Georgia Medicaid Care Coordination & Case Management 2026

In Georgia, Medicaid case management and care coordination run through several parallel systems, and which one serves a person depends on their waiver, managed care plan, diagnosis, and age. A Medicaid card by itself does not connect a person to a doctor, schedule a dialysis ride, authorize durable medical equipment, or follow up when a referral stalls. A case manager or care coordinator does that work. Depending on the program, that person may sit at a Service Options Using Resources in a Community Environment (SOURCE) provider agency, at the Georgia Department of Community Health (DCH), at one of the Georgia Families Care Management Organizations (CMOs), at a Community Service Board (CSB), at a Department of Behavioral Health and Developmental Disabilities (DBHDD)-contracted support coordination agency, or inside a foster care coordination team. Georgia operates four Section 1915(c) Home and Community-Based Services (HCBS) waivers, three managed care plans, and a separate behavioral health system, and most families never realize how many parallel case management systems run at once until something falls through a gap between them.1,2

How Georgia Medicaid case management is organized

Case management is not one Medicaid service. It is a set of overlapping benefits delivered by different agencies under different federal authorities. The table below maps each major Georgia program to its authority, who administers it, who it serves, and what the case manager is typically called. Georgia operates four Section 1915(c) HCBS waivers (EDWP, ICWP, NOW, and COMP), and each one covers case management or support coordination. CCSP and SOURCE are the two service-delivery models inside EDWP, not separate waivers.1

The same person can receive case management under more than one authority at once. A SOURCE member with serious mental illness, for example, may have both a SOURCE case manager and a CSB behavioral health case manager. When authorities overlap, the same case management function cannot be billed twice.

The federal authorities behind Georgia Medicaid case management

Georgia's programs sit on a stack of federal authorities. The rules, payments, and protections vary by authority, which is why the programs behave differently.

• Section 1905(a)(19) of the Social Security Act is the base authority for case management as an optional Medicaid service. The federal definition at 42 CFR 440.169 describes services that help beneficiaries gain access to needed medical, social, educational, and other services.
• Section 1915(g) authorizes Targeted Case Management (TCM), an exception to the statewideness and comparability rules that lets a state target case management to defined populations such as people with serious mental illness, intellectual or developmental disabilities, or HIV/AIDS, and pregnant women. The regulations are at 42 CFR 441.18; our dedicated TCM guide covers the target populations and billing rules in depth.
• Section 1915(c) authorizes HCBS waivers. Federal HCBS rules require the case management a waiver delivers to be conflict-free: the case manager generally cannot also deliver direct services to the same person. Georgia runs four such waivers, and each one covers case management or support coordination.1
• Section 1945, added by Section 2703 of the Affordable Care Act, authorizes Health Homes for people with multiple chronic conditions or a serious and persistent mental health condition. States that adopt Health Homes receive enhanced federal matching funds for a limited initial period, after which the match returns to the regular state rate. Georgia has not adopted a broad Health Home benefit.
• Section 1932 authorizes managed care, and 42 CFR 438.208 requires managed care plans to coordinate care across providers, identify members with special health care needs, and provide care management for high-need members.
• Sections 1902(a)(43) and 1905(r) authorize Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children under 21, including case management to help children with complex conditions reach diagnosis and treatment.

How person-centered service planning works

For every HCBS waiver participant in Georgia, the case manager facilitates a person-centered service planning process required by 42 CFR 441.301(c). Georgia runs four HCBS waivers, and the planning rule applies to all of them.1 The plan must:

• Reflect the individual's own goals, preferences, strengths, and desired outcomes, not the agency's or family's preferences.
• Be developed through a meeting the individual chooses to attend, with people the individual chooses to include, which can include family caregivers, friends, or advocates.
• Document the services, providers, frequency, and responsible parties.
• Identify the risks the individual faces and the strategies to manage them, written to support the person's dignity and autonomy.
• Specify back-up plans for critical supports, such as what happens if the personal support worker does not show up or the family caregiver is hospitalized.
• Be reviewed at least once a year and whenever circumstances change.
• Be signed by the individual or the individual's authorized representative.

The case manager's role is to facilitate, document, and authorize, not to dictate. A family that feels the case manager is steering the plan toward agency preferences rather than the individual's goals can raise the concern through the program and, if needed, request a different case manager. Managed care members with special health care needs receive a comparable planning process under 42 CFR 438.208.

