Georgia Medicaid MLTSS: Does Georgia Have It? (2026)

Georgia does not operate Managed Long-Term Services and Supports (MLTSS). As of 2026, Georgia delivers Medicaid long-term services and supports through four Section 1915(c) home and community-based services (HCBS) waivers and nursing facility Medicaid, not through a managed care plan that takes a capitated payment to coordinate long-term care. All four waivers are administered by the Georgia Department of Community Health, which delegates day-to-day operation of the two developmental-disability waivers to DBHDD; none is run by a Georgia Families health plan. So for a Georgia family the practical path to long-term care runs through a waiver or a nursing facility, not an MLTSS plan. This guide explains what MLTSS is, how Georgia's system works instead, and where to apply.1,2

In This Guide

• What MLTSS is and why it matters
• How Georgia delivers long-term care instead
• Georgia's four HCBS waivers
• What a Georgia nursing facility resident pays
• The federal authorities behind MLTSS
• Why Georgia Medicaid MLTSS does not exist
• What Georgia Medicaid MLTSS would change for families
• How to apply and who to call
• Frequently asked questions
• Learn More

What MLTSS is and why it matters

Managed Long-Term Services and Supports (MLTSS) is the delivery of Medicaid long-term services and supports (LTSS) through managed care. Instead of paying each provider directly for each service, the state pays a managed care organization (MCO) a fixed per-member-per-month payment, called a capitation rate, and the MCO arranges and pays for the enrollee's covered care within that payment.1,10

Because the capitation rate is fixed and is paid whether or not the member uses services in a given month, the MCO carries the financial risk: it can lose money if a member's care costs exceed the payment, or keep the difference if costs come in under it. That structure is meant to give the MCO a reason to coordinate care and to favor lower-cost home and community-based settings over institutional care when appropriate.3

This matters for a Georgia reader for one direct reason: Georgia does not use it. Under Georgia's fee-for-service system, no single plan is paid to coordinate a person's long-term care across providers, and no plan carries financial risk for keeping someone in the community. Knowing what MLTSS is helps you understand both the limits of Georgia's current system and how long-term care works if your family moves to a state, such as Florida, that runs it.

How Georgia delivers long-term care instead

Georgia splits its Medicaid delivery in two. Georgia Families is the state's Medicaid and PeachCare for Kids managed care program, operated by three Care Management Organizations: Amerigroup Community Care, CareSource, and Peach State Health Plan. Long-term services and supports run on a separate track.4

Georgia Medicaid delivers long-term services and supports at home through its HCBS waivers, and the state runs those waivers itself rather than handing them to a plan: DCH administers all four, delegating day-to-day operation of NOW and COMP to DBHDD through six regional field offices. Applications follow the same split: the CCSP and SOURCE models of EDWP are applied for through Georgia's Aging and Disability Resource Connection offices, and NOW and COMP through DBHDD. Because no Care Management Organization is paid to arrange a member's long-term care, no plan carries the capitated risk that defines MLTSS. If you want to know what your own Georgia Families plan does and does not pay for, ask the plan or call DCH Medicaid Member Services at 1-866-211-0950.2,11,8

The table below shows how the two paths differ.

Georgia's four HCBS waivers

Georgia operates four Section 1915(c) HCBS waivers as of 2026, each serving a defined population that would otherwise need an institutional level of care. Every 1915(c) waiver rests on three separate federal tests, and Georgia's four are no exception: cost neutrality, meaning average per capita waiver spending may not exceed what the institutional level of care would have cost; an individual level-of-care determination for each enrollee, reevaluated at least annually; and limited enrollment, under which the state's waiver application names a maximum number of unduplicated participants per waiver year. That participant cap is what creates waiting lists; it is a distinct federal feature from cost neutrality, not a consequence of it.2,12

