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 from the Georgia Division of Family and Children Services (DFCS), which by federal rule has up to 45 days. A stall on any one leaves the family paying privately for weeks. Families who start the slow track first, in the first week of the Medicare skilled-nursing stay, keep 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, the moment months or years of preparation meet 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 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 then.9 When one stalls, the family pays the facility privately in the meantime, and even a short delay can cost thousands that would otherwise have been covered.

This guide walks through who decides what, what paperwork is required, what deadlines matter, and what to do before, during, and after admission so coverage begins as early as possible. Read it before the admission, not during.

The Georgia nursing facility admission process: three parallel tracks

Every Georgia nursing facility admission for Medicaid runs three separate processes in parallel. What each track does, who runs it, and what triggers it is the foundation of everything below.

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

Preadmission Screening and Resident Review (PASRR) is a federal Medicaid requirement under section 1919(e)(7) of the Social Security Act, implemented at 42 CFR 483.100 through 483.138. It reaches every individual with mental illness or intellectual disability who applies to or resides in a Medicaid-certified nursing facility, whoever is paying: private-pay, Medicare and Medicaid admissions all run PASRR. Preadmission screening is not quite universal, though: 42 CFR 483.106(b)(1) subjects new admissions to it with the exception of certain hospital discharges the next paragraph describes, so a direct hospital-to-facility transfer may travel a different route.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 making two determinations: whether the individual needs the nursing-facility level of care, and whether they need specialized services beyond what the facility provides. In Georgia it 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 have to discharge them, and Medicaid payment may be denied. Confirm in writing that Level I is done before signing admission paperwork. The screen itself, including Georgia's Level I contractor and the categorical determinations, is covered in the Georgia Medicaid PASRR Screening guide.

Track 2: Level of care determination (Georgia DCH)

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

In Georgia the Georgia Department of Community Health (DCH) determines LOC. The assessment weighs the need for 24-hour nursing supervision, help with activities of daily living (eating, bathing, dressing, toileting, transferring), cognitive function, conditions needing ongoing monitoring, and behavioral or psychiatric symptoms needing nursing oversight. A registered nurse at the admitting facility or an independent assessor usually completes it, and it is reviewed annually and on any 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 or by paper at the local DFCS office, and the documentation is extensive: photo ID; Social Security number; proof of citizenship or lawful immigration status; income records; asset records (bank statements covering the look-back, deeds, vehicle titles, life insurance, retirement accounts); Medicare and other insurance information; a marriage certificate if married; Power of Attorney papers if someone else signs; and details of 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 on the basis of disability. