Georgia Medicaid Eligibility & Income Limits 2026

Georgia Medicaid income limits depend entirely on which of three eligibility pathways you fall into, and each one tests income and assets by different rules. The pathway determines whether the program applies an income-only test (Modified Adjusted Gross Income, or MAGI), an income-and-asset test pegged to the federal Supplemental Security Income (SSI) standard for the aged, blind, and disabled (ABD), or a higher income test for long-term-care applicants paired with a $2,000 asset limit and a 60-month lookback.1

Picking the wrong pathway is the most common source of erroneous "I don't qualify" answers in Georgia. Because Georgia is not a full Medicaid expansion state, many adults assume they have no pathway at all, when in fact the limited Pathways to Coverage demonstration or the long-term-care pathway may apply.

In This Guide

• The 2026 Income and Asset Figures
• Pathway 1: MAGI Income Limits
• Pathway 2: ABD Income Limits
• Pathway 3: Long-Term Care Income Limits
• Medicare Savings Programs
• Pathways to Coverage
• Appeals and State Hearings
• Frequently Asked Questions
• Learn More

Federal and Georgia Authority

Federal Authority

The eligibility categories sit in 42 USC 1396a, with mandatory and optional groups under 1396a(a)(10)(A) (the 300 percent SSI long-term-care pathway is an optional group) and MAGI methodology under 1396a(e)(14). SSI rules (42 USC 1382 and 1383) supply the ABD standards; the transfer penalty, Miller Trust, home equity exclusion, and spousal impoverishment rules sit in 42 USC 1396p and 1396r-5. Section 1115 authorizes the Pathways to Coverage demonstration; ACA Section 2001 is the expansion option Georgia did not adopt.2

Georgia Authority

Georgia implements these rules through O.C.G.A. Title 49, Chapter 4, the Department of Community Health Medicaid Policy Manuals (the operational reference Division of Family and Children Services (DFCS) workers use), and the federally approved Georgia State Medicaid Plan. Its Section 1115 demonstrations include Georgia Pathways to Coverage and Planning for Healthy Babies, and its four 1915(c) HCBS waivers are the Elderly and Disabled Waiver Program (EDWP), delivered through the Community Care Services Program (CCSP) and SOURCE service models, the Independent Care Waiver Program (ICWP), and the New Options and Comprehensive Supports Waivers (NOW and COMP).6

The 2026 Georgia Medicaid Income Limits and Asset Figures

These are the figures Georgia DFCS workers use for 2026 Georgia Medicaid income limits and asset tests.1,7,3,8,9

Income Figures

Medicare Savings Program income and asset limits are in the Medicare Savings Program section below.

Resource (Asset) Figures

The 2026 federal home equity limit is not a single number: it starts at a federal minimum of $752,000, and a state may elect a higher standard up to $1,130,000, so confirm with DFCS which standard Georgia applies before assuming a home disqualifies an applicant. Under Public Law 119-21 (the One Big Beautiful Bill Act of 2025), the limit becomes a flat $1,000,000 cap for non-agricultural homes effective January 1, 2028; a home on an agriculturally zoned lot stays under the indexed rules.1,3,2

Federal Poverty Level Conversion Table

For MAGI categories that use FPL percentages, here is the 2026 Federal Poverty Level for the 48 contiguous states and DC at the percentages Georgia uses. (Monthly equivalents are the annual figure divided by 12.)7

Pathway 1: MAGI (Modified Adjusted Gross Income) Income Limits

The MAGI pathway uses Affordable Care Act (ACA) methodology: income only, no asset test. Households follow federal tax-household rules under 42 CFR 435.603, and income is calculated monthly.