SOURCE: case management built around primary care

SOURCE (Service Options Using Resources in a Community Environment) is one of the two service-delivery models inside Georgia's Elderly and Disabled Waiver Program (EDWP), serving older adults and adults with physical disabilities who are at nursing facility level of care and need both primary care and home-based supports. It is not a separate 1915(c) waiver. What sets SOURCE apart is that it coordinates physician-led care with HCBS in a single program design.1

The SOURCE case manager is the central figure in the program. Responsibilities include:

• Conducting the initial comprehensive assessment to establish nursing facility level of care and document functional, medical, behavioral health, and social needs.
• Facilitating the person-centered service planning meeting with the member, family caregivers (with the member's permission), and the SOURCE primary care provider.
• Authorizing services such as personal support, adult day health, home-delivered meals, emergency response systems, respite, and skilled nursing.
• Coordinating with the SOURCE primary care provider so that medical needs translate into community supports and specialty care.
• Conducting monthly contact, with quarterly or more frequent in-home visits to verify service delivery and reassess needs.
• Acting on critical incidents such as falls, hospitalizations, and reports of abuse or neglect, then following up to support safety.
• Conducting the annual reassessment of level of care and service needs, which is filed with DCH and triggers renewed authorizations.

Caseloads are large enough that monthly contact is the norm but the case manager cannot answer every minor question instantly. Families should ask what the typical response time is for non-emergencies and what to do for urgent issues, such as contacting the provider directly or calling emergency services.

CCSP: the long-standing elderly and disabled service model

CCSP (Community Care Services Program) is the older of the two EDWP service models, covering adults at nursing facility level of care. Like SOURCE, it is a delivery model within that waiver rather than a waiver of its own. It predates SOURCE and serves a broader population, including people who do not need or want the SOURCE primary care integration.1

The CCSP case manager performs the same core functions as the SOURCE case manager (assessment, planning, authorization, monitoring, and annual reassessment) but coordinates with whatever primary care provider the member already has, often a community physician separate from the case management agency. CCSP services include personal support, adult day health, home-delivered meals, alternative living services, emergency response systems, and skilled nursing. As in SOURCE, monthly contact is the norm and the case manager is not available instantly for every question.

ICWP: case management for adults with severe physical disabilities

ICWP (Independent Care Waiver Program) is Georgia's HCBS waiver for adults who apply between the ages of 21 and 64 with severe physical disabilities, such as spinal cord or traumatic brain injury, who would otherwise require hospital or nursing facility level of care but can live in the community with supports.1 ICWP emphasizes independent living and supports many participants in self-directed care, where the participant selects, hires, and supervises their own personal support workers.

The ICWP case manager (often called a support coordinator) verifies eligibility and level of care, develops the person-centered plan with significant member direction, authorizes services, and monitors safety and delivery. For self-direction, the case manager helps the member work with the financial management services agency that handles payroll for the chosen workers and helps the member meet the responsibilities of being the employer of record. Georgia bars spouses, parents of minor recipients, legal guardians, and conservators from being hired as paid personal support workers across its self-direction pathways, including ICWP; adult children, siblings, and other adult relatives may be hired. Holding a power of attorney for the participant is not on that list, and DCH's own ICWP pages do not address paid-relative eligibility at all, so ask the case manager to confirm your role rather than assuming you are barred.3

NOW and COMP: support coordination for intellectual and developmental disabilities

NOW (New Options Waiver) and COMP (Comprehensive Supports Waiver) are Georgia's two HCBS waivers for people with intellectual or developmental disabilities, administered by DBHDD with DCH as the single state Medicaid agency. NOW serves people who need less intensive supports; COMP serves people who need more intensive supports, including residential settings such as host homes and group homes.1 To qualify, a person must have an intellectual disability, or a closely related developmental disability such as autism, cerebral palsy, or epilepsy, that substantially impairs intellectual or adaptive functioning, with onset by age 18 for an intellectual disability or by age 22 for a developmental disability, and must meet an intermediate care facility (ICF/IID) level of care.4

NOW and COMP case management is called support coordination and is delivered through DBHDD-contracted support coordination agencies. The support coordinator:

• Conducts the assessment to establish ICF/IID level of care.
• Facilitates the Individual Service Plan (ISP) meeting, the I/DD version of the person-centered service plan.
• Authorizes services such as community living supports, supported employment, behavioral supports, therapies, residential supports, respite, and transportation.
• Coordinates with the direct support professionals and their employing agencies.
• Conducts regular monthly contact and quarterly in-home visits, and leads the annual ISP review.

Capacity is constrained. Approximately 7,900 Georgians were on the NOW and COMP planning list in September 2025. Of the roughly 4,900 who were age 22 or older, about 43% had been waiting at least six years, and the average wait across the list was close to five years. DBHDD prioritizes by unmet need rather than by time spent on the list, so waiting longer does not by itself move a person up.5 DBHDD prefers applications filed online through the Georgia Collaborative ASO's Individual IDD Connects portal, because paper applications have to be transcribed into the portal by hand, but a paper application faxed or mailed to a DBHDD Regional Field Office is also accepted, and applicants who need help can call their Regional Field Office.6 Under participant direction, Public Partnerships LLC serves as the financial management services agent, and Family Hire is permitted case by case with documented hardship.3

Children's care coordination: foster care, EPSDT, GAPP, and Katie Beckett

Children move through several coordination systems depending on their custody status and medical needs.

Georgia Families 360 is the specialized care coordination plan for children and youth in foster care custody, administered by Amerigroup statewide rather than through the three-plan choice model that applies to most members.2 It coordinates physical health, behavioral health, dental, and pharmacy with a trauma-informed approach, and works with the foster family, the child's Division of Family and Children Services caseworker, and the court. Foster families should hold contact information for both the caseworker and the 360 care coordinator.

EPSDT case management supports children under 21 who screen positive for conditions needing follow-up. Georgia delivers it primarily through CMO care management, with specialty case management layered on for qualifying conditions. The Georgia Pediatric Program (GAPP) serves medically fragile children under 21 who need skilled nursing or personal care to remain at home; Medicaid pays the enrolled GAPP provider agency, not the parent, and that agency's nursing team is the family's day-to-day contact.3 The Katie Beckett (TEFRA) pathway qualifies children with disabilities for Medicaid based on the child's own income, ignoring parental income, which then opens access to these services.

CMO Intensive Care Management

Each Georgia Families CMO provides care management as required by 42 CFR 438.208. Georgia Families currently contracts with three CMOs: Amerigroup Community Care, CareSource, and Peach State Health Plan.2 In a 2024 reprocurement the state issued a Notice of Intent to Award the next contract to CareSource, Humana, Molina Healthcare, and UnitedHealthcare, but per DCH that procurement is still in the protest phase and the Notice of Award has not been issued. The current three-plan contracts are extended through June 30, 2027, no member has been moved to an incoming plan, and DCH has not published a confirmed transition date.2

Each CMO runs a tiered model:

• Standard care coordination is telephonic outreach for preventive-care prompts, condition-specific education, and gaps-in-care follow-up. Most members receive this as part of routine plan operations.
• Care management is more intensive engagement for members with chronic conditions, where a licensed care manager (often a registered nurse or licensed clinical social worker) completes an assessment, builds a care plan, and conducts regular check-ins.
• Intensive Care Management (ICM) is the highest tier, reserved for high-need members and staffed by teams of nurses, social workers, behavioral health specialists, pharmacists, and community health workers. ICM members receive face-to-face engagement and frequent contact, often weekly for the highest-acuity members.

ICM is voluntary, and members can decline it. A member can be referred by a primary care provider, a hospital or emergency department, a behavioral health provider, the member or a family member, DCH, or the CMO's own data-driven outreach. Members enrolled in an HCBS waiver receive their primary case management from the waiver and may receive supplementary CMO care management for non-waiver needs, with the two teams coordinating. To request care management or ICM, members call the member services line on their plan ID card.

Behavioral health care coordination: CSBs, ACT, and crisis services

Georgia's behavioral health and developmental disability services run through DBHDD and its regional Community Service Boards, separate from the physical-health CMO system.

Community Service Boards

Community Service Boards (CSBs) are the public behavioral health and developmental disability authorities for the state, each serving a defined region. CSBs provide case management for adults with serious mental illness, case management for substance use disorders, crisis services, outpatient mental health and substance use treatment, psychiatric medication management, and ACT in many regions. CSB case management for serious mental illness is often delivered under Targeted Case Management authority at Section 1915(g), for a target population the Georgia State Plan defines by diagnosis and functional impairment. This case management generally carries a smaller caseload than long-term-services case management, which allows for more face-to-face and home-based contact.

Assertive Community Treatment teams

ACT is the most intensive community-based behavioral health model, designed for people with the most severe and persistent mental illness, often with multiple hospitalizations, justice involvement, homelessness, or co-occurring substance use. ACT teams are multidisciplinary, including a team leader, a psychiatrist or psychiatric nurse practitioner, registered nurses, social workers, substance use counselors, peer specialists, and vocational specialists. The teams share caseloads, deliver services wherever the client is, and are designed for around-the-clock availability. Georgia has been expanding ACT capacity in connection with the federal settlement described below.

Crisis services

In Georgia, calls to 988, the national Suicide and Crisis Lifeline, are routed to the Georgia Crisis and Access Line (GCAL), which DBHDD runs through its partner Carelon and which takes calls, texts, and chats 24 hours a day, every day of the year, at 1-800-715-4225. GCAL is the line DBHDD directs Georgians to for access to the state's behavioral health crisis system; its professionals provide crisis intervention by phone and can dispatch mobile crisis teams, which are themselves available around the clock.7 Crisis contact does not replace ongoing case management, but it is the right first call when a behavioral health situation becomes urgent.

Transitions out of institutions: Olmstead and Money Follows the Person

The Supreme Court's decision in Olmstead v. L.C. held that public agencies must serve people with disabilities in the most integrated setting appropriate to their needs. A federal settlement between the United States Department of Justice and the State of Georgia required Georgia to expand community-based services for people leaving state psychiatric hospitals and other institutions, including intensive case management teams, community supports, and housing, with progress reported to a court-appointed independent reviewer. The settlement remains in effect.

Georgia's operational mechanism for moving people from institutions to the community is Money Follows the Person (MFP), implemented by DCH on September 1, 2008 as a joint initiative of DCH, DBHDD, and the Department of Human Services Division of Aging Services, using the state's Medicaid waiver programs.8 Families with a member leaving a state hospital or large institutional setting should ask the discharge planner about intensive case management, ACT where appropriate, and MFP-supported transition.

Family caregivers as informal case managers

Family caregivers across Georgia perform de facto case management every day. They track appointments, manage medications, coordinate across specialists, advocate when services are denied, arrange transportation, and manage in-home workers and back-up plans. Non-emergency medical transportation (NEMT) for Medicaid trips is now coordinated statewide by Verida, which became the sole statewide Medicaid transportation broker for all five regions effective April 1, 2026.9

Medicaid generally does not pay family caregivers for case management. The limited exceptions fall under self-direction, where the participant or representative selects and supervises the workers; even then the family member is paid for direct care, not for case management as a separately billable service, and Georgia bars spouses, parents of minor recipients, legal guardians, and conservators from being the paid worker. Under DBHDD participant direction in NOW and COMP there is one further bar: the person named as the participant's Representative for Participant Directed Services cannot also be paid staff, and if that representative wants the job another representative has to be named. That rule applies to the representative role in NOW and COMP only, not to holding a power of attorney and not to the other waivers.3 The practical implication is that family caregivers should be treated as essential partners. Person-centered plans should document the caregiver's role, capacity, and back-up plans, and formal case managers should connect caregivers to training and respite.

Worked examples

The following are illustrative scenarios, not real individuals. Georgia operates four HCBS waivers and three managed care plans, and these examples show how those systems combine in practice.1

Eleanor, 78, Macon, EDWP through the SOURCE model. Eleanor lives alone with type 2 diabetes, hypertension, mild cognitive impairment, and limited mobility after a hip fracture. Her SOURCE case manager conducted the assessment, facilitated the planning meeting (her son joined by phone), and authorized personal support, adult day health, an emergency response system, and weekly skilled nursing for diabetes. The case manager conducts monthly phone contact and quarterly home visits and coordinates with the SOURCE primary care provider. When Eleanor fell and was hospitalized, the case manager handled the discharge plan, arranged a temporary increase in support hours, and added a medication-management visit when her memory declined. The arrangement is the connective tissue keeping Eleanor at home rather than in a nursing facility.

