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 decides whether you face 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 paired with a $2,000 asset limit and a 60-month lookback.1

Picking the wrong one is the most common source of erroneous "I don't qualify" answers. Because Georgia is not a full Medicaid expansion state, many adults assume they have no pathway at all, when Pathways to Coverage or long-term care may still 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 the 300 percent SSI long-term-care pathway an optional group under 1396a(a)(10)(A) 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 Pathways to Coverage.2

Georgia Authority

Georgia implements these rules through O.C.G.A. Title 49, Chapter 4, the Department of Community Health Medicaid Policy Manuals that Division of Family and Children Services (DFCS) workers use, and the approved State Medicaid Plan. Its Section 1115 demonstrations include Pathways to Coverage and Planning for Healthy Babies. Its 1915(c) HCBS waivers include the Elderly and Disabled Waiver Program (EDWP), delivered through the CCSP and SOURCE service models, the Independent Care Waiver Program (ICWP), and the New Options and Comprehensive Supports Waivers (NOW and COMP). That is the core list, not a census: no state source enumerates every 1915(c) waiver Georgia runs, and DCH's page also carries the Georgia Pediatric Program (GAPP).6

The 2026 Georgia Medicaid Income Limits and Asset Figures

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

Income Figures

HHS publishes the poverty guidelines as annual figures only, so every monthly FPL equivalent here is the annual figure divided by 12, not a published number. The guidelines fix the dollar amounts, not what is measured against them: HHS says the notice "does not provide definitions of such terms as 'income' or 'family'" and sends those questions to the program itself. Do not hold a gross paycheck against these figures; Medicaid counts income under its own MAGI or non-MAGI rules.7

Resource (Asset) Figures

The 2026 federal home equity limit is not one number: it starts at a $752,000 minimum and a state may elect up to $1,130,000, so ask DFCS which standard Georgia applies. Under Public Law 119-21 it becomes a flat $1,000,000 cap for non-agricultural homes on January 1, 2028; an agriculturally zoned lot stays under the indexed rules. Neither cap is a verdict on the house: the equity test does not apply while the applicant's spouse, or a child under 21 or a blind or disabled child, lawfully lives there, and an applicant over the limit may use a reverse mortgage or home equity loan to bring equity below it.1,3,2

Federal Poverty Level Conversion Table

The 2026 Federal Poverty Level for the 48 contiguous states and DC, at the percentages Georgia's MAGI categories use.7

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

The MAGI pathway uses Affordable Care Act methodology: income only, no asset test, monthly, on federal tax-household rules under 42 CFR 435.603.

Children

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

• Medicaid (RSM): to 220 percent FPL under age 1, 149 percent for ages 1 to 5, 205 percent for ages 6 to 18
• PeachCare for Kids (CHIP): uninsured children through 18 above the RSM ceiling for their age, to 247 percent FPL
• Continuous Eligibility: children under 5 keep continuous eligibility under the Consolidated Appropriations Act, 2023; ages 5 to 18 recertify annually

Pregnant Women

Georgia covers pregnant women to 220 percent FPL through the RSM Pregnant Women pathway, with no asset test. That percentage is not measured against a one-person household: DFCS budgets a pregnant woman "at minimum as two individuals (the pregnant woman and the unborn child)" and adds one per additional fetus, so a single pregnant woman is compared to the two-person limit and a woman expecting twins to the three-person limit. Coverage includes prenatal care, delivery, and a full 12 months of postpartum coverage, in place since November 1, 2022. There is a gate on the front of those 12 months: a woman not receiving Medicaid, or not eligible as a pregnant woman, before or during the month the pregnancy ended does not get them, even if she would meet the requirements during them.10

Parents and Caretaker Relatives

Georgia's parents-and-caretakers threshold is far lower than in expansion states and is updated periodically. Confirm yours through Georgia Gateway screening or the Customer Contact Center at 1-877-423-4746, 8:00 a.m. to 5:00 p.m. weekdays.11

Family Planning (Planning for Healthy Babies)

The Planning for Healthy Babies (P4HB) Section 1115 waiver covers women 18 to 44 at or below 211 percent FPL. The family-planning component is not comprehensive care; the Inter-Pregnancy Care component, for a woman within three years of delivering a very-low-birthweight baby, adds primary care (five visits a year) and chronic-disease management.12

Pathways to Coverage (Limited Expansion Adults)

