Georgia Medicaid Buy-In Options: Katie Beckett, Working Disabled, Pickle, DAC, 1619(b)

Georgia Medicaid buy-in options and protected pathways cover several specialized eligibility routes built into the Social Security Act that override the normal income-and-asset test for specific populations with disabilities. A child with severe cerebral palsy whose parents earn $120,000 a year can qualify for Medicaid as a household of one under the Katie Beckett TEFRA option, paying nothing, with full coverage. A 28-year-old man with autism who has just started a part-time job at a coffee shop can qualify for Medicaid through the Working Disabled Medicaid Buy-In, paying a modest premium. A 72-year-old widow whose Social Security cost-of-living adjustments slowly pushed her income above the SSI limit can keep her Medicaid coverage under the Pickle Amendment, which requires the eligibility worker to disregard the COLAs that knocked her off SSI. A 45-year-old man with Down syndrome whose father retires and starts collecting Social Security retirement, triggering Disabled Adult Child (DAC) Medicaid benefits for the son, can keep Medicaid. A working SSI recipient with multiple sclerosis whose part-time wages now exceed the SSI cash benefit threshold can keep Medicaid under Section 1619(b) so long as she still meets SSI disability and resource criteria and still needs Medicaid to continue working.

These are not state innovations. Each pathway is built into federal Medicaid law and is either mandatory for states (Pickle, DAC, 1619(b)) or available at state election (Katie Beckett TEFRA, Buy-In). Georgia has adopted the optional pathways and implements the mandatory ones through the Department of Community Health (DCH) and the Division of Family and Children Services (DFCS), with the Social Security Administration handling the federal pieces. The pathways do not appear in any single section of any single statute, so families navigating disability and aging often hear about them piecemeal, if at all. A pediatrician mentions Katie Beckett. A vocational rehabilitation counselor mentions the Working Disabled Buy-In. A Social Security claims representative mentions Section 1619(b). A legal aid attorney mentions Pickle.

This guide assembles Georgia Medicaid buy-in options and protected pathways into a single coherent picture. It explains the federal authority for each pathway, how Georgia implements it, how families qualify, apply, enroll, and maintain eligibility, and ends with worked examples drawn from the populations these pathways were designed to serve, a frequently asked questions section, and the phone numbers families need. Brevy publishes this guide because the specialized Medicaid pathways are critical for the disability community and the families who care for them, and most families do not learn about them until someone tells them.

By Brevy Care Team · Last verified May 12, 2026

Katie Beckett TEFRA option

The Katie Beckett TEFRA option is named for Mary Katherine "Katie" Beckett, an Iowa girl who developed viral encephalitis in infancy and required a ventilator. Katie's hospital stay extended for months, then years, because Medicaid would pay for ventilator care in the hospital but not at home. Katie's mother, Julie Beckett, became a national advocate for changing Medicaid rules to allow Katie to live at home with her family. The advocacy reached President Reagan, and the resulting federal legislation included a provision specifically to allow states to extend Medicaid coverage to severely disabled children at home using the child's own income, regardless of parental income.

The option is sometimes called the "deeming waiver" because the normal rules that would deem (attribute) parental income to a child applying for SSI or SSI-related Medicaid are waived for TEFRA children.

To qualify under Georgia's Katie Beckett TEFRA Deeming Waiver, a child must meet four criteria:

Age. The child must be a minor; at the age cutoff, the child can transition to adult Medicaid pathways including the Working Disabled Buy-In, DAC Medicaid (if eligible), or other applicable groups. Verify the current Georgia age cutoff with DCH.

Disability determination. The child must be determined to meet the Social Security Administration's definition of disability for children: a medically determinable physical or mental impairment that results in marked and severe functional limitations. Disability is determined by the state Disability Determination Unit using SSA criteria. Documentation includes medical records, functional assessments, and (for some conditions) developmental and educational records.

Institutional level of care. The child must require a level of care typically provided in a hospital (acute care or skilled nursing), nursing facility, or ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disability). The level-of-care determination considers the intensity of medical or nursing supervision required, the complexity of the medical needs, the technology dependence (ventilator, feeding tube, dialysis, central line), and other factors. The level-of-care determination is made by DCH or its contractor using level-of-care assessment tools.

