Georgia Medicare I-SNPs Institutional Special Needs Plans (2026)

Georgia Institutional Special Needs Plans (I-SNPs) are a specialized type of Medicare Advantage plan designed exclusively for Medicare beneficiaries who reside in long-term care facilities or who live in the community but need an institutional level of care. For Georgia families navigating nursing facility care, an I-SNP can deliver embedded on-site clinical staffing, reduced hospital transfers, and tighter coordination with the facility's medical team than standard Medicare provides.

A meaningful share of Medicare beneficiaries in Georgia reside in nursing facilities at any given time, with additional community-dwelling beneficiaries qualifying for nursing-facility level of care through the state's Medicaid HCBS waivers. For this population, typically frail elders with multiple chronic conditions, cognitive impairment, and functional limitations, the standard Medicare delivery system is not well-matched: it relies on outpatient physician visits, hospital admissions for acute exacerbations, and care coordination by primary care doctors who do not visit nursing facilities. The result is predictable: nursing facility residents are frequently transferred to hospitals for conditions that could be managed in the facility, leading to delirium, functional decline, hospital-acquired infections, and family distress.

I-SNPs are the federal response. This guide walks through every aspect of the Georgia I-SNP market: the federal statutory framework, the two I-SNP subtypes (Standard Institutional and Institutional Equivalent), the eligibility verification process, the benefit structure, the on-site care coordination model, the Georgia I-SNP carriers, and the practical decision framework for families considering enrollment.

By Brevy Care Team · Last verified May 22, 2026

Why I-SNPs Matter for Georgia's Institutional Population

The standard Medicare system was not designed for nursing facility residents. It relies on outpatient physician visits, hospital admissions for acute exacerbations, and care coordination by primary care doctors who don't visit nursing facilities. This produces predictable problems: nursing facility residents frequently get transferred to hospitals for conditions that could be managed in the facility, leading to delirium, functional decline, hospital-acquired infections, and family distress. Even when transfers are appropriate, the lack of coordination between the facility and the hospital fragments care.

Institutional Special Needs Plans (I-SNPs) are the federal solution. An I-SNP is a Medicare Advantage plan designed exclusively for beneficiaries who reside in long-term care facilities (nursing facilities, ICF/IID, certain assisted living facilities) or who live in the community but require an institutional level of care. I-SNPs deliver:

1. On-site clinical staff, nurse practitioners or physicians employed by the I-SNP who visit the facility regularly (often daily for higher-acuity facilities)
2. Embedded care coordination, with care coordinators integrated into the facility's clinical team
3. Reduced hospital transfers, through proactive on-site evaluation and treatment of conditions that would otherwise trigger transfer
4. Specialized geriatric networks of geriatricians, geriatric pharmacists, palliative care specialists, and dementia care specialists
5. Enhanced benefits tailored to the institutional population, including additional dental, vision, and hearing benefits, plus comprehensive medication management

Georgia's I-SNP market is smaller than its D-SNP and C-SNP markets, but I-SNPs provide some of the most concentrated value of any Medicare option for the institutional population.

The Federal Statutory and Regulatory Framework

Section 1859(b)(6) of the Social Security Act

I-SNPs are authorized by Section 1859 of the Social Security Act, which defines a "special needs individual" eligible for I-SNP enrollment as someone who resides (or is expected to reside) for an extended period in a long-term care facility (such as a nursing facility, intermediate care facility for individuals with intellectual disabilities, or a qualifying assisted living or board-and-care home), or who lives in the community but requires an institutional level of care.

The institutional residence threshold (or expected residence) is the central eligibility criterion for Standard Institutional I-SNPs. The "institutional equivalent" provision allows Institutional Equivalent I-SNPs (IE I-SNPs) for community-dwelling beneficiaries who meet nursing-facility level-of-care criteria. For the operative day-count and the precise statutory definition, consult the current Section 1859 text and CMS Medicare Managed Care Manual guidance.

Statutory History

I-SNPs were created as one of three SNP types (D-SNP, C-SNP, I-SNP) by the Medicare Modernization Act of 2003. MIPPA 2008 strengthened SNPs by requiring care coordination, and the Bipartisan Budget Act of 2018 permanently authorized SNPs. For exact section numbers, refer to the current statutes.