• Elderly and Disabled Waiver Program (EDWP): Administered by the Georgia Department of Community Health (DCH); serves frail elderly and disabled Georgians who are otherwise eligible under a nursing facility level of care; provides case management for service coordination, adult daycare, alternative living services, personal care, home-delivered meals, and respite care for family caregivers. EDWP is delivered through two service models, not two separate waivers: the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE), which adds enhanced case management coordinated through a primary care physician.2
• Independent Care Waiver Program (ICWP): Administered by DCH; serves a limited number of adults who apply between the ages of 21 and 64, with eligibility based on either a nursing facility or a hospital level of care, for adults with severe physical disabilities or traumatic brain injury. Covered services include personal support, home health services, specialized medical equipment and supplies, counseling, emergency response systems, and home modifications.2
• New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP): Both are administered by DCH, which delegates day-to-day operation to the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) through six regional field offices. Both serve people with intellectual or developmental disabilities. Eligibility requires an intellectual disability, or a closely related developmental disability such as autism, cerebral palsy, or epilepsy, that substantially impairs intellectual or adaptive functioning and originated during the developmental years, with onset by age 18 for an intellectual disability or by age 22 for a developmental disability. The person must also be Medicaid-eligible and meet the level of care required for an intermediate care facility for individuals with intellectual and developmental disabilities (ICF-I/DD); both waivers apply the Medicaid Cap special income standard of 300% of the SSI federal benefit rate, which is $2,982 per month in 2026.2,13

All four waivers apply the federal HCBS post-eligibility treatment of income framework, and each rests on the same Section 1915(c) authority: the Secretary may waive certain Medicaid requirements so a state can cover home or community-based services for people who would otherwise require an institutional level of care, provided the waiver meets the three federal tests above.2,12

What a Georgia nursing facility resident pays

When a Georgia Medicaid member lives in a nursing facility, Medicaid pays the facility, but the resident contributes most of their own income toward the cost of care. As of 2026, Georgia keeps a personal needs allowance of $70 per month for the resident's personal expenses; this rate has been in effect since July 2019 and exceeds the federal minimum of $30 per month.5

The rest of the resident's income, after allowed deductions such as a community-spouse maintenance needs allowance, dependent allowances, and health-insurance premiums including the Medicare Part B premium, is applied to the cost of care as patient liability. For example, a single resident with $1,800 in monthly Social Security income and no other deductions would keep $70 and owe $1,730 per month toward the nursing facility. A separate $90 allowance applies to a Department of Veterans Affairs pensioner or surviving spouse in a nursing home who has no dependents, but it is not extra spending money: that person's VA check is reduced to the amount of the allowance regardless of their other income. A VA pensioner or surviving spouse who does have dependents keeps the same $70.5

The federal authorities behind MLTSS

States that do run MLTSS build it by combining federal Medicaid managed care authorities with LTSS authorities under the Social Security Act. The same authorities sit unused for LTSS in Georgia, which relies on its 1915(c) waivers instead.1

• Section 1932(a) (42 U.S.C. 1396u-2(a)) is the state-plan managed care option, under which a state may require eligible individuals to enroll with a managed care entity as a condition of receiving assistance.1
• Section 1915(b) (42 U.S.C. 1396n(b)) is the managed care waiver, which a state can pair with a Section 1915(c) HCBS waiver (42 U.S.C. 1396n(c)) so one MCO can deliver both acute care and waiver services.1
• Section 1115 (42 U.S.C. 1315(a)) demonstrations let the Secretary of Health and Human Services waive state-plan requirements for projects that promote Medicaid's objectives, and a state can build an MLTSS program on this authority.1,14
• Section 1915(a) voluntary managed care programs round out the set. CMS describes the available managed care authorities for MLTSS as a 1915(a) voluntary program, a 1932(a) state plan amendment, a 1915(b) waiver, or a Section 1115 demonstration, any of which can be paired with state-plan HCBS benefits or a 1915(c) waiver.1

When an MLTSS program does take effect, federal rules govern its payments and protections. Under 42 CFR 438.4, the MCO's capitation rates must be actuarially sound, meaning projected to cover all reasonable and appropriate contract costs and certified by an actuary.15

On May 20, 2013, the Centers for Medicare and Medicaid Services issued guidance to states using 1115 demonstrations or 1915(b) waivers for MLTSS, setting out ten essential elements it expects a state MLTSS program to incorporate: adequate planning, stakeholder engagement, enhanced provision of home and community-based services, alignment of payment structures and goals, support for beneficiaries, person-centered processes, a comprehensive and integrated service package, qualified providers, participant protections, and quality.1

States also use related federal tools to shift LTSS toward the community. The Community First Choice option under Section 1915(k), added by the Affordable Care Act, gives a state that elects it a Federal Medical Assistance Percentage increased by 6 percentage points for those attendant services. Because CFC is a state plan benefit rather than a capped Section 1915(c) waiver, a state that elects it must make the services available statewide, as needed, with no enrollment cap or waiting list.16

Why Georgia Medicaid MLTSS does not exist

Georgia has not built an MLTSS program. The state has not published a reason, but several features of the system it already has would make the switch a large one.

