Georgia Medicaid Eligibility & Income Limits 2026

Whether you qualify for Georgia Medicaid in 2026 comes down to which of three pathways you fall into, and each one tests your income and assets by different rules. The pathway determines whether the program applies an income-only test (MAGI), an income-and-asset test pegged to the federal SSI standard (ABD), or a higher income test for long-term-care applicants paired with a $2,000 asset limit and the 60-month lookback. The wrong pathway analysis is the most common source of erroneous "I don't qualify" answers in Georgia, especially because Georgia is not a full Medicaid expansion state and many adults assume they have no pathway at all when in fact the limited Pathways to Coverage Section 1115 demonstration or the LTC pathway may apply.

This guide walks through every operational piece of Georgia's 2026 eligibility framework: the federal authority that drives each pathway, the 2026 figures (SSI Federal Benefit Rate, Special Income Limit, asset limits, CSRA, MMMNA, Excess Shelter Allowance, Personal Needs Allowance), each MAGI category with its FPL threshold, the ABD income and asset rules, the LTC pathway including the Miller Trust requirement above the Special Income Limit, the Medicare Savings Program thresholds, the Pathways to Coverage demonstration with its 80-hour qualifying activity rule, four worked examples, where to verify the figures, and how to challenge an eligibility determination.

Federal and Georgia Authority

Georgia's eligibility rules derive from federal Medicaid statute with state implementation through DCH policy.

Federal Authority

• 42 USC 1396a (state Medicaid plan framework, including required and optional eligibility categories)
• 42 USC 1396a(a)(10)(A)(i) (mandatory categorical eligibility groups)
• 42 USC 1396a(a)(10)(A)(ii) (optional categorical eligibility groups, including the 300 percent SSI LTC pathway)
• 42 USC 1396a(e)(14) (MAGI methodology under the ACA)
• 42 USC 1382 / 1383 (SSI rules incorporated by reference for ABD)
• 42 USC 1396p(c) (LTC transfer penalty)
• 42 USC 1396p(d)(4)(B) (Miller Trust / Qualified Income Trust)
• 42 USC 1396p(f) (home equity exclusion)
• 42 USC 1396r-5 (spousal impoverishment)
• Section 1115 of the Social Security Act (Pathways to Coverage demonstration authority)
• ACA Section 2001 (the expansion option Georgia did NOT adopt)
• Pub. L. 119-21 (2025) (flat $1,000,000 home equity cap effective 1/1/2028)
• 42 CFR 435 (eligibility regulations)

Georgia Authority

• O.C.G.A. Title 49, Chapter 4 (Georgia Public Assistance, including Medicaid)
• DCH Medicaid Policy Manuals (the operational reference used by DFCS workers)
• Georgia State Medicaid Plan (the federally approved plan document)
• Section 1115 Demonstration Waivers: Georgia Pathways to Coverage, Family Planning for Healthy Babies, others
• Georgia 1915(c) HCBS Waivers: CCSP, SOURCE 1915(b), ICWP, NOW, COMP

The 2026 Numbers (Updated for the SSA COLA and FPL Cycle)

These are the figures CDFCS workers use for 2026 Georgia Medicaid eligibility. They derive from federal sources (SSA COLA, HHS Federal Poverty Level) and from O.C.G.A. and DCH policy.

Income Figures

Resource (Asset) Figures

Federal Poverty Level Conversion Table (2026, 48 States + DC)

For MAGI categories that use FPL percentages, here is the 2026 FPL with common percentages:

(Monthly equivalents = annual ÷ 12.)

Pathway 1: MAGI (Modified Adjusted Gross Income)

The MAGI pathway uses ACA-style methodology: income only, no asset test. Households for MAGI follow federal tax-household rules under 42 CFR 435.603. Income is calculated on a monthly basis.

Children

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

• 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 5-18 have annual recertification

Pregnant Women

• Up to 220 percent FPL
• Coverage continues through the postpartum period (currently 12 months postpartum)
• Includes prenatal care, delivery, and postpartum care
• No asset test

Parents and Caretaker Relatives

Georgia's parents/caretakers income threshold is much lower than ACA-expansion states. Specific thresholds are updated periodically in DCH policy; consumers should verify with DCH at 1-877-423-4746 or through Georgia Gateway eligibility screening.