Pathways to Coverage covers adults 19 to 64 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 covers adults 65+ or with an SSA-defined disability 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). Those are net figures, not gross: Georgia charts them under "ABD MEDICAID NET INCOME LIMITS (GROSS - $20)," so the $20 general income disregard comes off first and a single applicant with $1,014 in gross income still tests at $994. 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 single and $3,000 for a couple, and only countable resources count. DFCS excludes a non-institutionalized applicant's homeplace entirely, regardless of value, plus one household automobile, so a Georgia homeowner is not over the limit because of the house. Federal SSI rules also exclude up to $1,500 per person in segregated burial funds and the cash value of life insurance with face value at or under $1,500.1,13

1634 State Auto-Enrollment

Georgia is a 1634 state: an SSI application is automatically also a Medicaid application, so an SSI award enrolls you with no separate Medicaid filing.14

Protected Categories Above the ABD Limit

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

• Pickle Amendment (Section 503 of Pub. L. 94-566): someone who lost SSI because Social Security COLAs raised their income keeps Medicaid if they would still qualify with those COLAs disregarded, under 42 CFR 435.135.15
• 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.16
• Section 1619(b) (42 USC 1382h(b)): a working SSI recipient whose earnings stop the cash payment keeps Medicaid if they still meet SSI's non-earnings rules, still need Medicaid to work, and have earned income at or below Georgia's 2026 charted threshold of $41,927; only earnings count, not unearned income. Earning above that figure does not by itself end the protection: SSA can build a higher individualized threshold from your own Medicaid expenditures, impairment-related and blind work expenses, PASS-excluded income, and publicly funded attendant care, but someone over it with none of those expenses is ineligible.17,18

ABD Medically Needy (Spend-Down)

Georgia's Aged, Blind and Disabled Medically Needy (AMN) class serves people whose income or resources exceed every other ABD limit. Net countable income (gross minus the $20 disregard) above the ABD Medically Needy Income Level (AMNIL) becomes a "spenddown" met with incurred medical expenses before approval. The AMNIL is $317 a month for an individual and $375 for a couple; the AMN resource limit is $2,000 and $4,000. Because the AMNIL sits far below the ABD income limit, most over-limit applicants face a substantial spenddown; someone already at or below it is "de facto" eligible with none. A spenddown cures excess income only: resources must still be at or below the AMN limit in both cases, so medical bills cannot spend down a bank balance. AMN is a last resort by design: every other ABD class except Q track and SSI must be ruled out first.19,13,20

Pathway 3: Long-Term Care Income Limits

The long-term-care pathway covers adults seeking institutional Medicaid or an HCBS waiver (EDWP, covering the CCSP and SOURCE models, plus ICWP, NOW, and COMP). Program of All-Inclusive Care for the Elderly (PACE) is further along than it was: Georgia's solicitation (Procurement Registry event 41900-DCH0000139, closed June 4, 2025) carries Notices of Intent to Award for Athens, Savannah and Gainesville, and Notices of Award for Gainesville and Savannah. No state source says whether any center has opened to participants, so ask DCH before planning around PACE.6,21

Special Income Limit

The Special Income Limit is $2,982 a month for a single applicant in 2026, 300 percent of the SSI Federal Benefit Rate. Below it, standard categorical long-term-care rules apply. At or above it, 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 single and $3,000 for a couple applying together, but the home is not exempt here as it is in the community: DFCS treats an institutionalized applicant's homeplace as a countable resource, exempt only in certain instances and subject to the home equity limit. And where one spouse stays home, Georgia's Appendix A1 sets the LA-D standard at "$162,660 + 2000 = $164,660," not $2,000.1,13

Spousal Impoverishment Protection for the Community Spouse

Under 42 USC 1396r-5, when one spouse enters long-term care the other keeps federal protections: a Community Spouse Resource Allowance (CSRA) of $32,532 to $162,660 in 2026, and a Minimum Monthly Maintenance Needs Allowance of $2,705.00 (through June 30, 2027) to $4,066.50, which an excess-shelter allowance can raise. Those rules are written for an institutionalized spouse; extending the resource protection to a waiver applicant is a state option, not a federal guarantee, so ask DFCS how the CSRA applies to your case. See Georgia spousal impoverishment.3

