Georgia Medicaid Nursing Facility Admission Process (2026)

The Georgia nursing facility admission process for Medicaid clears three separate approvals before Medicaid pays a single nursing home bill. The three run in parallel: a federal clinical screening called Preadmission Screening and Resident Review (PASRR), a state level of care determination run by the Georgia Department of Community Health (DCH), and a financial eligibility decision made by the Georgia Division of Family and Children Services (DFCS), which by federal rule has up to 45 days to decide. A stall on any one of them leaves the family paying privately for weeks. Families who start the slow track (the financial application) first, in the first week of the Medicare skilled-nursing stay, preserve their coverage. Families who wait pay out of pocket while the system catches up.

In This Guide

• Why the Georgia Nursing Facility Admission Process Matters
• The Three Parallel Tracks
• The Medicare Day-101 Transition
• 2026 Georgia Financial Eligibility Figures
• Facility Selection: Three Tools to Use
• Admission Paperwork to Read Carefully
• Patient Liability and the Personal Needs Allowance
• The First 30 Days After Admission
• Frequently Asked Questions
• Learn More

Why the Georgia nursing facility admission process matters

A nursing facility admission in Georgia is rarely the start of long-term care planning. It is the end. By the time a parent moves into a nursing home, the family has typically spent months (sometimes years) preparing: powers of attorney executed, financial records gathered, spend-down strategies considered, facility tours completed, advance directives signed. The admission itself is the moment when all of that preparation meets administrative reality.

Medicaid does not begin paying the day someone walks through the nursing home door. Coverage begins only after three separate processes complete: PASRR clinical screening (federal), the level of care determination (Georgia DCH), and financial eligibility (Georgia DFCS). Each process has its own timeline, its own paperwork, and its own potential for failure.

When all three close cleanly, Medicaid pays from the date of admission, or for the three months before the application month if the applicant was eligible during those months.9 When any one of the three stalls, the family pays the facility privately while waiting for resolution. Georgia nursing facility care is expensive, and even a short delay in Medicaid approval can cost a family thousands of dollars that would have been covered if the admission had been managed correctly.

This guide walks through every step of the Georgia nursing facility admission process: who decides what, what paperwork is required, what deadlines matter, and what families should do before, during, and after admission so Medicaid coverage begins as early as possible. It addresses both planned admissions and emergency admissions, the federal PASRR mandate, the Georgia level of care assessment, the financial Medicaid application, the Medicare-to-Medicaid transition at day 101, patient liability, facility selection, and the first 30 days after admission. Read it before the admission, not during.

The Georgia nursing facility admission process: three parallel tracks

Every Georgia nursing facility admission for Medicaid coverage involves three separate processes running in parallel. Understanding what each track does, who runs it, and what triggers it is the foundation of the entire admission process.

Track 1: PASRR (federal clinical screening for mental illness and intellectual disability)

Preadmission Screening and Resident Review (PASRR) is a federal Medicaid requirement based on section 1919(e)(7) of the Social Security Act, with implementing rules at 42 CFR 483.100 through 483.138. It applies to every individual with mental illness or intellectual disability who applies to or resides in a Medicaid-certified nursing facility, regardless of the source of payment for the nursing facility services. A private-pay admission, a Medicare admission, and a Medicaid admission all run PASRR.1

PASRR runs in two stages. PASRR Level I is the initial screen that identifies individuals suspected of having serious mental illness (MI) or intellectual disability (IID). Level I is typically completed by the hospital discharge planner, the referring physician, or the receiving nursing facility, and it must be completed before the person is admitted. If Level I screens negative, the admission proceeds. If Level I screens positive, Level II is triggered.1

PASRR Level II is a comprehensive evaluation that makes two interrelated determinations: whether the individual needs the nursing-facility level of care, and whether the individual needs specialized services beyond what the nursing facility provides. In Georgia, Level II is administered by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD). Where specialized services are required, the state must provide or arrange for them.1

A facility that admits a resident without PASRR completion may be required to discharge the resident, and Medicaid payment may be denied. Families should confirm in writing that PASRR Level I has been completed before signing admission paperwork. The deep treatment of the screen itself, including Georgia's Level I contractor and the categorical determinations, lives in the dedicated Georgia Medicaid PASRR Screening guide.