Children

Georgia's children's Medicaid program is Right from the Start Medicaid (RSM). Income ceilings vary by age.4

• Medicaid (RSM): infants under age 1 up to 220 percent FPL; ages 1 through 5 up to 149 percent FPL; ages 6 through 18 up to 205 percent FPL
• PeachCare for Kids (CHIP): uninsured children through age 18 with family income above the RSM ceiling for their age, up to 247 percent FPL
• Continuous Eligibility: Children under age 5 have continuous Medicaid eligibility under the Consolidated Appropriations Act, 2023; children 5 to 18 have annual recertification

Pregnant Women

Georgia covers pregnant women up to 220 percent FPL through the RSM Pregnant Women pathway, with no asset test. Coverage includes prenatal care, delivery, and a full 12 months of postpartum coverage (extended effective November 1, 2022 and made permanent under the Consolidated Appropriations Act, 2023).10

Parents and Caretaker Relatives

Georgia's parents-and-caretakers income threshold is much lower than in ACA-expansion states. The specific threshold sits in Department of Community Health policy and is updated periodically, so confirm yours through Georgia Gateway eligibility screening or the statewide Customer Contact Center at 1-877-423-4746, which takes Medicaid inquiries 8:00 a.m. to 5:00 p.m. Monday through Friday.11

Family Planning (Planning for Healthy Babies)

The Planning for Healthy Babies (P4HB) Section 1115 waiver covers women ages 18 to 44 with family income at or below 211 percent FPL. Its family-planning component does not cover comprehensive medical care, but the Inter-Pregnancy Care component, for a woman within three years of delivering a very-low-birthweight baby, adds primary care (limited to five office or outpatient visits a year) plus management and treatment of chronic diseases.12

Pathways to Coverage (Limited Expansion Adults)

Georgia Pathways to Coverage covers adults age 19 to 64 with income at or below 100 percent FPL ($15,960 for an individual, $21,640 for a couple in 2026).5,7

Pathway 2: ABD (Aged, Blind, Disabled) Income Limits

The ABD pathway applies to adults 65+ or with an SSA-defined disability (blindness or other) who are not seeking long-term care.1

Income Limit

The ABD income limit is $994 per month for a single person and $1,491 for a couple in 2026 (the SSI Federal Benefit Rate after the 2.8 percent COLA). A standard $20 general income disregard applies, so effective countable income for many applicants is $20 below gross. Income above the limit may still qualify under a protected category or the ABD Medically Needy class (both below).1

Asset Limit

The ABD asset limit is $2,000 for a single applicant and $3,000 for a couple. Standard SSI exempt assets apply: the home, one vehicle, household effects, a burial fund, an irrevocable funeral contract, life insurance under the cash-value limit, and retirement accounts in pay status under specific rules.1

1634 State Auto-Enrollment

Georgia is a 1634 state, which means SSI receipt automatically confers Medicaid eligibility. SSI recipients do not need to file a separate Medicaid application.1

Protected Categories Above the ABD Limit

Several federal protections preserve Medicaid for individuals whose income would otherwise disqualify them:

• Pickle Amendment (Section 503 of Pub. L. 94-566): aged, blind, or disabled people who lost SSI because Social Security COLA increases raised their income keep Medicaid if they would still qualify with those COLAs disregarded, under 42 CFR 435.135.13
• Disabled Adult Child (DAC) (42 USC 1383c(c)): a person disabled before age 22 who loses SSI because they become entitled to a Title II child's insurance benefit keeps Medicaid.14
• Section 1619(b) (42 USC 1382h(b)): a working SSI recipient whose earnings stop the SSI cash payment keeps Medicaid, provided they still meet SSI's non-earnings rules, still need Medicaid in order to work, and have gross earned income at or below Georgia's 2026 charted threshold of $41,927. Earning above that figure does not by itself end the protection: SSA can set a higher individualized threshold.15,16
• Medicaid Buy-In for Workers with Disabilities: working adults with disabilities can buy into Medicaid at higher income thresholds with a sliding-scale premium (verify Georgia's program specifics with the Department of Community Health).

