The Independent Care Waiver Program (ICWP) is Georgia Medicaid's home-based alternative to a nursing facility for working-age adults with severe physical disabilities or a traumatic brain injury. It fills a specific gap: CCSP and SOURCE serve older adults and adults with chronic disability who meet nursing facility level of care, while NOW and COMP serve individuals with intellectual or developmental disabilities. ICWP is the operational answer for someone in their 30s, 40s, or 50s with a spinal cord injury, late-stage multiple sclerosis, advanced muscular dystrophy, ALS, or a moderate-to-severe traumatic brain injury that requires complex personal care.

ICWP is administered directly by the Department of Community Health (DCH) under Section 1915(c) of the Social Security Act at 42 USC 1396n(c), with intake through the DCH ICWP unit at 1-866-211-0950 rather than through Empowerline. Statewide slot capacity is limited, so understanding the eligibility framework, the application process, the waitlist mechanics, and the appeal options matters more for ICWP than for the larger waivers. This guide explains who qualifies, what services are covered, how to apply, how the waitlist works, how cost share is calculated, and how ICWP fits alongside the other Georgia HCBS waivers.

Federal and Georgia Authority

ICWP exists under the federal HCBS waiver authority with Georgia-specific operational rules.

Federal Authority

  • 42 USC 1396n(c) (Section 1915(c) HCBS waivers; the primary ICWP statutory authority)
  • 42 CFR Part 441 Subpart G (HCBS waiver regulations, including cost neutrality, person-centered planning, and quality assurance)
  • 42 USC 1396a(a)(10)(A)(ii)(VI) (300 percent SSI Special Income Limit for LTC)
  • 42 USC 1396p(d)(4)(B) (Miller Trust)
  • 42 USC 1396r-5 (spousal impoverishment)
  • Americans with Disabilities Act, Title II (Olmstead community integration mandate, which underpins HCBS waiver expansion)

Georgia Authority

  • O.C.G.A. Title 49 Chapter 4 (Public Assistance, including Medicaid administration)
  • ICWP Section 1915(c) Waiver Application (approved by CMS; renewed in five-year cycles)
  • DCH ICWP Provider Manual (operational procedures)
  • Georgia ICWP Operations Office at DCH (intake, eligibility determination, slot management)

Eligibility

ICWP eligibility has four parts: age, functional, financial, and residency.

Age Eligibility

  • Initial enrollment: 21 to 64 years old. Applicants must be in this age range when they apply for ICWP.
  • Continuous enrollment after 65. Participants enrolled before age 65 can continue in ICWP after they turn 65 (continuous-enrollment protection). They do not need to switch to CCSP or SOURCE simply because they reach 65, although they may choose to switch if a different waiver better suits their needs.
  • New enrollments after 65. Adults 65 and older who have severe physical disability or TBI and need HCBS should be evaluated for CCSP or SOURCE, not ICWP. The Empowerline intake at 1-404-463-3333 is the appropriate path for older adults.

Functional Eligibility

ICWP requires severe physical disability or traumatic brain injury such that, without HCBS services, the applicant would require hospital or nursing facility level of care.

Common qualifying conditions:

  • Spinal cord injury (especially cervical C1-C7 and high thoracic T1-T6, which often produce tetraplegia or high paraplegia)
  • Traumatic brain injury (moderate to severe, with persistent functional impairment)
  • Amyotrophic lateral sclerosis (ALS)
  • Late-stage multiple sclerosis
  • Advanced muscular dystrophy
  • Cerebral palsy with severe motor impairment (adult onset typically continued from childhood)
  • Post-stroke severe physical impairment (in working-age adults)
  • Anoxic brain injury
  • Severe Parkinson's disease in working-age adults (less common given typical age of onset)

DCH conducts a medical and functional review using the standardized ICWP assessment instrument. The reviewer evaluates:

  • ADLs: bathing, dressing, toileting, transferring, eating, mobility
  • IADLs: meal preparation, housekeeping, medication management, transportation, shopping
  • Medical complexity: respiratory support, feeding, wound care, medication regimen
  • Cognitive status (for TBI applicants particularly)
  • Behavioral status (for TBI applicants particularly)

Financial Eligibility

ICWP uses the LTC pathway:

  • Income: Gross monthly income at or below $2,982 (2026 SIL) directly, or routed through a Miller Trust if above
  • Assets: $2,000 for a single applicant; $3,000 for a married applicant with both applying; full spousal impoverishment for a married applicant with a community spouse (CSRA $32,532 to $162,660 in 2026)
  • Lookback: 60-month transfer-penalty lookback under 42 USC 1396p(c)
  • Home equity: $752,000 in 2026 (flat $1,000,000 from 1/1/2028); not counted while community spouse or dependent lives in home

Residency

Georgia residency required. U.S. citizenship or qualified non-citizen status.

What ICWP Covers

ICWP services support independent community living for adults with severe physical disabilities or TBI.

Personal Support Services (PSS)

Hands-on personal care delivered in the home: bathing, dressing, toileting, transferring, eating assistance, light housekeeping, meal preparation, medication reminders. Provided by a personal support aide from an approved ICWP provider agency. Hours per day vary by care plan; ICWP allows higher PSS hours than CCSP for participants with very high physical care needs.

Skilled Nursing

Periodic skilled nursing services in the home for medication administration, complex wound care, tracheostomy care, ventilator management, feeding tube management, catheter care, and other skilled nursing tasks. Provided by an RN or LPN.

Adult Day Health

Center-based program providing daytime supervision, social activities, meals, personal care, nursing oversight, and rehabilitation. Particularly valuable for ICWP participants whose caregivers work or need respite during the day.

Respite Care

Short-term in-home or out-of-home respite to give the family caregiver a break. Out-of-home respite is typically in a nursing facility or approved respite setting.

Counseling

Mental health and adjustment counseling for participants and their family caregivers. Particularly important for TBI and SCI participants and families adjusting to permanent disability.

Specialized Medical Equipment and Supplies

Power wheelchairs, ventilators, BiPAP/CPAP, communication devices, adaptive computer equipment, transfer equipment, hospital beds, pressure-relief mattresses, incontinence supplies beyond what regular Medicaid covers.

Environmental Accessibility Adaptations

Home modifications to support independent living: ramps, widened doorways, roll-in showers, lifts, accessible kitchens, accessible bathrooms. ICWP can fund modifications up to specific cost caps; expensive modifications may require multi-year planning or co-funding.

Vehicle Adaptations

Modifications to the participant's vehicle (lifts, hand controls, accessibility modifications) to support transportation independence. Vehicle adaptations have separate cost caps and approval criteria.

Emergency Response System

Wearable or in-home button connecting to a 24-hour monitoring center for emergency assistance.

How to Apply

Step 1: Call DCH ICWP

DCH Member Services: 1-866-211-0950

Ask for the ICWP eligibility screening. The DCH intake specialist asks initial screening questions to verify age, condition, and basic functional status.

Note: ICWP intake is NOT through Empowerline. Empowerline serves CCSP, SOURCE, and PACE (which are aging-services oriented). ICWP is direct to DCH.

Step 2: Medical and Functional Review

DCH ICWP unit reviews:

  • Medical records documenting the qualifying condition
  • Recent physician evaluations
  • Functional assessment
  • Hospital discharge summary (if recently institutionalized)
  • Specialty consultations (neurology, physical medicine and rehabilitation, neurosurgery)

The review may require additional medical evaluations if records are incomplete.

Step 3: Medicaid Application

If not already a Medicaid recipient, apply for LTC Medicaid through DFCS using Form 700 plus the LTC supplement Form 700-A. Apply online at gateway.ga.gov, by phone at 1-877-423-4746, or in person at the local DFCS office. See our Georgia Medicaid Application guide.