42 CFR Part 422 (Medicare Advantage SNP Regulations)

The Medicare Advantage SNP regulations at 42 CFR Part 422 define:

• Standard Institutional I-SNP: enrolls beneficiaries who reside in a long-term care facility for the institutional-residency threshold
• Institutional Equivalent I-SNP: enrolls beneficiaries who live in the community but require an institutional level of care

The same Part 422 regulations establish SNP categories (D-SNP, C-SNP, I-SNP) and the care coordination requirements that apply to all SNP types, including the requirement to conduct an initial health risk assessment (HRA), develop an individualized care plan, maintain an interdisciplinary care team, update the care plan annually, and coordinate with the institutional setting. Verify the operative timeframes and specific subsection requirements against the current CFR text.

CMS Institutional Level of Care Verification

For Institutional Equivalent I-SNPs (community beneficiaries), CMS requires a standardized institutional level of care assessment. In Georgia, this is typically conducted through the Georgia Department of Community Health's level-of-care assessment process used for Medicaid HCBS waiver determinations.

The Two I-SNP Subtypes

Subtype 1: Standard Institutional I-SNPs

Standard Institutional I-SNPs enroll Medicare beneficiaries who reside in a long-term care facility for an extended period. The facility may be:

• Nursing facility (NF), most common; includes both skilled nursing facilities (SNFs) and intermediate care facilities (ICFs)
• Intermediate care facility for individuals with intellectual disabilities (ICF/IID), for developmentally disabled residents
• Assisted living facility (ALF), only certain ALFs that meet CMS institutional criteria; not all Georgia ALFs qualify
• Board and care home, only those meeting CMS institutional criteria

Characteristics:

• I-SNP delivers care through facility-embedded clinical staff
• Care coordinator typically employed by the I-SNP and works at the facility
• Frequent on-site visits (NP or physician sees enrollee at a regular cadence)
• Coordinated with the facility's medical director
• Reduces unnecessary hospital transfers
• Manages chronic conditions in the facility

Most common in Georgia: All major Georgia I-SNPs are Standard Institutional I-SNPs serving nursing facility residents.

Subtype 2: Institutional Equivalent I-SNPs (IE I-SNPs)

Institutional Equivalent I-SNPs enroll Medicare beneficiaries who live in the community (their own home, family member's home, or assisted living) but require an institutional level of care. Eligibility is typically demonstrated through a state-conducted level-of-care assessment.

Characteristics:

• Beneficiary lives in community
• Beneficiary requires nursing-facility level of care
• I-SNP coordinates community-based care to keep beneficiary out of nursing facility
• Often integrated with Medicaid HCBS waiver services
• Care coordinator helps coordinate home health, personal care, adult day services, and similar supports

In Georgia: Limited availability. Georgia's IE I-SNP market is small because Georgia's HCBS waivers, the Community Care Services Program (CCSP), Service Options Using Resources in a Community Environment (SOURCE), and Independent Care Waiver Program (ICWP), operate primarily through Medicaid fee-for-service rather than managed care.

Eligibility Requirements

Medicare Eligibility

I-SNP enrollees must be enrolled in Medicare Part A AND Part B.

Institutional Residency or Institutional Level of Care Need

For Standard Institutional I-SNPs:

• Beneficiary must reside (or expect to reside for the institutional-residency threshold) in a qualifying institution
• The threshold can be met either through documented current stay length or a physician's expectation of continued stay

For Institutional Equivalent I-SNPs:

• Beneficiary lives in the community
• Beneficiary requires nursing-facility level of care per state assessment
• Documentation through Georgia DCH level-of-care assessment

Pre-Enrollment Verification

I-SNPs require pre-enrollment verification:

• For Standard Institutional I-SNPs: facility verification of the institutional-residency threshold or expected stay
• For IE I-SNPs: state level-of-care assessment

CMS requires use of a standardized Health Risk Assessment (HRA) tool to support I-SNP eligibility determination.

Loss of Eligibility

If a beneficiary no longer meets I-SNP institutional criteria (for example, discharged from a nursing facility to the community), the I-SNP must:

1. Provide a grace period
2. Help the beneficiary transition to a non-I-SNP plan
3. Coordinate continuity of care during transition

Confirm the operative grace-period duration in the current CMS Medicare Managed Care Manual.