ABD Medically Needy (Spend-Down)

Georgia operates an Aged, Blind and Disabled Medically Needy (AMN) class of assistance for individuals whose income or resources exceed the limits for every other ABD pathway. When net countable income (gross income minus the $20 general income disregard) exceeds the ABD Medically Needy Income Level (AMNIL), the excess is a "spenddown" that must be met by subtracting allowable incurred medical expenses before Medicaid is approved under AMN. Georgia's AMNIL is $317 per month for an individual and $375 for a couple, and the AMN resource limit is $2,000 for an individual and $4,000 for a couple. Because the AMNIL sits far below the ABD income limit, most over-limit applicants face a substantial monthly spenddown.17,18,19

Pathway 3: Long-Term Care Income Limits

The long-term-care pathway applies to adults seeking nursing-facility institutional Medicaid or an HCBS waiver (EDWP, which covers the CCSP and SOURCE service models, ICWP, NOW, or COMP). Program of All-Inclusive Care for the Elderly (PACE) is a long-term-care pathway in other states, but Georgia had no confirmed operating PACE site as of mid-2026 (its request for proposals closed in May 2025 and procurement is unfinished), so do not plan around PACE enrollment here yet.6,20

Special Income Limit

The Special Income Limit is $2,982 per month for a single applicant in 2026 (300 percent of the SSI Federal Benefit Rate). Income up to the limit qualifies under standard categorical long-term-care eligibility. When income equals or exceeds the limit, Georgia (an income-cap state) requires a Qualified Income Trust (Miller Trust) under 42 USC 1396p(d)(4)(B) to shelter the excess.1,9,2

Asset Limit (Long-Term Care)

The long-term-care asset limit is $2,000 for a single applicant and $3,000 for a couple applying together, with the same federal SSI exempt-asset categories as ABD.1

Spousal Impoverishment Protection for the Community Spouse

Under 42 USC 1396r-5, when one spouse enters long-term care and the other remains in the community, the community spouse receives federal protections. The Community Spouse Resource Allowance (CSRA) is $32,532 to $162,660 in 2026, and the Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,705.00 (through June 30, 2027) to $4,066.50. An additional excess-shelter allowance can raise the MMMNA when the community spouse's shelter costs are high. The federal spousal impoverishment rules are written for a spouse who is institutionalized; extending the same resource protection to an HCBS waiver applicant is a state option rather than a federal guarantee, so confirm with DFCS how the CSRA is applied to an EDWP, ICWP, or NOW/COMP application before assuming it carries the same protection a nursing-facility case does. See Georgia spousal impoverishment for the operational deep dive.3

60-Month Lookback

Long-term-care applications trigger a 60-month review of asset transfers under 42 USC 1396p(c). Transfers within the lookback that are not exempt are penalized by dividing the uncompensated value by Georgia's penalty divisor, the average Georgia private-pay nursing-facility billing rate DFCS publishes in Appendix A1. That divisor is $11,122.00 per month effective April 2026, and DCH redetermines it annually, generally each April.2 See Georgia long-term care for the operational deep dive.

Personal Needs Allowance for Nursing-Facility Residents

Georgia's Personal Needs Allowance for a nursing-facility resident is $70 per month in 2026. The resident keeps this amount for personal use; the remainder of monthly income (after Medicare premiums, any MSP cost-sharing, and the spousal maintenance allowance for a community spouse) is the patient liability paid to the facility.8

Medicare Savings Program (MSP)

For Medicare beneficiaries with limited income, Georgia administers the federal Medicare Savings Program categories that pay Medicare cost-sharing. Three of them (QMB, SLMB, and QI) carry the limits below; a fourth, QDWI at 200 percent FPL, pays only the Part A premium and does not remove the Part B late-enrollment penalty. The income limits below include the standard $20 general income disregard (per SSA POMS HI 00815.023), and the asset limit for QMB, SLMB, and QI is $9,950 for a single person and $14,910 for a couple in 2026.21

QMB and the State Buy-In cover the 2026 Medicare Part B standard premium of $202.90 per month. Apply through Georgia Gateway or your local DFCS office, using the same application form as standard Medicaid.21,22

Pathways to Coverage (Detailed Mechanics)

Eligibility

• Adults age 19 to 64
• Not eligible for any other Medicaid category
• Income at or below 100 percent FPL
• Georgia resident, not pregnant