Care in the home is appropriate and cost-effective. The required level of care can be safely provided at home with appropriate supports, and the estimated cost of home care under Medicaid is no greater than the estimated cost of institutional care. The cost test is essentially budgetary; if home care costs more than institutional care, the option does not apply. In practice, home care is almost always less expensive than institutional care because the family provides much of the day-to-day care.

A child who meets all four criteria qualifies for Medicaid as a household of one. Parental income and resources are not counted. The child has the same income and resource limits as a Medicaid-eligible adult applying for SSI-related coverage.

The TEFRA-eligible child gets full Medicaid coverage. Benefits include EPSDT (the comprehensive child benefit covering all medically necessary services), prescription drugs, durable medical equipment, therapies (physical, occupational, speech), behavioral health, dental, vision, home health, and HCBS when needed (potentially through the Georgia Pediatric Program (GAPP) for medically complex children).

Application is made to DCH. The application includes the state's medical packet (Georgia uses a designated DMA medical form; confirm the current form number with DCH), medical records from the child's physicians (including any specialists involved in care), therapy evaluations and progress notes, hospital discharge summaries if applicable, education and developmental records if relevant, documentation of equipment, medications, and services received, and family financial information for the cost-effectiveness analysis (though parental income is not counted for the child's eligibility, family information may be relevant for understanding what services the family provides versus what Medicaid would cover).

Initial determinations can take several months, and timelines for new applications follow the federal Medicaid processing windows (verify Georgia's current determination timeline with DCH). If denied, the family can appeal through Georgia's fair hearing process. Appeals are common; many families succeed on appeal with additional documentation or with legal aid representation.

Once approved, eligibility is reviewed annually. The annual review requires updated medical documentation and re-verification of the level of care.

Medicaid Buy-In for Workers with Disabilities

The Medicaid Buy-In is a federal option that lets states extend Medicaid coverage to working adults with disabilities at income levels above the traditional ABD limit. The Buy-In was created by federal work-incentives legislation that added Medicaid eligibility categories for working individuals with disabilities and for those whose medical condition improves to the point that they no longer meet SSA's strict disability test but still have a severe medically determinable impairment.

The Buy-In's policy purpose: people with disabilities want to work, and traditional Medicaid rules created a strong work disincentive because earning income above the ABD or SSI threshold would result in loss of Medicaid coverage. The loss of Medicaid was often catastrophic because the individual's healthcare needs were not adequately covered by employer-sponsored insurance or marketplace insurance. The Buy-In creates a pathway where individuals with disabilities can work, earn income, and pay a premium to maintain Medicaid coverage.

Georgia operates a Medicaid Buy-In sometimes called the Working Disabled Medicaid program. Eligibility criteria typically include:

Age. Georgia's Buy-In serves working-age adults; above age 64, individuals can apply for traditional Medicaid for the aged. Verify Georgia's current age range with DCH.

Disability determination. The applicant must meet SSA's definition of disability for adults, or qualify under the Medical Improvement Group. Disability is established through SSA documentation (if the applicant has been determined disabled by SSA for SSI or SSDI purposes) or through state Disability Determination Unit assessment using SSA criteria.

Employment. The applicant must be employed. Georgia defines employment broadly to include traditional employment, self-employment, and certain other earning activities. Verify Georgia's specific definition with DCH.

Income. Income must be within program limits. The exact income limit varies; verify with DCH. The general structure across state Buy-In programs is to allow income up to several times the federal poverty level, with sliding-scale premiums for higher-income participants.

Resources. Resources must be within program limits. The resource limit for Buy-In programs is typically higher than the SSI/ABD limit, recognizing that working individuals need to save for retirement and emergencies.

Premium payment. Higher-income participants pay a monthly premium on a sliding scale based on income. Lower-income participants may pay no premium.

The Buy-In serves a critical role in disability employment. Common Buy-In participants include:

• Individuals with autism spectrum disorders working part-time
• Individuals with mental illness in supported employment
• Individuals with intellectual or developmental disabilities working at vocational programs or in community jobs
• Individuals with physical disabilities working office or other accommodated positions
• Individuals with chronic medical conditions (e.g., multiple sclerosis, lupus, HIV) working with accommodations

Application is through DFCS. Applicants should ask specifically about the Working Disabled Medicaid Buy-In; eligibility workers may not raise it spontaneously. Documentation includes disability determination (SSA award letter or state determination), employment verification, income verification, and the standard Medicaid application form.