I-SNP Benefit Structure

Standard MA Benefits

I-SNPs provide all standard Medicare Advantage benefits:

• Part A (hospital insurance)
• Part B (medical insurance)
• Part D (prescription drugs) in most I-SNPs
• Out-of-pocket maximum

On-Site Clinical Staff

The defining feature of an I-SNP is its on-site clinical staffing model. The I-SNP employs (or contracts) clinical staff who work at the institutional facility:

Typical staffing:

• Nurse practitioners (NPs) visit facility residents at a regular cadence
• Physicians, typically geriatricians, internal medicine, or family medicine
• Care coordinators, clinical nurses managing comprehensive care
• Physician assistants (PAs) for supplemental clinical coverage
• Geriatric pharmacists for medication management

Visit frequency: Initial assessment within the timeframe required by CMS regulations after enrollment; routine visits at a regular cadence for most residents; more frequent for higher-acuity residents; available for urgent on-site evaluation (or rapid call-back). Verify operative cadence requirements with the specific I-SNP.

Hospital Transfer Reduction

The primary clinical value proposition of I-SNPs is reducing unnecessary hospital transfers. I-SNPs accomplish this through:

• On-site clinical evaluation (NP or physician available)
• Higher tolerance for managing acute conditions in the facility
• Better coordination with hospital discharge planners when transfer is necessary
• Proactive management of common transfer-triggering conditions (UTIs, pneumonia, falls, behavioral disturbances)

Independent research and CMS evaluations of I-SNP populations have shown meaningful reductions in hospital admissions and emergency department visits compared with similar populations served by standard Medicare; consult current CMS SNP performance data and peer-reviewed evaluations for the magnitude of effect.

Specialized Networks

I-SNP networks typically include:

• Geriatricians
• Geriatric psychiatrists
• Palliative care specialists
• Wound care specialists
• Dental services (often delivered in-facility)
• Behavioral health
• Hospice coordination

Enhanced Benefits

I-SNPs often include enhanced benefits tailored to institutional populations:

• Comprehensive dental
• In-facility dental services
• Vision benefits
• Hearing aids
• Podiatry
• Medical equipment
• Behavioral health
• Hospice support

Specific dollar values for supplemental benefits vary by plan and contract year; verify the current Summary of Benefits for any plan under consideration on the Medicare Plan Finder.

Bundled Part D

Most I-SNPs include bundled Part D. The Part D component is critical because institutional residents typically take many medications and require careful coordination. I-SNPs typically include:

• Comprehensive formulary
• In-facility pharmacy delivery
• Medication therapy management (MTM)
• Pharmacist-led medication reviews

Coordination with Medicaid for LTSS

Most institutional residents are dual eligibles (Medicare + Medicaid), with Medicaid paying for the institutional residency (room and board, custodial care) while Medicare pays for medical care. I-SNPs coordinate with:

• Medicaid for institutional level of care
• The facility for daily care management
• Medicare for medical services

Enrollment Process

When to Enroll

I-SNP enrollment opportunities:

1. At admission to the nursing facility (Special Enrollment Period for institutional change)
2. During the Medicare Annual Enrollment Period (AEP)
3. During the Medicare Advantage Open Enrollment Period (MA-OEP)
4. Initial Enrollment Period (IEP), when first becoming Medicare-eligible
5. 5-Star SEP, year-round if a 5-star I-SNP is available

Confirm current dates on Medicare.gov.

Pre-Enrollment HRA

I-SNPs use a Health Risk Assessment (HRA) tool to verify institutional eligibility and assess clinical needs. The HRA typically includes:

• Verification of facility residence or expected residence
• Functional status assessment
• Cognitive status assessment
• Medical conditions inventory
• Medication review
• Behavioral health screen
• Social support assessment

Enrollment Methods

• Through the facility, many I-SNPs have agents who work directly with facilities
• Through the I-SNP carrier directly, most common
• Medicare Plan Finder at medicare.gov
• Insurance broker or agent, though fewer agents specialize in I-SNPs
• GeorgiaCares SHIP at 1-866-552-4464

Verification Window

CMS allows enrollment to proceed pending full verification, with a defined window for completion. If verification fails, the I-SNP may disenroll the beneficiary.

