid buy-in or protected pathway

Start with the person's situation:

  • A child 18 or younger who needs institutional level of care but can be served at home: Katie Beckett (TEFRA).
  • A working-age adult with a disability, employed or wanting to work: the Buy-In and Section 1619(b).
  • A former SSI recipient who lost SSI to Social Security COLAs: the Pickle Amendment.
  • An adult disabled before age 22 whose parent has retired, become disabled, or died: DAC Medicaid.
  • A current SSI recipient working above the SSI cash-benefit limit: SSA should already have moved them to 1619(b); confirm.

The pathways are not mutually exclusive: an adult with a childhood-onset disability working part-time may qualify under DAC, the Buy-In, and 1619(b) at different points, and takes whichever gives the broadest, most stable protection.

Coordination with HCBS waivers

Each pathway establishes eligibility; the services that follow depend on what else the person qualifies for. Georgia runs several Section 1915(c) Home and Community-Based Services (HCBS) waivers, including the Elderly and Disabled Waiver Program (EDWP) for older adults and adults with physical disabilities, delivered through two service models rather than two waivers (the Community Care Services Program, or CCSP, and Service Options Using Resources in a Community Environment, or SOURCE), and the New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP) for people with developmental disabilities. A Katie Beckett child can add the Georgia Pediatric Program; a DAC or Buy-In adult can add NOW or COMP if they meet the waiver's level-of-care criteria. Establish the pathway first, then layer on the waiver.

Worked examples

The scenarios below are illustrative; details vary by case.

David, Macon, Georgia Medicaid for Workers with Disabilities. David has autism and an intellectual disability and has had SSI and Medicaid since 18. A part-time coffee-shop job through the Georgia Vocational Rehabilitation Agency stopped his SSI cash payment, and SSA placed him on Section 1619(b). As his savings neared the SSI resource limit, a benefits counselor moved him to GMWD, where the $4,000 limit lets him keep saving.

Eleanor, Savannah, Pickle Amendment. COLAs raised Eleanor's Social Security benefit past the SSI limit, her DFCS worker did not apply Pickle, and she lost Medicaid along with SSI. A GeorgiaCares SHIP counselor spotted it and asked DFCS for a Pickle review; Eleanor was approved with retroactive coverage.

Marcus, Atlanta, Disabled Adult Child Medicaid. Marcus, an adult with Down syndrome, had SSI and Medicaid. When his father retired, a DAC benefit on his father's record exceeded the SSI limit and ended his SSI. His DFCS worker applied the DAC protection at the termination notice and kept his Medicaid, COMP waiver services included.

Diana, Bulloch County, Section 1619(b). Diana has multiple sclerosis and receives Social Security Disability Insurance and Medicaid. She took a part-time medical-billing job from home. Her earnings exceed the SSI cash-benefit limit but stay under Georgia's $41,927 threshold, so SSA placed her on 1619(b) and her Medicaid ran on uninterrupted.

Common problems and how to solve them

  • The worker did not consider Pickle or DAC. If a person lost SSI and was then denied Medicaid, ask DFCS to review for Pickle or DAC and bring the SSA documents. If a denial stands, contact the Atlanta Legal Aid Society or the Georgia Legal Services Program, which serves the 154 counties outside metro Atlanta and does not represent people in Clayton, Cobb, DeKalb, Fulton, or Gwinnett.
  • A Katie Beckett application was denied. Denials usually turn on the level-of-care or cost-effectiveness finding, and the clock is 30 days from the date on the letter to appeal or send more clinical information. A level-of-care denial does not go where other Medicaid appeals go: route it to DCH's Legal Services Section, not OSAH. Benefits do not continue during the fight, but if a judge overturns the denial the case is re-registered on the original application date. Disability Rights Georgia can help.
  • The Buy-In premium seems too high. The GMWD premium is set by age and countable income. If income dropped, ask DFCS to recalculate.
  • A Katie Beckett child is nearing 19. Plan the Continuing Medicaid Determination ahead of the closure, and the move to the Buy-In (if working), DAC Medicaid (if a parent is retired, disabled, or deceased), Aged, Blind and Disabled Medically Needy, or an HCBS waiver.

Frequently Asked Questions

Does Georgia have a Medicaid buy-in for working adults with disabilities?

Yes. Georgia Medicaid for Workers with Disabilities (GMWD) has been in effect since March 2008. DFCS policy 2149 sets seven criteria, all of which must be met: age 16 to 64, a disability meeting SSA's standard, disability income between $600 and $699 a month, employment with compensation, Georgia residency, countable income under 300 percent of the federal poverty level, and countable resources under $4,000 for an individual or $6,000 for a couple. Participants may pay a monthly premium based on age and income.