• Existing state-run waiver infrastructure. Georgia already runs four HCBS waivers with established case management, provider networks, and payment systems, administered by DCH and DBHDD. Folding those functions into MCO operations would require a large system change.2
• No CMO track record in long-term care. The Georgia Families CMOs do not operate any of the four waivers today, so they would have to build clinical and network capacity for long-term care.4,2
• Competing reform priorities. Georgia's recent Medicaid reform effort has centered on Georgia Pathways to Coverage, the Section 1115 demonstration that covers adults aged 19 through 64 whose household income is up to 95% of the federal poverty level, effectively 100% once the 5% income disregard is applied, and who complete at least 80 hours per month of qualifying activities. Pathways is not permanently approved: its original five-year approval period closed September 30, 2025, and it was temporarily extended and amended through December 31, 2026.17

Georgia's neighbors have not all made the same choice. Florida delivers its Medicaid long-term care through the Statewide Medicaid Managed Care (SMMC) program, whose Long-Term Care track covers home and community-based long-term services and supports for members meeting a nursing-facility level of care, alongside a separate Managed Medical Assistance track for acute and primary care.18

Nationally, though, the approach has spread. Per MACPAC, 24 states operated MLTSS programs as of 2021, meaning their state Medicaid agencies contract with managed care plans to deliver LTSS, up sharply from just 8 states in 2004. That 24 is MACPAC's count as of 2021, not a current-year figure. CMS describes MLTSS as a strategy increasing numbers of states use for expanding home- and community-based services, promoting community inclusion, ensuring quality, and increasing efficiency.19

What Georgia Medicaid MLTSS would change for families

If Georgia adopted MLTSS, the day-to-day experience for a long-term care family would shift in a few concrete ways.

• One coordinator. A single MCO care coordinator would replace the current mix of a CCSP or SOURCE case manager, the nursing facility, and separate physicians.
• Network rules. Members would generally use the MCO's network after an initial continuity-of-care period, instead of any Medicaid-enrolled provider.
• Service authorization. The MCO would authorize LTSS within state limits, subject to federal appeal and grievance protections and a state fair hearing as a backstop.
• A push toward home. Because home care typically costs less than a nursing facility, the MCO would have a financial reason to support community living when it fits the person's needs and preferences.3

For dual eligibles, MLTSS often pairs with a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) to coordinate Medicare and Medicaid together. Georgia's dual-eligible integration is limited today: D-SNPs operate in the state, but Georgia Medicaid delivers long-term services and supports at home through the CCSP and SOURCE models of the Elderly and Disabled Waiver Program rather than through one integrated Medicare-Medicaid plan, and DCH placed a moratorium on contracting with new D-SNPs effective August 1, 2025.11

Georgia has also used federal rebalancing tools. The Money Follows the Person (MFP) demonstration, originally authorized by Section 6071 of the Deficit Reduction Act of 2005, gives states enhanced matching funds to move people from institutions to the community; the Consolidated Appropriations Act, 2023 extended it through September 30, 2027. Georgia implemented its MFP program on September 1, 2008 as a joint effort of DCH, DBHDD, and the Division of Aging Services.20,21

How to apply and who to call

You do not apply for MLTSS in Georgia, because it does not exist here. You apply for a specific HCBS waiver or for nursing facility Medicaid, and the entry point depends on the population.2,6,7,8,22

Expect a wait for the developmental-disability waivers. Georgia's planning list for NOW and COMP held roughly 7,900 people as of September 2025, per the Georgia Department of Audits and Accounts, and those on it had been waiting nearly five years on average; among the roughly 4,900 adults on the list, 43% had been waiting at least six years, and nearly all of them were waiting for NOW services. Time on the list is not what moves you up it: DBHDD prioritizes by assessed need, generally serving those with the greatest unmet needs first, so a more urgent circumstance can move ahead of a longer wait. Applications are reviewed by DBHDD Regional Field Office intake and evaluation staff, and applicants found pre-eligible are placed on the I/DD planning list. Ask DBHDD about interim supports while you wait.23

Learn More

Find personalized help navigating Georgia Medicaid long-term services and supports 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.