Family Involvement

For institutional residents, family members often play crucial roles in I-SNP enrollment decisions:

• Powers of attorney may sign enrollment forms
• Legal guardians may enroll on behalf of beneficiaries
• Family conferences with I-SNP care coordinators help explain benefits

Georgia I-SNP Carriers and Plans

UnitedHealthcare Nursing Home Plan

• Among the largest I-SNP carriers in Georgia
• Strong on-site clinical staffing model
• Partnerships with major Georgia nursing home chains
• Availability in many counties
• Strong dental and pharmacy benefits

Optum I-SNP (UnitedHealth Group affiliate)

• Specialized I-SNP focused on nursing facility populations
• Optum-employed NPs and care coordinators on-site
• Hospital transfer reduction is the central value proposition
• Available in Atlanta metro and select regional markets

Humana CareSource

• Coordinated Care of Georgia partnership model
• Presence in rural Georgia
• Coordinates with facility staff
• Dental and vision benefits

Coordinated Care of Georgia

• Georgia-focused I-SNP partnership
• Regional presence
• Local care coordinators

Other Carriers

Smaller and emerging I-SNPs may include:

• WellCare/Centene I-SNP options (limited Georgia availability)
• Regional Medicare Advantage Organization (MAO) I-SNPs
• Emerging value-based care I-SNPs

Plan availability changes annually; check the Medicare Plan Finder during each AEP and confirm with the facility administrator about which I-SNPs serve the specific facility.

On-Site Care Coordination Model in Detail

Clinical Staffing at the Facility

The I-SNP clinical staffing model is the differentiator. A typical I-SNP staffing arrangement at a mid-sized nursing facility with a meaningful share of I-SNP enrollees might include:

• A nurse practitioner working on-site
• A part-time physician (typically a geriatrician)
• One or more care coordinators
• On-call clinical coverage

Daily Clinical Activities

I-SNP clinical staff at the facility typically:

• Round on each I-SNP enrollee at a regular cadence
• Respond to acute clinical changes
• Coordinate with facility nursing staff
• Manage chronic conditions (diabetes, CHF, COPD, dementia)
• Conduct medication reviews
• Facilitate goals-of-care conversations
• Coordinate hospice transitions

Reducing Hospital Transfers

When a facility resident has a clinical change, the I-SNP NP can:

• Conduct on-site evaluation
• Order labs and X-rays (most facilities have in-house capabilities)
• Manage acute conditions (UTI, pneumonia, behavioral changes, falls)
• Coordinate with hospital only when truly necessary
• Initiate IV antibiotics in-facility when appropriate

Coordination with Facility Medical Director

I-SNP clinical staff work in close coordination with the facility's medical director (the physician responsible for overall facility clinical operations). The medical director and I-SNP clinical staff jointly develop:

• Facility-level care protocols
• Quality improvement initiatives
• Specific resident care plans
• Hospice and end-of-life planning

Decision Framework: Should a Nursing Facility Resident Enroll in an I-SNP?

When an I-SNP Is a Strong Fit

Strong fit if the resident:

• Resides in a nursing facility for an extended period
• Has multiple chronic conditions
• Has had recent hospitalizations or ED visits
• Has cognitive impairment (dementia)
• Has frequent acute clinical changes
• Is a dual eligible (or could become one)
• Has family that values reduced hospital transfers
• Is in a facility partnered with an I-SNP

When to Consider D-SNP Instead

D-SNP may be preferable if:

• Resident is dual eligible
• Facility does not have I-SNP partnerships
• D-SNP offers better dental benefits
• D-SNP's care coordinator model is sufficient

When to Stay in Original Medicare

Original Medicare may be preferable if:

• The resident's family or legal guardian prefers fee-for-service flexibility
• The resident has providers outside any I-SNP network
• The facility has strong medical director coverage without I-SNP support

Best Practices for I-SNP Enrollment

1. Ask the facility administrator which I-SNPs partner with the facility
2. Meet the I-SNP NP or care coordinator before enrolling
3. Verify the I-SNP's hospital transfer reduction performance
4. Involve family or legal representatives in the enrollment decision
5. Coordinate with the facility's medical director
6. Review the formulary to ensure medications are covered
7. Verify enhanced benefits (dental, vision, hospice support) on the current Summary of Benefits
8. Get free help from GeorgiaCares SHIP at 1-866-552-4464
9. Check dual eligibility status; I-SNP and D-SNP coordination matters
10. Confirm CMS HRA verification has been completed
11. Document the institutional-residency verification
12. Coordinate with hospice services if the resident has end-stage conditions
13. Plan for discharge; transition to a community plan if discharge becomes possible
14. Review I-SNP performance metrics annually during AEP

