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 specialized 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 of these routes are optional and Georgia chose to adopt them (Katie Beckett TEFRA and the Buy-In); three are mandatory federal protections every state must apply (Pickle, DAC, and 1619(b)). Georgia administers the state-run pieces through the Georgia Department of Community Health (DCH) and the Georgia Division of Family and Children Services (DFCS), while 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. This guide states the 2026 rules, the dollar limits, the forms, and the agency to contact for each route.

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 18 DCH and DFCS None Optional (Georgia adopted)
Georgia Medicaid for Workers with Disabilities (GMWD) Working adults aged 16 to 64 with a disability DFCS Sliding-scale monthly premium 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 definition of disability. Under 42 U.S.C. 1382c(a)(3), a person is disabled if a medically determinable physical or mental impairment keeps them from substantial gainful activity and is expected to last at least 12 continuous months or result in death. Georgia's aged, blind, and disabled (ABD) Medicaid is SSI-linked: the state covers SSI recipients automatically, and the 2026 SSI Federal Benefit Rate (the standard ABD income limit) is $994 a month for an individual and $1,491 for a couple, with a resource limit of $2,000 (individual) or $3,000 (couple). Each pathway below changes how that test is applied for a specific population.

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 using only the child's own income and resources, with parental income and resources not deemed (counted) to the child. It is named for Katie Beckett, an Iowa child who could get Medicaid-funded ventilator care in a hospital but not at home until federal law changed to allow home coverage.

In Georgia, the Katie Beckett (TEFRA) Deeming Waiver covers a child through the month the child turns 18, after which the case transitions to other coverage such as Aged, Blind and Disabled Medically Needy. A child qualifies by meeting four criteria:

  • Institutional level of care. The child is chronically impaired enough to be a suitable candidate for institutional care (a nursing facility, hospital, or intermediate care facility for the intellectually disabled).
  • Financial ineligibility for SSI. The child is ineligible for SSI in a private living arrangement because of the child's own income and resources or income and resources deemed from the parents.
  • Level-of-care criteria met. The child meets the program's basic level-of-care eligibility rules.
  • Cost-effectiveness. The estimated cost of home care under Medicaid is no greater than the cost of institutional care.

A child who meets all four is covered as a household of one, with the same income and resource limits as an SSI-related adult, parental income set aside. 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. Children who are medically complex can also receive private-duty nursing through the Georgia Pediatric Program (GAPP).

To apply, families submit the Pediatric DMA-6(A) application plus three supporting forms: the Medical Necessity and Level of Care statement (DMA-706), the Cost-Effectiveness form (DMA-704), and the Level-of-Care routing form (DMA-705). Applications go through the DCH Katie Beckett portal or the Centralized Katie Beckett Medicaid Team (678-248-7449), or online at Georgia Gateway, with level-of-care review handled by Alliant Health Solutions. Federal rules require Georgia to decide a disability-based Medicaid application within 90 calendar days. If the application is denied, the family can request a fair hearing; TEFRA denials often turn on the level-of-care or cost-effectiveness finding and are frequently won on appeal with added documentation.

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. 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.
  • Be employed and receiving compensation.
  • 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 resource limit is the program's central advantage for working people: at $4,000 (individual) or $6,000 (couple), it is double the standard SSI and ABD limit of $2,000 and $3,000, so a worker can keep more savings and still qualify., GMWD participants may owe a monthly premium set on a sliding scale by age and total countable income; lower-income participants can owe nothing, and the premium is far less than private coverage.

Apply through DFCS, and ask specifically for Georgia Medicaid for Workers with Disabilities, because an eligibility worker may not raise it on their own. Bring a disability determination (an SSA award letter or a state determination), employment and income verification, and the standard Medicaid application. The Georgia Vocational Rehabilitation Agency connects workers with disabilities to the Buy-In during employment planning, and SSA's Ticket to Work program supports the same goal.