The Georgia Vocational Rehabilitation Agency helps individuals with disabilities pursue employment and can connect applicants to the Buy-In as part of employment planning. SSA's Ticket to Work program similarly supports employment for disability beneficiaries with associated Medicaid coordination.

Pickle Amendment

The Pickle Amendment is named for Texas Congressman J. J. Pickle and addresses a structural problem in the relationship between SSI and Title II Social Security benefits.

Some individuals receive both SSI and Title II benefits. The SSI program has a strict income limit; the Title II benefit is counted as income for SSI purposes. When Title II benefits increase due to annual cost-of-living adjustments (COLAs), the SSI benefit decreases proportionally (because the higher Title II income reduces the SSI deficit calculation). Eventually, after enough COLAs, the Title II benefit alone exceeds the SSI income limit and the individual loses SSI entirely.

Without the Pickle Amendment, the loss of SSI would also mean loss of Medicaid (because Medicaid eligibility for SSI recipients is automatic in most states). The Pickle Amendment requires states to treat the individual as if still receiving SSI for Medicaid purposes, by disregarding the Title II COLAs that have occurred since the loss of SSI.

The mechanics: an eligibility worker identifies that an individual was eligible for both SSI and Title II in some month during the period covered by SSA's Pickle screening guidance (see SSA POMS for the current screening month), and subsequently lost SSI. The worker calculates what the individual's SSI eligibility would be if Title II COLAs since the loss-of-SSI date were excluded. If the individual would still be eligible for SSI without the COLAs, the individual qualifies for Pickle-protected Medicaid.

The calculation is documented in SSA POMS guidance on Pickle eligibility; Georgia eligibility workers should apply Pickle whenever potentially applicable.

Pickle is particularly important for older adults. A typical Pickle scenario:

A woman in her early 60s was receiving SSI and Title II disability benefits. Her Title II benefits over the years grew with COLAs. At some point, her Title II benefits alone exceeded the SSI income limit and she lost SSI. She also lost Medicaid (unless the worker applied Pickle).

At age 65, when she would otherwise be applying for traditional Medicare-Medicaid dual coverage, the Pickle Amendment ensures she keeps Medicaid (which provides her dual eligibility) without having to reapply or meet the strict ABD income test that COLAs have pushed her past.

The Pickle Amendment is mandatory; Georgia is required to implement it. The practical problem is that it is underutilized because eligibility workers may not identify eligible individuals or may not perform the calculation correctly. Advocates (legal aid attorneys, GeorgiaCares SHIP counselors, Aging and Disability Resource Connection (ADRC)) often find Pickle eligibility for clients initially denied Medicaid.

If you or a family member lost SSI in the past and was subsequently denied Medicaid because of income, ask DFCS to perform a Pickle calculation. If the original denial was incorrect, the individual may be entitled to retroactive Medicaid coverage from the date of the incorrect denial.

Disabled Adult Child (DAC) Medicaid

The Disabled Adult Child Medicaid protection preserves Medicaid eligibility for adults who lose SSI when they become entitled to Social Security Disabled Adult Child benefits.

DAC benefits are Social Security Title II benefits payable to adults who became disabled before adulthood (per SSA's DAC eligibility rules) and have a parent who is currently receiving Social Security retirement or disability benefits or who has died. The DAC benefit amount is calculated as a percentage of the parent's primary insurance amount.

The DAC trigger event: a parent of an adult child with a childhood-onset disability becomes eligible for Social Security retirement benefits (typically at full retirement age), becomes eligible for Social Security disability benefits, or dies. The adult child becomes entitled to DAC benefits on the parent's earnings record. The DAC benefit amount is often higher than the SSI federal benefit rate (because Social Security benefits are based on the parent's earnings, which may have been substantial).

When DAC benefits exceed SSI's income limit, the adult child loses SSI. Without DAC Medicaid protection, the adult child would also lose Medicaid.