Family Planning (Planning for Healthy Babies Waiver)

• Women of childbearing age up to 211 percent FPL
• Section 1115 demonstration coverage for family planning services only
• Does not cover comprehensive medical care

Pathways to Coverage (Childless Adults)

• Adults age 19-64 not eligible for any other Medicaid category
• Income at or below 100 percent FPL ($15,960 individual / $21,640 couple in 2026)
• 80 hours per month of qualifying activity: employment, education, vocational training, community service, or other approved activity
• Monthly reporting of qualifying activity
• Premium: $0 to $50 per month based on income
• Coverage through Georgia Families CMOs

Pathway 2: ABD (Aged, Blind, Disabled)

The ABD pathway applies to adults 65+ or with SSA-defined disability (blindness or other) who are not seeking LTC.

Income Limit

• $994 single / $1,491 couple (2026 SSI FBR after 2.8 percent COLA)
• Standard $20 SSI income disregard applies; effective income for many ABD applicants is therefore $20 lower than gross
• Income above the limit may still qualify under specific protected categories (see below)

Asset Limit

• $2,000 single / $3,000 couple (federal SSI standard)
• Standard SSI exempt assets apply: home, one vehicle, household effects, burial fund, irrevocable funeral contract, life insurance under cash value limit, retirement accounts in pay-status under specific rules

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.

Protected Categories Above the ABD Limit

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

• Pickle Amendment (P.L. 94-566 § 503): Adults who lost SSI after 4/1/1977 due to Social Security COLA increases retain Medicaid if they would still qualify with COLAs disregarded
• Disabled Adult Child (DAC) (42 USC 1383c(c)): Adult children disabled before age 22 who lose SSI from parent-record Social Security retain Medicaid
• Disabled Widow(er) (DW) (42 USC 1383c(d)): Disabled widow(er)s who lose SSI from widow benefits retain Medicaid
• 1619(b) (42 USC 1382h(b)): Working SSI recipients whose earnings push them above SSI cash retain Medicaid for disability supports
• Medicaid Buy-In for Workers with Disabilities: Working adults with disabilities can buy into Medicaid at higher income thresholds with a sliding-scale premium (Georgia's specific working-disabled program details should be verified with DCH)

For any ABD applicant whose income exceeds the limit, the first step is to check these protected categories before assuming ineligibility.

Georgia Is NOT a Medically-Needy State

Unlike some states (e.g., Pennsylvania, Michigan, New York), Georgia does not operate a medically-needy spend-down pathway under 42 USC 1396a(a)(10)(C) for ABD applicants. There is no monthly spend-down option for ABD applicants whose income exceeds the limit and who do not fall into a protected category. The LTC pathway with Miller Trust is the operational fallback for ABD applicants who need long-term services and supports; for community-medical-only ABD applicants with income above the limit and no protected category, options are limited.

Pathway 3: LTC (Long-Term Care)

The LTC pathway applies to adults seeking:

• Nursing facility (NF) institutional Medicaid
• HCBS waiver enrollment: CCSP, SOURCE, ICWP, NOW, COMP
• PACE enrollment

Special Income Limit (SIL)

• $2,982 single in 2026 (300 percent SSI FBR)
• Income up to the SIL: standard categorical LTC eligibility
• Income above the SIL: Qualified Income Trust (Miller Trust) required under 42 USC 1396p(d)(4)(B)

Asset Limit (Long-Term Care)

• $2,000 single / $3,000 couple-applying-together
• Same federal SSI exempt-asset categories as ABD (home, vehicle, household effects, burial fund, irrevocable funeral contract, life insurance, certain retirement accounts)

Spousal Impoverishment Protection for Community Spouse

Under 42 USC 1396r-5, when one spouse enters LTC and the other remains in the community, the community spouse receives federal protections:

• CSRA (Community Spouse Resource Allowance): $32,532 minimum / $162,660 maximum in 2026
• MMMNA (Minimum Monthly Maintenance Needs Allowance): $2,643.75 minimum / $4,066.50 maximum
• Excess Shelter Allowance: Adds to MMMNA when shelter costs exceed 30 percent of the MMMNA minimum

These protections apply to NF, CCSP, SOURCE, ICWP, NOW, and COMP applications (ACA 2010 made spousal impoverishment mandatory for HCBS waivers effective 1/1/2014). See /medicaid/georgia/spousal-impoverishment for the operational deep dive.

Miller Trust (Qualified Income Trust)

When LTC applicant income exceeds the SIL, a Miller Trust under 42 USC 1396p(d)(4)(B) is required for eligibility. See /medicaid/georgia/miller-trust for the operational deep dive.