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 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. In 2026 the COLA was 2.8 percent, following 2.5 percent in 2025, 3.2 percent in 2024, and 8.7 percent in 2023. Over years, those raises push a Social Security benefit past the SSI limit, which in 2026 is the $994 monthly Federal Benefit Rate for an individual, and the person loses SSI and, without Pickle, Medicaid too. The Pickle test is a counterfactual, not a question of timing: the worker subtracts the COLAs and checks whether SSI eligibility returns.

Pickle is widely underused because eligibility 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. 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. Advocates at the GeorgiaCares SHIP and the Georgia Aging and Disability Resource Connection (ADRC) regularly find Pickle eligibility for clients first turned down.

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 requires the state to keep treating the person as an SSI recipient for Medicaid so long as they would still be eligible for SSI in the absence of those DAC benefits.

The trigger is usually a parent's retirement, disability, or death. When that happens, the adult child becomes entitled to a DAC benefit calculated from the parent's earnings, which is often higher than the SSI Federal Benefit Rate of $994 a month, so SSI ends. Without DAC Medicaid, the adult child would lose Medicaid as well. The protection covers common childhood-onset conditions, including Down syndrome, intellectual disability, autism, cerebral palsy, and severe mental illness with childhood onset. DFCS makes the determination 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. A worker whose actual Medicaid costs run high (for example, Home and Community-Based Services or specialty drugs) can ask SSA for an individualized threshold above $41,927 based on those costs. The cash benefit itself stops once countable earnings climb past the SSI break-even point, which sits well above the 2026 Substantial Gainful Activity level of $1,690 a month for a non-blind worker and $2,830 a month for a worker who is blind.

SSA, not the state, makes the 1619(b) finding, and Georgia accepts it as conclusive: when SSA notifies DCH of 1619(b) status, Medicaid continues automatically. For a 1619(b) question, contact SSA at 1-800-772-1213. Georgia-specific detail is in our guide to Georgia Medicaid Section 1619(b).

Less restrictive methodologies

Federal law (section 1902(r)(2) of the Social Security Act) lets a state count income and resources more generously than the SSI baseline for SSI-related ABD groups, and Georgia does so in several places. Katie Beckett counts the child alone, with no parental deeming. The Buy-In counts income with employment-related disregards and applies the higher $4,000 and $6,000 resource limits. A separate spend-down 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, and is where a Katie Beckett child often lands after turning 18.

Choosing the right Georgia Medicaid buy-in or protected pathway

Many families are unsure which route applies. Start with the person's situation:

  • A minor child with a severe disability. Look at Katie Beckett (TEFRA) if the child needs institutional level of care but can be served at home.
  • A working-age adult with a disability who is employed or wants to work. Look at Georgia Medicaid for Workers with Disabilities and Section 1619(b).
  • A former SSI recipient who lost SSI because of Social Security COLAs. Look at the Pickle Amendment.
  • An adult disabled before age 22 whose parent now receives Social Security retirement or disability benefits or has died. Look at DAC Medicaid.
  • A current SSI recipient working above the SSI cash-benefit limit. SSA should have moved the person to 1619(b); confirm with SSA.

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 the person is covered under whichever route gives the broadest, most stable protection.

Coordination with HCBS waivers

Each pathway establishes Medicaid eligibility; the services a person then receives depend on what they otherwise qualify for. Georgia runs five Section 1915(c) Home and Community-Based Services (HCBS) waivers in 2026, including the Community Care Services Program (CCSP) and Service Options Using Resources in Community Environments (SOURCE) for older adults and adults with physical disabilities, 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 and other criteria. Establish the eligibility pathway first, then layer on the waiver.

Worked examples

The scenarios below are illustrative; dollar amounts and timelines vary by case.

David, Macon, Georgia Medicaid for Workers with Disabilities. David is an adult with autism and intellectual disability who has received SSI and Medicaid since age 18. With help from the Georgia Vocational Rehabilitation Agency, he took a part-time job at a coffee shop. His earnings stopped his SSI cash payment, so SSA first placed him on Section 1619(b). As his savings grew toward the SSI resource limit, a benefits counselor moved him to GMWD, where the $4,000 resource limit lets him save more and the sliding-scale premium adjusts as his hours change instead of threatening his coverage.