Step 4: ICWP Provider Selection

Once approved, the participant selects an ICWP provider agency from approved providers in their geographic area. The agency conducts an in-home assessment and develops the care plan.

Step 5: Care Plan Development and Approval

The agency-developed care plan is submitted to DCH for review and approval. Once approved, services begin. The agency provides ongoing care coordination, monthly contact, and quarterly home visits.

Slot Capacity and Waitlist

ICWP has a limited number of statewide slots under the Section 1915(c) waiver agreement with CMS.

Why ICWP Slots Are Limited

  • Cost-neutrality requirement: ICWP cost per participant cannot exceed equivalent NF or hospital cost
  • Federal slot cap negotiated in the waiver agreement
  • Georgia budget appropriation determines state-funded slot expansions

How the Waitlist Works

  • Applicants are placed on the waitlist after DCH eligibility approval
  • Order is determined by date of application plus category of need
  • Categories of need:
    • Crisis priority: imminent hospital or NF placement, caregiver collapse, recent traumatic injury with no safe discharge plan
    • High priority: significant unmet care needs
    • Standard priority: ongoing care needs that are not immediately critical

How to Get Crisis Priority

Document the urgency:

  • Recent traumatic injury (SCI, TBI) with imminent discharge
  • Caregiver hospitalization or death
  • Risk-of-self-harm assessment
  • APS involvement
  • Physician letter documenting NF placement risk

Submit to DCH ICWP unit with a written crisis-priority request.

Cost Share

ICWP cost share is calculated by DCH based on:

  • Gross monthly income
  • Care plan cost
  • Maintenance allowance for community living expenses
  • Health insurance premiums
  • Family allowance (if applicable)

Most ICWP participants pay $0 to $50 per month, similar to CCSP and SOURCE. The maintenance allowance for community living is intended to leave the participant with enough income for rent or mortgage, utilities, food, and personal expenses.

How ICWP Differs From Other Georgia HCBS Waivers

Feature ICWP CCSP SOURCE NOW/COMP
Age range 21 to 64 initial; continuous after 65 Typically 65+; adults with physical disability eligible Typically 65+; adults with physical disability eligible Diagnosed before age 22
Eligibility category Severe physical disability or TBI NF LOC, any cause NF LOC, any cause ICF/IID LOC
Level of care Hospital or NF NF NF ICF/IID
Intake DCH 1-866-211-0950 Empowerline 1-404-463-3333 Empowerline 1-404-463-3333 DBHDD 1-855-579-7505
Slot capacity Smaller Largest Medium Substantial waitlist
Primary care model Standard Standard PCP Integrated SOURCE PCP Standard
Structured Family Caregiving Not standard (limited under ICWP) Available Available Different family support models
Typical services intensity Higher (often 24-hour care plans for ventilator-dependent or tetraplegic participants) Mixed Mixed High intensity (24-hour residential supports for COMP)

Worked Examples

Example 1: Mr. Bennett, 38, Spinal Cord Injury

Facts: Mr. Bennett, 38, sustained a C5-C6 spinal cord injury in a motor vehicle accident two years ago. He has tetraplegia with limited arm function. He lives in DeKalb County with his wife and two young children. He has Medicare (qualified after 24 months on SSDI) and is also eligible for Medicaid. Income: SSDI $2,200/month. Assets: $1,900. He uses a power wheelchair, has a urinary catheter, and needs assistance with all ADLs.