Common Issues with I-SNPs in Georgia

1. Limited I-SNP availability by facility, not every nursing facility has an I-SNP partnership
2. Family resistance to managed care, some families prefer original Medicare
3. HRA verification delays, pre-enrollment can take several weeks
4. Discharge from facility, discharge to community triggers I-SNP disenrollment after the grace period
5. Provider network limitations, some specialists may not be in-network
6. Hospice coordination, beneficiaries on Medicare hospice are typically disenrolled from MA
7. Cognitive impairment, enrollment decisions made by family or legal representatives can be complex
8. Dual eligible navigation, Medicare and Medicaid coordination is complex
9. Facility staff turnover, I-SNP clinical staff turnover disrupts care
10. Quality variability, I-SNPs vary in hospital transfer reduction performance
11. Plan switching limitations, discharge mid-year may not match enrollment windows
12. Behavioral health coverage, institutional residents often need specialized behavioral health
13. Medication management, high-medication regimens require careful coordination
14. End-of-life transitions, palliative care and hospice coordination requires expertise

A few more common questions:

What is an I-SNP? An Institutional Special Needs Plan (I-SNP) is a Medicare Advantage plan designed exclusively for Medicare beneficiaries who reside in a long-term care facility for an extended period or who live in the community but need institutional level of care.

What facilities qualify as institutional for I-SNP? Nursing facilities (NF), skilled nursing facilities (SNF), intermediate care facilities for individuals with intellectual disabilities (ICF/IID), certain assisted living facilities (ALFs) meeting CMS criteria, and certain board and care homes.

How is institutional residency verified? Through facility verification of the institutional-residency threshold or expected stay, plus a CMS Health Risk Assessment (HRA) tool.

What is the institutional equivalent provision? The IE I-SNP provision allows community-dwelling beneficiaries who need nursing-facility level of care to enroll in an I-SNP that coordinates community-based care.

How many I-SNPs are in Georgia? A small number of carriers offer I-SNPs across Georgia. Specific facility coverage varies; check the current Medicare Plan Finder by county.

What are the top I-SNP carriers in Georgia? UnitedHealthcare Nursing Home Plan, Optum I-SNP, Humana CareSource, and Coordinated Care of Georgia.

When can I enroll in an I-SNP? At admission to the facility (SEP for institutional change), during the Medicare Annual Enrollment Period (AEP), the Medicare Advantage Open Enrollment Period (MA-OEP), the Initial Enrollment Period (when first Medicare-eligible), or via the 5-Star SEP year-round if available.

How do I-SNPs reduce hospital transfers? On-site NPs or physicians can evaluate clinical changes, order labs and treatments at the facility, manage acute conditions, and transfer only when truly necessary.

Will the I-SNP NP replace the resident's regular doctor? The I-SNP NP supplements (not replaces) the facility's medical director and regular physicians. The facility's medical director retains overall clinical authority.

How does the I-SNP coordinate with Medicaid for LTSS? For dual-eligible institutional residents, Medicaid pays for room and board and custodial care, while Medicare and the I-SNP pay for medical care.

Will an I-SNP cover specialists outside the facility? Yes, within the I-SNP network. For specialty care not available on-site, the I-SNP coordinates transport and access.

Can a person have an I-SNP and hospice? Generally no. Medicare hospice election typically requires disenrollment from Medicare Advantage. I-SNPs work with families to plan hospice transitions carefully.

How does an I-SNP work with dementia? I-SNPs are particularly valuable for dementia residents because on-site staff can manage behavioral disturbances without hospitalization, NPs coordinate medication management, and care plans address dementia-specific needs.

Can a family member or legal guardian enroll on behalf of the resident? Yes. Powers of attorney, legal guardians, and authorized representatives can enroll on behalf of incapacitated beneficiaries.

How does the I-SNP coordinate with the facility's medical director? The I-SNP NP works in collaboration with the medical director, who retains overall clinical authority. They jointly develop care protocols and resident care plans.

What if the facility doesn't have an I-SNP partnership? The resident may not be able to enroll in an I-SNP. Alternatives include D-SNP (if dual eligible), C-SNP (if there is a qualifying chronic condition), standard Medicare Advantage, or original Medicare.