Eleanor, Savannah, Pickle Amendment. Eleanor received Social Security disability benefits and SSI. Over years, COLAs raised her Social Security benefit until it passed the SSI limit and she lost SSI, and her DFCS worker did not apply Pickle, so she lost Medicaid too. A GeorgiaCares SHIP counselor recognized the pattern, asked DFCS for a Pickle review, and Eleanor was approved, with retroactive coverage for the period of the incorrect denial. She now keeps Pickle-protected Medicaid as a Medicare-Medicaid dual eligible.

Marcus, Atlanta, Disabled Adult Child Medicaid. Marcus, an adult with Down syndrome, had SSI and Medicaid. When his father retired and began Social Security retirement benefits, Marcus became entitled to a DAC benefit on his father's record that exceeded the SSI limit, ending his SSI. His DFCS worker recognized the DAC protection at the termination notice and kept his Medicaid in place, including his COMP waiver services.

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 continued without interruption, covering the MS medications and therapy that make continued work possible.

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 (if the loss followed Social Security COLAs) or DAC (if the person has a childhood-onset disability and now receives DAC benefits). Bring the SSA documents. If a denial stands, contact the Georgia Legal Services Program or Atlanta Legal Aid Society.
  • A Katie Beckett application was denied. Denials usually turn on the level-of-care or cost-effectiveness finding. Request a fair hearing and add documentation from the treating specialists. Disability Rights Georgia can help.
  • The Buy-In premium seems too high. The GMWD premium is set on a sliding scale by age and countable income. If income dropped, ask DFCS to recalculate.
  • A Katie Beckett child is nearing 18. Plan months ahead for the transition 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.
  • A 1619(b) finding looks wrong. Contact SSA at 1-800-772-1213; SSA owns the determination and Georgia follows it.

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. It covers employed adults aged 16 to 64 who meet SSA's disability standard, with 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 sliding-scale monthly premium based on age and income. Apply through DFCS and ask for the program by name.

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, eligibility runs through the month the child turns 18. Apply with the Pediatric DMA-6(A) plus the DMA-706, DMA-704, and DMA-705 forms through the DCH Katie Beckett portal or at Georgia Gateway.

Who qualifies for the Pickle Amendment?

A person qualifies for Pickle if they received both SSI and Social Security in the past, lost SSI after April 1977 because Social Security cost-of-living raises pushed their income up, and would still be SSI-eligible if those raises were 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 as conclusive. For 2026, a former Georgia SSI recipient can earn up to $41,927 in gross annual earnings and keep full Medicaid; a worker with higher actual Medicaid costs can request an individualized threshold above that amount from SSA.

Not sure which Georgia Medicaid pathway fits your family? Start by calling 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 for or renew any Georgia Medicaid pathway, and ask for the Buy-In, Pickle, or DAC by name. 1-877-423-4746
DCH Medicaid Member Services Verify active Medicaid coverage and benefits once a pathway is approved. 1-866-211-0950
DCH Aged, Blind, Disabled and Long-Term Care Unit Questions on 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 for a child. 678-248-7449
Georgia Vocational Rehabilitation Agency Connects working adults with disabilities to the Buy-In during employment planning. 1-844-367-4872
Social Security Administration Owns the Section 1619(b), Pickle, and DAC determinations and disability findings. 1-800-772-1213
GeorgiaCares SHIP and ADRC Free benefits counseling, including Pickle reviews and Medicare-Medicaid coordination. 1-866-552-4464
Disability Rights Georgia Advocacy and help appealing a denied disability-based Medicaid application. 404-885-1234
Georgia Department of Public Health, Children with Special Health Care Needs Support for families of children with complex medical needs. 1-855-707-8277
DBHDD Intake Entry point for NOW and COMP developmental-disability waiver services. 1-888-273-1414
SSA Ticket to Work Employment support for SSI and SSDI beneficiaries who want to work. 1-866-968-7842
211 Georgia Local referrals to community resources across the state. 211

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

Learn More

MedicaidGeorgia Medicaid Programs OverviewGeorgia Medicaid 2026: income and asset limits, CCSP and SOURCE waivers, Pathways to Coverage, the Miller Trust rule, 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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