What is Katie Beckett (TEFRA) in Georgia, and what is the age limit?

Katie Beckett (TEFRA) lets a child with a severe disability qualify for Medicaid on the child's own income, with parental income not counted, when the child needs institutional level of care but can be cared for at home. In Georgia it covers children 18 and younger: coverage runs through the month the child turns 19 and closes the month after. Apply through the Centralized Katie Beckett Medicaid Team, a local DFCS office, or Georgia Gateway, with Forms DMA 6A, 706, and 704.

Who qualifies for the Pickle Amendment?

A person qualifies for Pickle if they once received both SSI and Social Security, lost SSI after April 1977 because cost-of-living raises pushed their income up, and would still be SSI-eligible with those raises subtracted out. It is mandatory in Georgia. Ask DFCS to run the calculation; a corrected denial can carry retroactive Medicaid.

Will my adult child lose Medicaid when my Social Security retirement starts?

Usually not. When your retirement begins, a child disabled before age 22 typically becomes entitled to Disabled Adult Child benefits on your record. If that ends their SSI, federal law (Section 1634(c)) requires Georgia to keep their Medicaid as long as they would still qualify for SSI without the DAC benefit. Ask DFCS to apply DAC Medicaid when the SSI termination is processed.

Who decides Section 1619(b), and what is Georgia's 2026 threshold?

SSA decides 1619(b) status and Georgia accepts it. For 2026, Georgia's charted threshold is $41,927 in gross annual earned income: the earnings ceiling in one of the five 1619(b) tests, not a guarantee on its own. A worker with higher actual Medicaid costs can ask SSA for an individualized threshold above that.

Not sure which Georgia Medicaid pathway fits your family? Call DFCS Customer Service at 1-877-423-4746, or reach a free benefits counselor through GeorgiaCares SHIP at 1-866-552-4464 before you apply.,

Key contacts

DFCS Customer Service Apply or renew, and ask for the Buy-In, Pickle, or DAC by name. 1-877-423-4746https://dhs.georgia.gov/contact
DCH Medicaid Member Services Verify coverage and benefits once a pathway is approved. 1-866-211-0950https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
DCH Aged, Blind, Disabled and Long-Term Care Unit ABD-linked eligibility and long-term-care coverage. 1-866-322-4260
Centralized Katie Beckett Medicaid Team Start or check a Katie Beckett (TEFRA) application. 678-248-7449
Georgia Vocational Rehabilitation Agency Employment planning, including the route into the Buy-In. 1-844-367-4872
Social Security Administration Disability findings, 1619(b), and the DAC benefit itself; DFCS decides DAC Medicaid. 1-800-772-1213https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare
GeorgiaCares SHIP and ADRC Free benefits counseling, Pickle reviews included. 1-866-552-4464https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship
Disability Rights Georgia Help appealing a denied disability-based application. 404-885-1234
Georgia DPH, Children with Special Health Care Needs Support for families of medically complex children. 1-855-707-8277
DBHDD Intake Entry point for NOW and COMP waiver services. 1-888-273-1414
SSA Ticket to Work Employment support for SSI and SSDI beneficiaries. 1-866-968-7842

Phone numbers change; verify with the agency before calling.

Learn More

MedicaidGeorgia Medicaid Programs OverviewGeorgia 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 Eligibility & Income LimitsGeorgia Medicaid income limits in 2026: the $994 ABD limit, $2,982 long-term-care cap, $2,000 asset limit, Miller Trust, CSRA, and Pathways to Coverage. MedicaidGeorgia Medicaid Section 1619(b)Georgia Section 1619(b) lets working former SSI recipients keep full Medicaid up to the 2026 threshold of $41,927. Here is who qualifies and how it works. MedicaidGeorgia ABLE AccountsGeorgia ABLE accounts in 2026: how a person with a disability can save up to $20,000 a year without losing Medicaid or SSI, who qualifies, and how to open one. MedicaidGeorgia Disability Determination ProcessHow the Georgia Medicaid disability determination works: the SSA five-step evaluation, the 1634 rule, DAS review, 2026 SGA and resource limits, and appeals. MedicaidHow to Apply for Georgia MedicaidHow to apply for Georgia Medicaid in 2026: Georgia Gateway, your local DFCS office, Form 700, the documents you need, processing timelines, and how to appeal.

Find personalized help navigating Georgia Medicaid buy-in options 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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