How are I-SNP NPs different from facility nurses? Facility nurses provide direct nursing care. I-SNP NPs are advanced practice providers who diagnose, prescribe, order tests, and manage medical conditions, typically functioning similarly to a physician.

Can I-SNPs cover dental work? Most I-SNPs include enhanced dental benefits as a supplemental benefit; verify the operative annual allowance on the plan's current Summary of Benefits.

How are I-SNP quality measures tracked? CMS tracks SNP-specific HEDIS measures including care coordination, medication reconciliation, hospital admissions, ED visits, and member experience. Performance varies by plan.

Can someone switch from I-SNP to D-SNP? Yes, generally during AEP or the MA-OEP. For dual-eligible residents, this may be appropriate if family circumstances change.

What if the resident's cognitive status declines? I-SNPs continue to provide care. Legal authority (POA, guardianship) may shift to family. I-SNP care coordinators help families navigate the changes.

How does an I-SNP work for short-term rehab stays? Short-term rehab below the institutional-residency threshold typically doesn't qualify for I-SNP. Beneficiaries return to their pre-admission plan. For longer-term stays expected to exceed the threshold, I-SNP enrollment becomes appropriate.

Worked Examples

Example 1: Margaret, Fulton County, Nursing Facility Resident

Margaret, 82, has been in a Fulton County skilled nursing facility for several months following a hip fracture that left her unable to live independently. She has diabetes, hypertension, mild dementia, and chronic kidney disease (stage 3).

Her facility partners with the UnitedHealthcare Nursing Home Plan I-SNP. Her son enrolls her (with POA) during AEP. The I-SNP provides:

• On-site UHC NP visits at a regular cadence
• A care coordinator managing her medication regimen (a long medication list)
• Telehealth physician access
• A supplemental dental benefit covering in-facility cleanings
• Coordinated transportation to specialist appointments
• Comprehensive medication therapy management

In the months since enrollment, Margaret has avoided hospitalization despite previously having multiple hospital admissions. Her family reports better communication and clearer care plans.

Example 2: James, DeKalb County, Recent NF Admission

James, 78, was admitted to a DeKalb County nursing facility a few months ago following a stroke that left him with significant left-sided hemiparesis. He has CHF, COPD, and Type 2 diabetes.

His family initially kept him on his original Medicare plus Medigap Plan G. After several months, they observed the facility's I-SNP enrollees seemed to receive more proactive care.

During the next open enrollment, the family switches James to Optum I-SNP. Benefits include:

• On-site NP rounding at a regular cadence
• Care coordinator integrated with facility nursing
• Heart-failure-specific medication management
• COPD action plan coordinated with the facility
• Diabetes monitoring with bedside glucometer
• Annual supplemental benefits including dental, vision, and hearing

Family observation: more proactive care management, fewer crises, better communication.

Example 3: Robert, Cobb County, Long-term NF Resident with Dementia

Robert, 85, has advanced Alzheimer's dementia and has been in a Cobb County nursing facility for several years. Before I-SNP enrollment, he had multiple hospitalizations in a single year, primarily for UTIs, pneumonia, falls, and behavioral disturbances. Each hospitalization caused delirium and significant functional decline.

His wife Susan enrolled him in Humana CareSource I-SNP. Since enrollment:

• The on-site NP manages UTIs with oral antibiotics in-facility (vs hospital-based IV antibiotics)
• Falls are evaluated on-site by an NP, with transfer only for true emergencies
• Behavioral disturbances are managed with non-pharmacological approaches and consultations
• Pneumonia is treated in-facility with on-site IV antibiotics where appropriate
• Goals-of-care conversations led to advance directives

In the months since I-SNP enrollment, Robert's hospitalization rate has dropped sharply. He has avoided delirium episodes and maintained more stable cognitive function.

Example 4: Linda, Worth County, HCBS Waiver Recipient, IE I-SNP

Linda, 79, lives in rural Sylvester (Worth County). She has diabetes, CHF, mild dementia, and severe functional limitations. She qualifies for nursing-facility level of care under Georgia DCH assessment but is enrolled in the Community Care Services Program (CCSP) HCBS waiver to remain at home with her daughter as caregiver.