The DAC protection: states must treat the adult child as if still receiving SSI for Medicaid purposes, as long as:

• The adult child has a qualifying childhood-onset disability under SSA's DAC rules
• The adult child is currently receiving DAC benefits
• The adult child would still be eligible for SSI if not for the DAC benefits (i.e., other than DAC, the adult child meets SSI's disability and resource criteria)

DAC Medicaid is critical for the adult disability community. Common populations include:

• Adults with Down syndrome
• Adults with intellectual disability of various causes
• Adults with autism spectrum disorder
• Adults with cerebral palsy
• Adults with severe and persistent mental illness with childhood onset
• Adults with other childhood-onset disabilities

The trigger is often the parent's retirement. Consider a man with Down syndrome living with his parents and receiving SSI plus Medicaid. The father retires and starts receiving Social Security retirement benefits. The son becomes entitled to DAC benefits on the father's record. The DAC benefit, calculated from the father's earnings record, exceeds the SSI limit. Without DAC Medicaid, the son would lose SSI and Medicaid. With DAC Medicaid, the son keeps Medicaid because the federal protection requires the state to treat him as if still receiving SSI.

DAC determinations are made by DFCS eligibility workers. The worker reviews the applicant's situation, identifies that DAC benefits are being received, and determines whether the applicant meets the criteria for DAC-protected Medicaid.

DAC Medicaid is sometimes confused with regular Medicaid for adult children of retired or disabled parents. The key distinction is that DAC protection applies when the adult child has a childhood-onset disability and is receiving DAC benefits (Title II benefits on a parent's record) and would otherwise be ineligible for SSI because of those benefits.

Section 1619(b)

Section 1619(b) protects Medicaid eligibility for SSI recipients who continue to work despite their disability and whose earnings rise above the threshold at which SSI cash benefits cease.

The 1619(b) protection: the individual is treated as if still receiving SSI for Medicaid purposes, even though no SSI cash benefit is being paid, as long as:

• The individual has been eligible for SSI in a previous month
• The individual still meets SSI's disability criteria (the disability has not improved to the point of recovery)
• The individual still meets SSI's resource limit
• The individual has earnings above the SSI substantial gainful activity threshold (after the SSI cash benefit phases out) but below the state's 1619(b) threshold amount
• The individual needs Medicaid to continue working (a determination usually made automatically; individuals who use Medicaid services in the year are presumed to need Medicaid)

The state's 1619(b) threshold amount is published by SSA annually. Individuals with earnings above the standard Georgia threshold may qualify for an "individualized threshold" determination based on their actual annual Medicaid expenses. See the current SSA threshold table for Georgia's published amount.

Section 1619(b) is administered by SSA, not by the state Medicaid agency. SSA determines 1619(b) status; Georgia accepts that determination as conclusive for Medicaid eligibility.

Common 1619(b) participants include:

• Individuals with mental illness who work part-time
• Individuals with intellectual or developmental disabilities in supported employment
• Individuals with physical disabilities who work full-time with accommodations
• Individuals with chronic conditions (HIV, MS, lupus) who work despite ongoing medical needs

1619(b) and the Medicaid Buy-In can overlap. 1619(b) is for SSI recipients who continue to work; the Buy-In is broader and includes individuals who were never SSI recipients. In practice, working individuals with disabilities often start with 1619(b) (because they were on SSI when they started working) and may later transition to the Buy-In as their work history develops.

For 1619(b) determinations, contact SSA at 1-800-772-1213.

Less restrictive methodologies

Federal Medicaid law allows states to use less restrictive income and resource counting methodologies than the SSI baseline for SSI-related ABD groups. Georgia applies less-restrictive methodologies in several places:

• Katie Beckett TEFRA. The child's income and resources are counted using methodologies appropriate to a household of one (no parental deeming).
• Medicaid Buy-In. Income is counted with employment-related disregards. Resources are counted with disregards for work-related expenses and retirement savings.
• ABD generally. Some income and resource disregards apply for individuals applying for SSI-related ABD coverage.

The specifics are in the DCH Medicaid Eligibility Manual.

Choosing the right Georgia Medicaid buy-in or protected pathway

Many individuals with disabilities and many families are not sure which pathway applies. A starting framework:

Is the individual a minor child? Yes: Investigate Katie Beckett TEFRA if the child has severe disability requiring institutional level of care.

Is the individual an adult working (or able to work)? Yes: Investigate the Medicaid Buy-In and Section 1619(b).

Is the individual a former SSI recipient who lost SSI due to Social Security COLAs? Yes: Investigate the Pickle Amendment.

Is the individual an adult with childhood-onset disability whose parent receives Social Security retirement or disability benefits or has died? Yes: Investigate DAC Medicaid.