Track 2: Level of care determination (Georgia DCH)

The level of care (LOC) determination is the state clinical assessment that decides whether the individual needs the level of care a nursing facility provides. LOC is distinct from PASRR: PASRR is federal and focuses on mental illness and intellectual disability, while LOC is state-administered and focuses on functional and medical need. There is no single federal nursing-facility LOC definition; each state sets its own assessment instrument and threshold, evaluating ADL dependence, skilled-nursing and medical need, and cognitive and behavioral impairment.2

In Georgia, the Georgia Department of Community Health (DCH) determines LOC. The assessment evaluates need for 24-hour nursing supervision, assistance with activities of daily living (ADLs) such as eating, bathing, dressing, toileting, and transferring, cognitive function, medical conditions requiring ongoing monitoring, and behavioral or psychiatric symptoms requiring nursing oversight. It is typically completed by a registered nurse at the admitting facility or an independent assessor, and it is reviewed annually and whenever the resident has a significant change in condition.

A positive LOC determination is required for Medicaid to pay for nursing facility services, independent of financial eligibility. The LOC standard itself is covered in the Georgia Nursing Facility Level of Care guide.

Track 3: Financial eligibility (Georgia DFCS)

The financial Medicaid application is decided by the Georgia Division of Family and Children Services (DFCS), which determines whether the applicant meets the asset, income, and other financial rules for long-term care Medicaid.

Applications are filed through Georgia Gateway, the state's online portal, or by paper at the local DFCS office. The application requires extensive documentation: photo identification; Social Security number; proof of U.S. citizenship or lawful immigration status; income documentation; asset documentation (bank statements covering the look-back, deeds, vehicle titles, life insurance policies, retirement account statements); Medicare and other health insurance information; a marriage certificate if married; Power of Attorney documentation if the applicant is not signing personally; and information about any asset transfers in the look-back period.

By federal rule, the eligibility determination may not exceed 45 days for most applicants, or 90 days for applicants who apply for Medicaid on the basis of disability. Those are ceilings on the agency, not a promise of how quickly your decision will come back: they set the longest DFCS may take, and the regulation lets DFCS run past even that in the unusual circumstances it names, such as a delay or failure to act by the applicant or an examining physician, or an administrative emergency beyond the agency's control. A third exception was added effective July 31, 2026 and binds no one yet: once the federal community-engagement requirement is live, an applicant sent a notice of noncompliance has a 30-calendar-day window to respond, and the agency may exceed the standard while it runs. Returning every requested document promptly is what keeps the deadline enforceable.3

The three tracks run on different clocks. PASRR Level I must be done before admission. PASRR Level II, when triggered, takes days to weeks. The DCH level of care assessment is typically completed within the first two weeks of admission. The DFCS financial application is the slow track at up to 45 days. Coordinating all three, and starting the slow one first, is the central challenge of the admission process.

The Medicare Skilled Nursing Facility benefit: the critical transition

Most Georgia nursing facility admissions begin with a hospitalization. Medicare covers the hospital stay under Part A. For post-acute rehabilitation, Medicare offers the Skilled Nursing Facility (SNF) benefit under section 1812 of the Social Security Act.

The Medicare SNF benefit covers up to 100 days per spell of illness under specific conditions:

1. The patient must have had a qualifying hospital stay of at least three consecutive days as an inpatient (the "three-day rule"). Time spent under observation status or in the emergency room before admission does not count toward the three days.4
2. The three-day minimum is not universal. CMS waives it for a beneficiary assigned to a Medicare Shared Savings Program ACO in a two-sided-risk model when the care is furnished by a SNF with a written waiver-partnership agreement with that ACO, and a Medicare Advantage plan may choose to waive it for its own enrollees, so an MA member should check the plan's rules rather than assume the Original Medicare requirement applies.5
3. The facility must be a Medicare-certified SNF, and the skilled care must relate to the condition treated during the qualifying hospital stay.11
4. The patient must need daily skilled nursing or rehabilitative services.

The 2026 coverage breakdown is precise:

• Days 1 through 20: Medicare pays in full; the beneficiary owes $0.4
• Days 21 through 100: the beneficiary owes $217 per day in coinsurance in 2026, often covered by Medicare Supplement insurance or by Medicaid if the person is dual eligible.4
• Day 101 and beyond: the Medicare SNF benefit ends. The beneficiary is responsible for the full cost, or Medicaid begins if the person qualifies and has applied.