Linda enrolls in an Institutional Equivalent I-SNP (limited carriers in Georgia). The IE I-SNP includes:

• Home-based NP visits at a regular cadence
• Care coordinator working with the CCSP waiver case manager
• Medication management
• Coordination with the home health agency
• Diabetic and cardiac monitoring
• Transportation to specialty appointments

The IE I-SNP allows Linda to remain at home while receiving institutional-quality care coordination.

Example 5: David, Bibb County, Discharged from NF to Community

David, 76, had been in a Macon nursing facility for several months following a serious cardiac event. He was enrolled in UnitedHealthcare Nursing Home Plan I-SNP during this stay.

After significant rehabilitation, David's clinical team determined he could return to the community with home health services. He is a dual eligible (QMB-Plus).

The I-SNP coordinator helped David transition:

• A defined grace period after discharge
• During the grace period, transition to UnitedHealthcare Dual Complete D-SNP
• D-SNP picked up care coordination for community living
• Home health services arranged through the D-SNP and Medicaid
• Medication regimen continued seamlessly

The transition demonstrated I-SNP to D-SNP continuity.

Example 6: Sarah, Hall County, Long-term NF Resident, Dual Eligible

Sarah, 88, has been in a Gainesville nursing facility for several years. She has end-stage CHF, severe dementia, recurrent UTIs, and chronic pain. Her son David lives in Atlanta and visits regularly.

Sarah was originally enrolled in a standard Humana MA-PD plan when she entered the facility. David noticed the facility had Optum I-SNP presence, with on-site NPs visiting facility residents at a regular cadence.

After observation, David switched Sarah (via POA) to Optum I-SNP during AEP. Benefits:

• On-site NP at a regular cadence and responsive to acute issues
• Dual eligibility means Medicaid pays Medicare cost-sharing
• Comprehensive dental for facility-delivered services
• Hospice planning conversations with care coordinator
• A coordinated medication review reduced her overall medication burden
• Pain-management protocol coordinated with hospice consultation

David reported better communication, clearer care plans, and significantly fewer crises. After a period of stability, the family transitioned Sarah to Medicare hospice, which required I-SNP disenrollment but maintained continuity through I-SNP coordination.

Conclusion: The Specialized Medicare Advantage Option for the Institutional Population

I-SNPs are the Medicare Advantage option specifically designed for Georgia's institutional population: the many nursing facility residents and additional community beneficiaries needing institutional level of care. By embedding clinical staff in the facility, providing on-site care coordination, and reducing unnecessary hospital transfers, I-SNPs deliver measurable improvements in quality of life, family satisfaction, and clinical outcomes.

Georgia's I-SNP market is smaller than its D-SNP and C-SNP markets but provides concentrated value for the institutional population. The major Georgia carriers, UnitedHealthcare Nursing Home Plan, Optum I-SNP, Humana CareSource, and Coordinated Care of Georgia, operate through facility partnerships, which means I-SNP availability depends on whether the specific nursing facility has partnered with an I-SNP carrier.

For families of Georgia nursing facility residents, evaluating I-SNP options should be part of every annual review. The hospital transfer reduction benefits alone can significantly improve quality of life, especially for residents with dementia for whom hospitalization often causes severe delirium and functional decline.

The completion of the SNP trilogy (D-SNP for dual eligibles, C-SNP for chronic conditions, I-SNP for institutional populations) gives Georgia Medicare beneficiaries comprehensive Medicare Advantage options tailored to their specific situations. The federal framework under Section 1859 of the Social Security Act and 42 CFR Part 422, plus the statutory history through MMA 2003, MIPPA 2008, and the Bipartisan Budget Act of 2018, establishes the care coordination and quality standards that apply to all three SNP types.

For comprehensive help with I-SNPs:

• Medicare 1-800-MEDICARE
• SSA 1-800-772-1213
• GeorgiaCares SHIP 1-866-552-4464 (free I-SNP counseling)
• Georgia DCH (Medicaid for LTC residents)
• Georgia DOI
• Georgia Office of the State Long-Term Care Ombudsman
• Medicare Rights Center
• UnitedHealthcare Nursing Home Plan
• Optum I-SNP
• Humana CareSource
• Atlanta Legal Aid
• Georgia Legal Services Program
• Eldercare Locator 1-800-677-1116
• 211 Georgia

Find personalized help understanding I-SNP options in Georgia at brevy.com.