Is the individual currently receiving SSI and working with earnings above the SSI cash benefit threshold? Yes: SSA should have transitioned the individual to 1619(b); confirm with SSA.

Multiple pathways may apply. A child with TEFRA-eligible disability and parents at moderate income may also qualify for GAPP waiver services. An adult with childhood-onset disability working a part-time job may qualify for DAC Medicaid and the Buy-In and 1619(b). The pathways are not mutually exclusive; the individual is covered under whichever pathway provides the broadest protection.

Coordination with HCBS waivers and other services

Each of these pathways provides Medicaid eligibility. Once eligible, the individual receives the Medicaid services for which they otherwise qualify, which may include:

• HCBS waiver services (ICWP, CCSP, SOURCE, NOW, COMP, GAPP) for individuals meeting waiver level of care
• EPSDT comprehensive benefits for children under 21
• Behavioral health services including therapy, psychiatric medication, and case management
• Targeted Case Management for individuals in qualifying target populations
• Durable medical equipment
• Therapies (physical, occupational, speech)
• Long-term services and supports including nursing facility care if needed

The pathway determines eligibility; the services determine what the individual receives. Families navigating these pathways should also investigate which waivers and services the individual may qualify for once Medicaid is established.

Worked examples

The following examples are illustrative scenarios drawn from common populations; specific dollar amounts and timelines vary by case and by year, and any figures noted are for illustration only.

Maya, Atlanta, Katie Beckett TEFRA. Maya is a child with cerebral palsy involving significant motor impairment, intellectual disability, dysphagia (swallowing difficulty), and recurrent respiratory complications. She uses a power wheelchair, requires gastrostomy tube feedings, requires daily respiratory therapy, and receives physical, occupational, and speech therapy. Her parents both work, and their joint household income is well above the traditional Medicaid limit. Maya would not qualify for traditional Medicaid because her parents' income exceeds the limit. Maya's pediatrician told her parents about Katie Beckett TEFRA and connected them with a Medicaid eligibility specialist at the children's hospital. The specialist helped them assemble the application: medical records from Maya's neurologist, gastroenterologist, pulmonologist, primary care pediatrician, and therapists; a level-of-care assessment by the hospital social worker; and a cost-effectiveness analysis showing that estimated home care under Medicaid was substantially less expensive than estimated institutional care for a child with Maya's needs. The initial application was denied because the disability determination unit questioned the level-of-care designation. The family worked with Disability Rights Georgia to file an appeal. On appeal, additional documentation from the pulmonologist describing Maya's respiratory needs and from the gastroenterologist describing the complexity of her G-tube management persuaded the hearing officer. Maya was approved retroactively. She now receives full Medicaid coverage including her therapies, equipment, medications, and a private duty nursing benefit through GAPP, all without out-of-pocket cost.

David, Macon, Medicaid Buy-In for Workers with Disabilities. David is an adult with autism spectrum disorder and intellectual disability. He lives with his parents and has been receiving SSI plus Medicaid since age 18 (his original SSI award was based on childhood-onset disability). With support from the Georgia Vocational Rehabilitation Agency, David obtained a part-time job at a community coffee shop. He works regular part-time hours. His earnings are above the SSI cash benefit threshold, so his SSI cash benefit terminated. Initially, his SSA caseworker put him on Section 1619(b), which preserved his Medicaid. After two years of work, with David's earnings stable and his resources growing slowly as he saved part of his income, the SSA caseworker and a benefits counselor explored whether the Medicaid Buy-In would offer a more stable path. They concluded that the Buy-In would let David save more (because the Buy-In resource limit is higher than the 1619(b) resource limit) and would provide somewhat more flexibility. David transitioned to the Working Disabled Medicaid Buy-In. He pays a modest sliding-scale premium. He continues working and now has the option of increasing his hours if he wants to, with the Buy-In premium adjusting on a sliding scale rather than threatening loss of coverage.