60-Month Lookback

LTC applications trigger a 60-month review of asset transfers under 42 USC 1396p(c) and Georgia implementation. Transfers within the lookback that are not exempt are penalized by dividing the transfer value by Georgia's penalty divisor (the state-average private-pay NF rate, set periodically by DCH). See /medicaid/georgia/long-term-care for the operational deep dive (forthcoming).

Personal Needs Allowance for NF Residents

Georgia's PNA for NF residents is $70 per month in 2026 (subject to DCH update). The PNA is retained by the NF resident for personal use; the remainder of monthly income (after Medicare premiums, MSP cost-sharing if applicable, and CSMIA for a community spouse) is the patient liability paid to the NF.

Medicare Savings Program (MSP)

For Medicare beneficiaries with limited income, Georgia administers the three federal MSP categories that pay Medicare cost-sharing.

These figures include the standard $20 general income disregard (SSA POMS HI 00815.023).

Asset limit for QMB/SLMB/QI-1 in Georgia: $9,950 single / $14,910 couple (federal SSI MSP asset limit; periodically adjusted).

Apply through Georgia Gateway or DFCS; same application form as standard Medicaid.

Pathways to Coverage (Detailed Mechanics)

Georgia's Section 1115 alternative to standard Medicaid expansion.

Eligibility

• Adults age 19-64
• Not eligible for any other Medicaid category
• Income at or below 100 percent FPL
• Georgia resident
• Not pregnant
• Not a parent of a child under 6 in the same household (parents fall under a different MAGI pathway)

Required Conditions

• 80 hours of qualifying activity per month
• Qualifying activities: employment, education (high school, college, GED), vocational training, on-the-job training, community service or volunteering, job-readiness or workforce training programs
• Monthly reporting through Georgia Gateway or by phone
• Premium contribution: $0 to $50 per month, based on income tier

Failure to Comply

• 30-day notice of intent to disenroll
• Cure period to come into compliance
• Disenrollment after cure period expires
• Reapplication allowed once compliance restored

Coverage Scope

Comprehensive Medicaid benefits through Georgia Families CMOs. As of 2026, Georgia Families uses three Care Management Organizations: Amerigroup Community Care, CareSource, and Peach State Health Plan (per the Georgia Department of Community Health). WellCare is no longer a separate Georgia Families Medicaid CMO; a 2024 reprocurement proposing a different slate is in the bid-protest phase with no announced go-live date, and the current three-CMO contracts have reportedly been extended through June 30, 2027.

Where Pathways Fits

For adults age 19-64 who are not parents, pregnant, disabled, or 65+, Pathways is the only Medicaid coverage option in Georgia in 2026. Without Pathways, this population has no Medicaid pathway because Georgia did not adopt full expansion.

Worked Examples

Example 1: ABD Single Applicant Within Income Limit

Ms. Hayes, 68, lives alone in Athens, Georgia. Income: $880/month Social Security. Assets: $1,400 in a checking account, $50,000 home, one car.

• Pathway: ABD
• Income test: $880 < $994 income limit (after $20 SSI disregard: effective $860). Passes.
• Asset test: $1,400 in countable assets < $2,000. Passes. (Home and car exempt.)
• Result: Eligible for ABD Medicaid as a community member. Also automatic QMB eligibility (income below 100 percent FPL after disregards).

Example 2: LTC Single Applicant Above the SIL

Mr. Jefferson, 80, enters a nursing facility in Augusta. Income: $3,400/month (Social Security $1,800 + pension $1,600). Assets: $1,800.

• Pathway: LTC
• Income test: $3,400 > $2,982 SIL. Miller Trust required.
• Asset test: $1,800 < $2,000. Passes.
• Mechanism: Establish irrevocable Miller Trust, deposit excess income each month, monthly waterfall (PNA $70 → Medicare premiums → allowable medical → patient liability to NF)
• Result: Eligible for LTC Medicaid with Miller Trust; pays patient liability of approximately $3,300/month to NF after PNA and Medicare premium retentions

Example 3: LTC Married Couple With CSRA Snapshot

Mr. and Mrs. King. Mr. King enters CCSP HCBS waiver; Mrs. King remains in the community. Snapshot countable resources: $90,000 (savings + investment). Mrs. King's own income: $1,100/month Social Security. Mr. King's income: $2,200/month Social Security.