Day 101 is the critical transition point. Families who anticipate long-term nursing facility residency must file the Medicaid application during the Medicare SNF window so that Medicaid coverage can begin on day 101 without a gap. Filing in week one of the Medicare stay leaves DFCS its full 45-day limit before Medicare ends; the limit caps the agency rather than guaranteeing a decision by a given date.3

A common mistake is assuming Medicare covers long-term nursing facility care. It does not. Medicare is for skilled care and rehabilitation. Once the patient is medically stable but still needs nursing facility-level care for custodial reasons (assistance with ADLs, cognitive supervision), Medicare ends, and Medicaid is the only major payer for long-term custodial care. A second mistake is the three-day rule: many hospital stays are coded as observation status rather than inpatient admission, and observation status does not count toward the three-day requirement. Families should confirm inpatient status with the hospital before relying on the Medicare SNF benefit, and, if the parent is enrolled in a Medicare Advantage plan, ask the plan whether it waives the three-day stay.5

Hospital discharge planning: the front door

For most Georgia nursing facility admissions, the hospital is the front door. Under 42 CFR 482.43, every Medicare-participating hospital must have a discharge planning process. The hospital discharge planner, typically a social worker or registered nurse, coordinates the transition to post-acute care: assessing needs, providing a list of nursing facilities in the area, coordinating PASRR Level I, transferring medical records, and communicating with the family and Power of Attorney agent. The hospital cannot pressure a patient to choose a specific facility; patients and families have the right to choose.

Hospital discharge is often the most time-pressured part of the admission process, because hospitals and insurance utilization review push to discharge quickly, sometimes before the family has selected a facility. Families should engage the discharge planner early, often within the first 24 to 48 hours, to begin facility selection, PASRR coordination, and Medicaid application planning.

2026 Georgia financial eligibility figures

Georgia Medicaid for the aged, blind, and disabled is SSI-linked, and Georgia is an income-cap state for institutional care. The figures below govern the financial track in 2026.

The $2,000 and $3,000 asset limits are the SSI resource standards Georgia applies.6 The CSRA and MMNA figures in the table are the federal spousal-impoverishment maximums, and a community spouse is not automatically allotted them: for 2026 the CSRA runs from a $32,532 minimum to the $162,660 maximum, and the monthly maintenance allowance from a $2,705.00 minimum effective July 1, 2026 to the $4,066.50 maximum.7 The $752,000 home equity figure is the 2026 federal minimum standard; a state may elect a higher figure, up to $1,130,000.12 That equity limit does not apply at all when the applicant's spouse, a child under 21, or a blind or permanently and totally disabled child lawfully resides in the home, in which case the home is exempt as a resource without regard to the cap.12 The income cap is 300% of the 2026 SSI Federal Benefit Rate of $994, which is $2,982 per month.6 Georgia's nursing-facility Personal Needs Allowance is $70 per month, which exceeds the federal floor of $30 a month.13

Because Georgia is an income-cap state, an applicant whose gross monthly income is at or above the cap must establish a Qualified Income Trust (also called a Miller Trust) to direct excess income into a trust. The trust must be irrevocable and must name DCH as remainder beneficiary up to the amount Medicaid paid for the applicant's care.8,14

Transfers of assets for less than fair market value during the 60-month look-back period can trigger a penalty period, a span during which Medicaid will not pay for long-term care.12 Medicaid paid for nursing facility care is also subject to estate recovery after the beneficiary's death, but recovery may be made only after the death of a surviving spouse, and only when there is no surviving child who is under 21 or blind or permanently and totally disabled; every state must also waive recovery in cases of undue hardship.12 Georgia waives its claim against the first $25,000 of any estate for deaths on or after July 1, 2018.12

Retroactive coverage: the backstop that is shrinking

When the application is filed late, as often happens in emergency admissions, federal retroactive eligibility covers Medicaid services furnished in the three months before the application month if the applicant was eligible then. The statute is section 1902(a)(34) of the Social Security Act, with the implementing regulation at 42 CFR 435.915, and it expressly extends to applications made on a deceased individual's behalf.9

This window narrows for applications filed on or after January 1, 2027. Under section 71112 of Public Law 119-21, retroactive coverage shrinks to two months before the application month for most enrollees (and CHIP), and one month for the ACA Medicaid expansion adults.9 A family admitting a parent in late 2026 versus early 2027 faces a materially different safety net, so the practical rule is the same in either case: file the application as soon as possible after admission. Georgia's specifics are covered in the Georgia Medicaid Retroactive Eligibility guide.

Facility selection: the three tools every family should use

Choosing the right nursing facility is one of the most consequential decisions in the admission process, and quality varies widely across Georgia facilities. Three public tools let families compare, and every one is free.

Other selection factors

Beyond the three core tools, confirm Medicaid bed availability (not every facility accepts every payer, and some prioritize private-pay or Medicare admissions) and dual Medicare/Medicaid certification (families anticipating a Medicare-to-Medicaid transition should choose a dual-certified facility to avoid a forced transfer at day 101). Evaluate specialized programs (dementia care, behavioral health units, hospice partnerships), location, visitation policies, and quality of life. An in-person tour, with as many family members as possible, reveals more than any report: how staff interact with residents, how clean the facility is, and how residents look and behave.

Admission paperwork: what to read carefully

The day of admission involves a stack of paperwork. Families should not sign anything they have not read.