Eleanor, Savannah, Pickle Amendment. Eleanor receives Social Security disability benefits (Title II) based on a back injury sustained in her 40s and had received SSI as a supplement. Over the years, Eleanor's Title II benefits grew with annual COLAs while her SSI benefit shrank correspondingly. Her Title II benefit alone eventually exceeded the SSI income limit, and she lost SSI. She also lost Medicaid because the DFCS worker did not apply the Pickle Amendment at the time. Eleanor went without Medicaid for two years, struggling to afford medications and skipping specialist appointments. She later met with a GeorgiaCares SHIP counselor about Medicare coordination (Eleanor had Medicare based on the Title II disability). The SHIP counselor recognized a likely Pickle situation, helped Eleanor file a request for Pickle review with DFCS, and Eleanor was approved retroactively. She received retroactive Medicaid coverage for the period from her loss of SSI to the present, and she continues to receive Pickle-protected Medicaid as a Medicare-Medicaid dual eligible. Her medications, specialist visits, and durable medical equipment are now covered.

Marcus, Atlanta, Disabled Adult Child (DAC) Medicaid. Marcus is an adult with Down syndrome and intellectual disability. He has been receiving SSI plus Medicaid since age 18. He lives with his parents in suburban Atlanta. His father, who worked many years as an engineer, retired and started receiving Social Security retirement benefits. Marcus became entitled to Disabled Adult Child benefits on his father's earnings record. The DAC benefit amount, calculated from the father's earnings record, exceeded the SSI federal benefit rate, and Marcus's SSI terminated. Without the DAC Medicaid protection, Marcus would have lost Medicaid. The DFCS worker, who was familiar with DAC Medicaid, identified the protection at the time of the SSI termination notice and converted Marcus's case to DAC Medicaid. Marcus continues to receive Medicaid coverage including his prescription medications, his behavioral health support, his preventive medical care, and his enrollment in the COMP waiver (he had been on the COMP waiver since age 18). The DAC benefits add to his and his family's monthly income, but his Medicaid coverage is preserved.

Aisha, Columbus, Katie Beckett TEFRA with GAPP. Aisha is a child with a complex congenital syndrome involving multiple organ systems. She has a tracheostomy with home ventilator support, gastrostomy feedings, and requires continuous monitoring. Her mother stays home as her primary caregiver. Her father works as a software engineer. Aisha was hospitalized for the first six months of her life and was discharged to home after the family pursued Katie Beckett TEFRA enrollment with help from the children's hospital social worker. The initial TEFRA approval came through within a few months of application. Aisha now receives the GAPP waiver private duty nursing benefit, her durable medical equipment (ventilator, suction machine, feeding pump), her medications, and her ongoing specialty care, all through Medicaid. The combined Katie Beckett TEFRA eligibility and GAPP waiver enrollment have allowed Aisha to live at home rather than in a long-term care facility, and have allowed her parents to maintain their employment because the nursing coverage provides relief for both parents.

Diana, rural Bulloch County, Section 1619(b). Diana is a woman with multiple sclerosis (MS) diagnosed in her mid-30s. After her diagnosis, her MS progression led her to stop working at around age 41, and she became eligible for SSDI and Medicaid. Several years later, with the help of the Georgia Vocational Rehabilitation Agency and a benefits counselor, Diana started a part-time job as a medical billing coordinator from her home. The work accommodates her fatigue and mobility limitations. Her earnings are above the SSI cash benefit threshold but well below the 1619(b) threshold for Georgia. SSA placed her on 1619(b), and Georgia Medicaid continued without interruption. Diana now has Medicare (based on SSDI) and Medicaid (under 1619(b)) as a dual eligible. The Medicaid coverage pays for her MS medications (which are extraordinarily expensive), her physical therapy, her durable medical equipment, and her behavioral health support (she has co-occurring depression). The 1619(b) protection has been the critical mechanism enabling her to continue working part-time while preserving the Medicaid coverage that makes her ongoing care possible.

Common problems and how to solve them

The eligibility worker did not consider Pickle or DAC. If you or a family member lost SSI and was subsequently denied Medicaid, ask DFCS to review the case for Pickle (if the loss was due to Title II COLAs) or DAC (if the individual has childhood-onset disability and is now receiving DAC benefits). Bring the relevant SSA documents. If denial persists, contact Georgia Legal Services Program or Atlanta Legal Aid Society for legal advocacy.

The Katie Beckett TEFRA application was denied. Common reasons for denial include the level-of-care determination (the state determined the child does not require institutional level of care), the disability determination (the state determined the child does not meet the disability criteria), or the cost-effectiveness analysis. Appeals are common and frequently successful with additional documentation. Disability Rights Georgia and CSHCN program staff can help with appeals.