• CSRA calculation: half of $90,000 = $45,000 (above minimum, below maximum)
• Mrs. King retains $45,000 CSRA; Mr. King must reach $2,000
• Spend-down: $43,000 ($90,000 minus $45,000 minus $2,000)
• MMMNA calculation: $2,643.75 minimum (no Excess Shelter Allowance because Mrs. King's shelter costs are modest); Mrs. King's income $1,100 is below MMMNA
• CSMIA = $2,643.75 minus $1,100 = $1,543.75 from Mr. King's income to Mrs. King each month
• Mr. King's patient liability after PNA, Medicare premiums, and CSMIA contribution

Example 4: Pathways to Coverage Adult

Mr. Lopez, 32, lives in Atlanta. No children, not pregnant, not disabled, not 65+. Works part-time at a coffee shop earning $1,200/month (about 90 percent of FPL).

• Standard Medicaid: Not eligible (no expansion category)
• Pathway: Pathways to Coverage
• Income test: $1,200 < $1,330 (100 percent FPL). Passes.
• Activity test: Documents 80 hours/month coffee-shop work. Passes.
• Premium: ~$20/month based on income tier (verify with DCH)
• Reporting: Monthly through Georgia Gateway
• Result: Eligible for Pathways coverage through a Georgia Families CMO

How to Verify the 2026 Figures

Several authoritative sources maintain current Georgia Medicaid figures:

• Department of Community Health Medicaid Policy Manuals: dch.georgia.gov (Policies and Manuals section)
• Georgia Gateway: gateway.ga.gov (eligibility pre-screening tool)
• DCH Customer Contact: 1-877-423-4746
• CMS State Medicaid Profiles: medicaid.gov (federal-level summary)
• KFF Medicaid State Data: kff.org (independent reference)
• GeorgiaCares (SHIP): 1-866-552-4464 (Medicare-Medicaid coordination)

For LTC and HCBS waiver application, work with your local Area Agency on Aging (Empowerline: 1-404-463-3333) who administers CCSP/SOURCE intake and can verify financial eligibility coordinated with DFCS.

For broader Medicaid context, see brevy.com.

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
• Aid pending if appeal is filed within 10 days and the service was previously authorized

Process

• Request a State Hearing through the Office of State Administrative Hearings (OSAH) or through DCH at 1-877-423-4746
• 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)

Federal Appeal

If the OSAH decision is adverse, federal review through CMS under 42 CFR 431.220 is available but rare; usually pursued by advocacy attorneys.

Common Eligibility Mistakes

1. Assuming Georgia has expansion. It does not. Many adults 19-64 incorrectly believe they have a standard Medicaid pathway based on income.
2. Missing Pathways to Coverage. Childless adults at or below 100 percent FPL with qualifying activity may qualify for Pathways.
3. Missing Pickle, DAC, DW, 1619(b) protections. ABD applicants whose income exceeds the limit may still qualify under protected categories.
4. Confusing the SIL with the ABD limit. The LTC pathway uses the $2,982 SIL; the ABD pathway uses the $994 FBR. Different applications, different thresholds.
5. Forgetting Miller Trust for LTC. Above the SIL, the Miller Trust is mandatory; without it, LTC Medicaid is denied.
6. Not coordinating with spousal impoverishment. Married LTC applicants must use the CSRA snapshot and MMMNA/CSMIA mechanics.
7. Counting only the institutionalized spouse's assets. Marital assets are evaluated jointly; the CSRA protects half (within bounds) for the community spouse.
8. Treating PeachCare and Medicaid as the same program. PeachCare is CHIP for children whose family income is above the Right from the Start Medicaid ceiling for their age (up to 247 percent FPL); Medicaid is for lower-income children. Eligibility verification distinguishes them.
9. Filing too early or too late on LTC applications. Application timing affects retroactive coverage and penalty start dates. Coordinate with attorney advice.
10. Not exploring Medicare Savings Program. Many older Georgians qualify for QMB, SLMB, or QI-1 without realizing it; MSP can save $185.00 to $200+ per month in Medicare Part B premiums.

Learn More

• Georgia Medicaid Alternative Benefit Plans: how Section 1937 ABPs structure covered benefits and the ten Essential Health Benefits
• Georgia Medicaid Programs Overview
• How to Apply for Georgia Medicaid
• Georgia Medicaid Covered Services
• Georgia Medicaid Asset Spend-Down Strategies
• Georgia Medicaid Estate Recovery
• Georgia Medicare Savings Programs
• Georgia Medicaid Eligibility Quality Control (PERM & MEQC)

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.