The admission agreement is the contract between the resident and the facility. The most consequential clause is the responsible-party or financial-guarantor language: federal law at 42 CFR 483.15(a)(3) prohibits a nursing facility from requiring a third-party guarantee of payment as a condition of admission or continued stay. A facility may ask a resident representative who has legal access to the resident's funds to agree to pay the facility from those funds, but signing as agent under Power of Attorney does not create personal liability when signed clearly as "Agent for [Principal]." Family members should not sign as personally liable unless they intend to be.10 Read the arbitration clause (you may refuse it), the discharge clauses, the bed-hold policy, and the notification provisions.

Georgia's Advance Directive for Health Care under O.C.G.A. §31-32-1 et seq. lets the resident name a healthcare agent and specify treatment preferences; it should be on file before admission. A separate HIPAA authorization names who may receive the resident's protected health information. The facility must have PASRR documentation on file before admission. The financial agreement specifies the payment source; if the resident is admitted as Medicaid pending, the facility may charge private-pay rates with a refund provision if Medicaid is approved retroactively, so confirm the refund provision is clear. Within 14 days of admission the facility must complete a comprehensive Minimum Data Set 3.0 (MDS 3.0) assessment under 42 CFR 483.20 and an initial care plan; the resident and family have the right to participate.

Patient liability and the Personal Needs Allowance

Once Medicaid is approved and the resident is in the facility, patient liability is the portion of the resident's income that goes to the facility each month, with Medicaid paying the rest of the facility rate. The calculation in Georgia runs in order:

The patient liability is paid directly to the facility each month. The PNA stays with the resident in a personal account for incidental expenses such as haircuts, magazines, snacks, and clothing.

For example, a single Georgia resident with Social Security income of $1,800 per month, paying the standard 2026 Medicare Part B premium of $202.90 and a Medicare Part D premium of $30, with no spouse, has a patient liability of $1,800 minus $70 (PNA) minus $202.90 (Part B) minus $30 (Part D), which is $1,497.10.4,13 The facility receives $1,497.10 from the resident plus the Medicaid daily rate. Patient liability is recalculated whenever income, premiums, or spousal allocation changes. The full mechanics are in the Georgia Medicaid Patient Liability and Cost of Care guide.

Planned versus emergency admission

A planned admission lets the family pre-establish durable Power of Attorney so an agent can sign the application as authorized representative, organize records for the look-back, and tour facilities. With POA in place, the family files the Medicaid application early in the Medicare SNF window, completes any needed spend-down with an elder law attorney, and reaches day 101 with no coverage gap.

An emergency admission, such as a sudden stroke with no POA, forces a guardianship detour that takes weeks and costs thousands of dollars, plus a records scramble for the look-back. This is exactly when retroactive coverage and the file-early rule matter most. Without POA, a spouse can often sign the application as the community spouse for shared decisions, but for the incapacitated person's individual assets the family may need emergency guardianship under O.C.G.A. §29-7-1 et seq. before the application can move. Federal spousal impoverishment rules protect the community spouse, who may keep countable assets up to the CSRA maximum and income up to the MMNA maximum.7

The first 30 days after admission

The first 30 days set the trajectory of the residency. Families should engage actively.

Days 1 to 3: Review the admission agreement carefully (or have an attorney review it). Confirm PASRR Level I is on file, and Level II if applicable. Confirm the DCH level of care assessment is initiated. Confirm the Medicaid application is filed. Note the facility's bed-hold and visitation policies. Identify the assigned social worker, nurse manager, and primary care nurse.

Days 4 to 14: Attend the initial care plan meeting. Review the MDS 3.0 assessment with the care team. Confirm the medication list is accurate, since errors at transitions are common. Confirm the advance directive and HIPAA authorization are on file. Establish a routine visit schedule.

Days 15 to 30: Follow up on Medicaid application status with DFCS. Confirm the level of care determination is approved. Schedule a 30-day care plan review. Connect with the Long-Term Care Ombudsman. Review billing and patient liability once Medicaid approves. If Medicaid is denied, file the hearing request with DFCS by the deadline printed on the notice of action: Georgia DFCS policy directs that a hearing on an eligibility decision be requested within 30 days of the notice, and federal rules cap any state's request window at 90 days rather than guaranteeing one, so the date on the notice governs.16 The hearing itself is conducted by the Georgia Office of State Administrative Hearings (OSAH).

The first 30 days are also the window for second chances. If the facility is not a good fit, families can transfer; residents have the right to choose their facility, and Medicaid coverage continues seamlessly when the new facility is Medicaid-certified. If the care plan is inadequate, families can request revisions.

Learn More

Find personalized help navigating the Georgia nursing facility admission process 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.