Marcus, 45, Albany, ICWP plus CMO ICM. Marcus has progressive multiple sclerosis and uses a power wheelchair. He lives with his sister, who is his self-directed personal support worker. His ICWP support coordinator set up the self-direction arrangement, works with the financial management services agency that handles his sister's payroll, and authorizes his support hours, equipment, and home modifications. After a hospitalization, Peach State enrolled him in ICM. The ICM nurse built a complementary plan for his neurology, infectious disease, and physical therapy needs and coordinates with the support coordinator on a standing schedule. The support coordinator owns the waiver and self-direction; the ICM nurse owns the medical and specialty coordination.

Aisha, 32, Savannah, CMO ICM during pregnancy. Aisha is pregnant and has lupus, stage 3 chronic kidney disease, and a history of preterm delivery. Amerigroup identified her as high-risk and enrolled her in ICM. Her ICM nurse coordinated her maternal-fetal medicine, nephrology, and rheumatology care, arranged NEMT through Verida for the longer-distance appointments, and built a high-risk delivery plan with the hospital. After a preterm cesarean, the nurse coordinated the hospital stay, the NICU connection, and postpartum care.9

Joanne, 65, Atlanta, COMP waiver. Joanne has an intellectual disability and lives in a host home managed by an I/DD provider agency. Her DBHDD-contracted support coordinator conducts monthly contact, quarterly in-home visits, and the annual ISP review, and authorizes the host home placement, day program, behavioral supports, therapy, transportation, and respite. When the host home changed staff, the support coordinator attended the transition meeting, helped onboard the new caregivers, and added extra contact for the first sixty days. The I/DD system has many moving parts, and the support coordinator is the connector.

Common problems and how to handle them

• Case manager turnover. Turnover is frequent. When a case manager leaves, get the new one's name, phone, and email, schedule an introductory meeting within two to four weeks, prepare a short overview of the member's needs and history, and confirm that existing service authorizations remain in place.
• Caseload pressure. Even an excellent case manager with a large caseload cannot respond instantly. Expect 24 to 48 hours for non-urgent calls, and use the provider directly for service-specific questions, such as calling the home care agency about a missed shift.
• Hand-offs between programs. Members transition between waivers, plans, and adult Medicaid.1 Request a joint meeting between the outgoing and incoming case manager and keep a copy of the current service plan to hand to the new team.
• Gaps between physical and behavioral health. Coordination between the physical-health CMO and behavioral health providers is a chronic challenge. Families can request that both care teams hold a joint call to align on the member's care.
• Authorization denials and service gaps. When an authorized service is not delivered, document the gap, contact the case manager, and escalate to the agency supervisor and then to DCH Member Services if it is not resolved.
• Disagreement with the plan. A family can request reconsideration, a different case manager, and ultimately a fair hearing under DCH appeal procedures. See Brevy's guide on appeals and fair hearings for the process.

How to get or change a Georgia Medicaid case manager

If you are not sure who your case manager is, start with the program you are enrolled in:

• HCBS waiver members are assigned a case manager or support coordinator by the administering agency. To change one, request a different case manager at your current agency, or transfer to a different agency if more than one serves your area.
• CMO members can request care management or a different care manager by calling the member services line on the plan ID card; the three current plans are Amerigroup Community Care, CareSource, and Peach State Health Plan.2
• People seeking NOW or COMP services apply through the Georgia Collaborative ASO's Individual IDD Connects portal, which DBHDD prefers, or on paper by fax or mail to a DBHDD Regional Field Office, which can also help with the application.6
• Older adults and adults with disabilities who are not yet enrolled can start with the Aging and Disability Resource Connection (ADRC) at 1-866-552-4464 for information, options counseling, and benefits screening.3

If a case manager is unresponsive, document the attempts, call the agency supervisor, and escalate to DCH Member Services for waiver case management or to your CMO for care management.

Key contacts

These statewide numbers are the fastest way to reach information, crisis help, and advocacy; the Aging and Disability Resource Connection line and the Georgia Crisis and Access Line behind 988 are the two most families start with.3,7

For DCH Member Services, the DBHDD intake and quality lines, the Long-Term Care Ombudsman, and the CMO member services numbers, use the number printed on your plan ID card or the agency's official website (medicaid.georgia.gov, dbhdd.georgia.gov, and aging.georgia.gov), because these numbers change as contracts shift.

Learn More

Find personalized help navigating Georgia Medicaid care coordination 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.