Eligibility:

  • Age: 38, eligible
  • Functional: C5-C6 tetraplegia, hospital or NF level of care without HCBS
  • Financial: $2,200 below SIL; $1,900 below asset limit (joint accounts with wife addressed through spousal impoverishment)
  • Standard or high priority on waitlist depending on current care situation

Care plan:

  • PSS 12 hours/day for personal care, transfers, bowel/bladder program
  • Skilled nursing twice weekly for catheter management and pressure-sore monitoring
  • Specialized medical equipment: power wheelchair, hospital bed, pressure-relief mattress, transfer equipment
  • Environmental modifications: roll-in shower retrofit, ramp to front door
  • Vehicle adaptation: lift for wife's van
  • Counseling for Mr. Bennett and family

Cost share: $0 to $30/month depending on care plan total

Example 2: Ms. Diaz, 52, Late-Stage MS

Facts: Ms. Diaz, 52, was diagnosed with multiple sclerosis at age 35. The disease has progressed; she now has minimal lower-extremity function, moderate upper-extremity weakness, and intermittent cognitive symptoms. She lives in Cobb County with her adult son. Income: $1,800/month (disability retirement). Assets: $1,200. She uses a power wheelchair.

Eligibility:

  • Age: 52, eligible
  • Functional: late-stage MS, NF level of care without HCBS
  • Financial: below SIL and asset limits
  • Standard priority

Care plan:

  • PSS 6 hours/day for personal care and meal preparation
  • Adult day health 3 days/week (cognitive stimulation, socialization)
  • Skilled nursing weekly for medication management
  • Specialized medical equipment: power wheelchair, hospital bed
  • Counseling for adjustment to progressive disease

Cost share: $0

Example 3: Mr. Edwards, 45, TBI Three Years Post-Injury

Facts: Mr. Edwards, 45, suffered a severe traumatic brain injury in a work-related fall three years ago. He has persistent cognitive impairment, behavioral disinhibition, and moderate physical impairment (left-sided hemiparesis). He lives in Fulton County with his wife. Income: workers' compensation settlement $2,400/month. Assets: $1,500. His wife works full-time.

Eligibility:

  • Age: 45, eligible
  • Functional: moderate-to-severe TBI with cognitive, behavioral, and physical impairments, NF level of care without HCBS
  • Financial: below SIL and asset limits
  • Standard priority

Care plan:

  • PSS 8 hours/day during wife's work hours (supervision, personal care, meal preparation, medication reminders)
  • Adult day health 2 days/week (cognitive rehabilitation, behavioral support)
  • Skilled nursing weekly for medication management
  • Counseling for Mr. Edwards (cognitive behavioral) and wife (caregiver support)
  • Environmental modifications: stair lift, bathroom grab bars

Cost share: $0 to $25/month

How to Verify the Numbers

  • ICWP Provider Manual and waiver application: dch.georgia.gov
  • Special Income Limit and asset limits: DCH Medicaid Policy Manuals
  • ICWP slot capacity and waitlist: DCH ICWP unit at 1-866-211-0950
  • Provider directory: request from DCH ICWP unit

For free legal help with an ICWP eligibility case or appeal, contact Georgia Legal Services Program at 1-833-457-7529, Atlanta Legal Aid at 1-404-524-5811, or the Brain Injury Association of Georgia at 1-404-844-6711. For more on how ICWP fits in the GA LTC framework see brevy.com's guides at /medicaid/georgia/long-term-care and /medicaid/georgia/eligibility-income-limits.

FAQ

ICWP serves working-age adults (21 to 64 at initial enrollment) with severe physical disabilities or traumatic brain injury. CCSP primarily serves older adults (typically 65+) and adults with physical disability who meet nursing facility level of care. ICWP has a smaller slot capacity, is intaken directly through DCH (not Empowerline), and often has higher-intensity care plans (24-hour care for ventilator-dependent or tetraplegic participants). CCSP is broader and serves a wider variety of needs.

New enrollments after age 65 are generally directed to CCSP or SOURCE instead of ICWP, because those waivers are designed for older adults. However, if you enrolled in ICWP before age 65, you can continue in ICWP after 65 (continuous-enrollment protection). Contact DCH at 1-866-211-0950 to discuss your specific situation.