The Buy-In premium seems too high. Verify the premium calculation. The premium is supposed to be on a sliding scale based on income. If your income has decreased or your circumstances have changed, ask for a recalculation. If the premium is unaffordable, work with the eligibility worker to identify what income or work changes might reduce the premium.

The transition from TEFRA to adult Medicaid. A TEFRA child approaching the age cutoff should plan for the transition. Options may include the Working Disabled Buy-In (if working), DAC Medicaid (if parents are retired/disabled/deceased), traditional ABD Medicaid (if income meets the limit), HCBS waiver enrollment (NOW, COMP, ICWP if applicable), or other pathways. Plan the transition months in advance.

The Section 1619(b) determination was incorrect. Contact SSA at 1-800-772-1213 for review. SSA is the responsible agency for 1619(b) determinations. If SSA's determination is wrong, request reconsideration with SSA. State Medicaid follows SSA's determination.

Multiple pathways apply. If multiple pathways might apply (e.g., DAC Medicaid plus Buy-In plus waiver), work with a benefits counselor (ADRC, SHIP, vocational rehabilitation benefits counselor) to identify which combination provides the broadest coverage and the most stable eligibility.

Frequently asked questions

A few more common questions:

My mother lost SSI years ago. Can she still get Pickle Medicaid? Possibly. Ask DFCS to perform a Pickle review. If she meets the criteria, she may be entitled to Medicaid going forward and potentially to retroactive Medicaid for past periods of incorrect denial.

What happens to a TEFRA-eligible child at the age cutoff? The young adult can transition to adult Medicaid pathways including the Working Disabled Buy-In (if working), DAC Medicaid (if eligible based on parental Social Security status), HCBS waiver enrollment (NOW, COMP, ICWP if applicable), or traditional ABD Medicaid (if income meets the limit). Plan the transition months in advance with help from CSHCN, DBHDD, or other transition supports.

Can my family caregiver also be paid for caregiving? Not in their role as case manager or eligibility worker. For direct care, certain HCBS waivers allow family caregivers to be paid for personal support services under self-direction arrangements (with limits and rules). See Brevy's guide to family caregiver compensation in Georgia for the specifics.

Do these pathways have premiums or copays? Katie Beckett TEFRA: no premium, no copay for most services (some adult services may have nominal copays). Medicaid Buy-In: sliding-scale premium based on income, with no copay for most services. Pickle and DAC: no premium; the individual receives the same Medicaid coverage as other SSI-related ABD beneficiaries. Section 1619(b): no premium; standard Medicaid coverage.

Can these pathways stack with HCBS waivers? Yes. Eligibility under one of these pathways establishes Medicaid coverage. Once Medicaid is established, the individual can enroll in any HCBS waiver for which they meet the additional waiver criteria (level of care, condition, age, geographic, financial). A Katie Beckett TEFRA child can enroll in GAPP. A Buy-In or 1619(b) adult can enroll in ICWP if they meet hospital level of care. A DAC Medicaid adult can enroll in NOW, COMP, or another applicable waiver.

Key contacts

• DCH Medicaid Member Services: 1-866-211-0950
• DCH Aged Blind Disabled and Long-Term Care unit: 1-866-322-4260
• DFCS Customer Service: 1-877-423-4746
• Georgia Vocational Rehabilitation Agency: 1-844-367-4872
• SSA national: 1-800-772-1213
• GeorgiaCares SHIP: 1-866-552-4464
• Aging and Disability Resource Connection (ADRC): 1-866-552-4464
• Disability Rights Georgia: 404-885-1234
• DPH Children with Special Health Care Needs (CSHCN) program: 1-855-707-8277
• DBHDD Intake: 1-888-273-1414
• Georgia Legal Services Program
• Atlanta Legal Aid Society
• 211 Georgia: dial 211
• Ticket to Work (SSA): 1-866-968-7842

Phone numbers change; verify with the agency directly at the URLs linked above before placing a call.

This guide is for educational purposes only and does not constitute legal, medical, or financial advice. Federal and state Medicaid rules change frequently, and eligibility decisions depend on the specific facts of each case. Verify current rules with the Department of Community Health, DFCS, SSA, Disability Rights Georgia, or other authoritative sources before making decisions about benefits.

Find personalized help navigating Georgia Medicaid buy-in options and protected pathways at brevy.com.