60-Month Lookback

Long-term-care applications trigger a 60-month review of asset transfers under 42 USC 1396p(c). A non-exempt transfer inside it is penalized by dividing the uncompensated value by Georgia's penalty divisor, the private-pay nursing-facility rate in Appendix A1: $11,122.00 a month, stamped 4-26 in the edition effective July 2026 (MT 80). That chart is edition-dated rather than annual, and Georgia leaves older editions live at their own URLs, so read the divisor off the newest one.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 a month in 2026. The rest of the resident's monthly income, after Medicare premiums, MSP cost-sharing, and any spousal maintenance allowance, is the patient liability paid to the facility. The $70 need not be all of it: 42 CFR 435.725 also lets a state deduct medical care Medicaid does not cover and, for up to six months, a home-maintenance allowance where a physician certifies the resident is likely to return home. Ask DFCS whether Georgia elects it.8

Medicare Savings Program (MSP)

Georgia administers the federal Medicare Savings Program categories, which pay Medicare cost-sharing for people with limited income. Three (QMB, SLMB, QI) carry the limits below; a fourth, QDWI, pays the Part A premium for working people with disabilities who lost premium-free Part A, on far higher limits: income $5,405 single, $7,299 a couple; resources $4,000 and $6,000. The limits below include the $20 general income disregard (SSA POMS HI 00815.023), and the QMB/SLMB/QI asset limit is $9,950 single / $14,910 couple, with a $1,500-per-person burial exclusion counted on top of it, not inside it. Those three sets of figures are federal floors, not cutoffs: a state may disregard income or resources to run higher limits, so apply rather than rule yourself out on a close figure. That authority does not extend to QDWI.22

QMB, SLMB, and QI also qualify you automatically for Part D Extra Help, the Low-Income Subsidy that cuts drug costs, with no second application. QDWI does not.22

QMB covers the 2026 Medicare Part B standard premium of $202.90 a month. Apply through Georgia Gateway or your DFCS office on the standard Medicaid form. DFCS is not the only door: an Extra Help application filed with SSA (form SSA-1020) also starts the MSP process unless you object.22,23

Pathways to Coverage (Detailed Mechanics)

Pathways covers Georgia residents 19 to 64 who are not pregnant, not eligible for any other Medicaid category, and at or below 100 percent FPL. CMS extended the demonstration through December 31, 2026 and a further application is pending, so treat its shape beyond 2026 as unsettled.5

Required Conditions

• 80 hours of qualifying activity a month: work, education (high school, college, GED), vocational or on-the-job training, or community service
• Reporting at application and annual renewal. Since October 1, 2025, members no longer report hours monthly.
• No premium. The September 2025 amendment removed the premium, tobacco-surcharge and modified-copayment authorities, none of which Georgia had implemented. Pathways members owe the same copayments as everyone else, in amounts that vary by service, and none under 21 or enrolled in HIPP. DCH says that if you cannot pay a copayment you may still receive services.5

Fall out of compliance and Georgia sends a notice of intent to disenroll and opens a cure period; you may reapply once compliant.

Coverage Scope

Benefits run through the Georgia Families managed-care organizations. As of September 2026 there are three: Amerigroup Community Care, CareSource, and Peach State Health Plan. DCH names no fourth.24

How to Verify the 2026 Figures

Two sources maintain the current figures: the Georgia Department of Community Health Medicaid Policy Manuals, and GeorgiaCares (SHIP) at 1-866-552-4464.25

For long-term-care and HCBS waiver applications, start with the Area Agency on Aging (AAA) network: it is EDWP's entry point and determines both consumer eligibility and the type of services needed. CCSP and SOURCE applications run through the county Aging and Disability Resource Connection (ADRC) offices. Empowerline (1-404-463-3333) is metro Atlanta's AAA only, so elsewhere call your own regional AAA or ADRC.26,6

Appeals and State Hearings

If DFCS denies your application or reduces a benefit, you have appeal rights.

Timeline

• 30 days from the date of the notice to request a State Hearing, under Georgia DFCS policy, and an oral request must be followed by a written one within 15 days. The 90 days in 42 CFR 431.221(d) is a ceiling on how long a state's window may run, not a floor you are guaranteed. Missing it is not automatically the end: DFCS forwards every request to OSAH regardless of when it arrived, and a judge decides whether good cause excuses a late one, so file anyway and ask.27
• Aid paid pending covers a cut to 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 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.28

Process

• Request the hearing through the Office of State Administrative Hearings (OSAH) at 1-404-657-2800 or 1-877-809-0007, or the DFCS Customer Contact Center at 1-877-423-474629,11
• An OSAH Administrative Law Judge hears it
• Free 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 $2,982; ABD uses $994.1
2. Forgetting the Miller Trust. At or above $2,982 it is mandatory, and without one the applicant is income ineligible under every LA-D class.9
3. Skipping 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.