CMS temporarily extended the demonstration through December 31, 2026, and a further application is pending with CMS, so treat the program's shape beyond 2026 as unsettled.5

Required Conditions

• 80 hours of qualifying activity per month: employment, education (high school, college, GED), vocational training, on-the-job training, or community service
• Reporting at application and annual renewal. Effective October 1, 2025, Georgia eased the rules so members no longer report hours monthly.
• No premium. The September 2025 amendment removed the demonstration's premium, tobacco-surcharge and modified-copayment authorities, none of which Georgia had implemented. Pathways members owe the same copayments as other Georgia Medicaid members, with none required for members under age 21 or enrolled in HIPP.5

Failure to Comply

• Notice of intent to disenroll
• Cure period to come into compliance
• Disenrollment after the cure period expires
• Reapplication allowed once compliance is restored

Coverage Scope

Comprehensive Medicaid benefits run through the Georgia Families managed-care organizations. As of June 2026, Georgia Families uses three Care Management Organizations: Amerigroup Community Care, CareSource, and Peach State Health Plan (per the Georgia Department of Community Health). The former fourth plan is no longer a separate Georgia Families CMO.23

How to Verify the 2026 Figures

Several authoritative sources maintain current Georgia Medicaid figures:

• Georgia Department of Community Health Medicaid Policy Manuals (Policies and Manuals section)
• GeorgiaCares (SHIP): 1-866-552-4464, for Medicare-Medicaid coordination24

For long-term-care and HCBS waiver applications, start with the Area Agency on Aging (AAA) network, which is EDWP's entry point and determines both functional eligibility and the services needed; applications for the CCSP and SOURCE models run through Georgia's Aging and Disability Resource Connection (ADRC) offices, which are organized by the counties they serve. Empowerline (1-404-463-3333) is the Atlanta Regional Commission's AAA and covers metro Atlanta only, so outside that region contact your own regional AAA or ADRC instead.25,6

Appeals and State Hearings

If DFCS denies your Medicaid application or reduces an existing benefit, you have appeal rights.

Timeline

• 30 days from the date of the denial or reduction notice to request a State Hearing, under Georgia DFCS policy. The 90 days in 42 CFR 431.221(d) is a ceiling on how long a state's request window may run, not a floor you are guaranteed: a state may set a shorter window, and Georgia's 30 days is the deadline that binds you. Go by the date printed on your own notice of action.26
• Aid paid pending covers a reduction or termination of services already authorized, and it turns on filing before the action takes effect, not on a 10-day clock. Request the hearing before the effective date on the notice and the agency may not cut the service until a decision issues. A request filed within 10 days after the action lets the agency reinstate the service but does not require it, and if the agency is upheld it may recoup the cost of services furnished solely by reason of the continuation.27

Process

• Request a State Hearing through the Office of State Administrative Hearings (OSAH), reachable at 1-404-657-2800 or toll-free at 1-877-809-0007, or through the DFCS Customer Contact Center at 1-877-423-474628,11
• Hearing by an OSAH Administrative Law Judge
• Free legal representation: Georgia Legal Services Program (1-833-457-7529), Atlanta Legal Aid (1-404-524-5811), Georgia Senior Legal Hotline (1-888-257-9519)11

Common Eligibility Mistakes

1. Confusing the Special Income Limit with the ABD limit. Long-term care uses the $2,982 Special Income Limit; ABD uses the $994 SSI rate. Different applications, different thresholds.1
2. Forgetting the Miller Trust for long-term care. At or above the Special Income Limit, the Miller Trust is mandatory; without it, the applicant is income ineligible under every LA-D class until one is established.9
3. Counting only the institutionalized spouse's assets. Marital assets are evaluated jointly; the CSRA protects a share (within bounds) for the community spouse.
4. Not exploring the Medicare Savings Program. Many older Georgians qualify for QMB, SLMB, or QI without realizing it.

Who to Call

Learn More

Find personalized help with Georgia Medicaid eligibility 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.