ICWP can authorize high PSS hours for participants whose physical care needs are extensive (for example, ventilator-dependent participants or those with tetraplegia requiring frequent repositioning). Whether 24-hour care is authorized depends on the individual care plan and cost-neutrality requirements. In some cases, the care plan combines PSS, skilled nursing, ADH, and family caregiver involvement to achieve effective 24-hour support without ICWP funding every hour.

ICWP does not have a Structured Family Caregiving service in the same way CCSP and SOURCE do. However, family members can be employed as PSS workers through an approved ICWP provider agency, subject to the agency's hiring policies and DCH approval. Some provider agencies actively hire family members as paid PSS workers; others do not. Ask the provider agency about their family-employment policies.

ICWP can serve participants with degenerative conditions. The care plan is reviewed and adjusted annually (or more often with changes in condition) to reflect the participant's evolving needs. For participants with rapidly progressive conditions like ALS, the care plan may add services frequently as new care needs develop.

Crisis priority is the fastest path. Document the urgency of your situation: recent traumatic injury, hospital discharge with no safe plan, caregiver collapse, abuse or neglect. Submit a written crisis-priority request to the DCH ICWP unit at 1-866-211-0950 with supporting medical and social documentation. A physician letter documenting imminent NF or hospital placement risk significantly strengthens the request.

Yes. Many ICWP participants are dually eligible for Medicare and Medicaid. Medicare covers acute medical care, hospitalization, short-term post-acute rehab, and a portion of skilled home health. ICWP pays for the long-term HCBS services that Medicare does not cover (PSS, ADH, respite, specialized equipment beyond Medicare DME, environmental modifications). Coordinate with your providers to ensure correct billing.

You can still qualify for ICWP by establishing a Miller Trust (Qualified Income Trust under 42 USC 1396p(d)(4)(B)). The trust is irrevocable, names the State of Georgia as primary residual beneficiary, and channels your income through a dedicated bank account each month. See our Miller Trust guide.

If your needs change or you reach an age where CCSP or SOURCE is a better fit, switching is possible. Coordinate with DCH (for ICWP exit) and Empowerline (for CCSP or SOURCE entry). There may be waitlist implications when switching to CCSP. SOURCE often has shorter waits and may be easier to switch to.

You have 30 days from the denial notice to request a State Hearing through the Office of State Administrative Hearings (OSAH) at 1-404-651-7500. If you file within 10 days, you can request aid pending (continued services during the appeal) if the denial was a termination or reduction of existing services. Free legal help is available through Georgia Legal Services Program at 1-833-457-7529, Atlanta Legal Aid at 1-404-524-5811, and the Brain Injury Association of Georgia at 1-404-844-6711.

Key Phone Numbers and Resources

Georgia Medicaid (DCH, ICWP Intake)

  • DCH Member Services: 1-866-211-0950
  • DFCS Application Hotline: 1-877-423-4746

Office of State Administrative Hearings (OSAH)

  • 1-404-651-7500

Brain Injury Association of Georgia

  • 1-404-844-6711

Spinal Cord Injury Resources (Shepherd Center, Atlanta)

  • 1-404-352-2020

Empowerline (For Comparison Programs: CCSP, SOURCE)

  • 1-404-463-3333

Department of Behavioral Health and Developmental Disabilities (For Comparison Programs: NOW, COMP)

  • 1-855-579-7505

Long-Term Care Ombudsman

  • 1-866-552-4464 (Empowerline)

Adult Protective Services

  • 1-866-552-4464

Free Legal Help

  • Georgia Legal Services Program: 1-833-457-7529
  • Atlanta Legal Aid: 1-404-524-5811
  • Georgia Senior Legal Hotline: 1-888-257-9519

Elder Law and Disability Attorney Referrals

  • State Bar of Georgia Lawyer Referral: 1-800-330-0446
  • NAELA Georgia Chapter: naela.org

Medicare Counseling (GeorgiaCares / SHIP)

  • 1-866-552-4464

Learn More

Find personalized help navigating the Georgia ICWP waiver 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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.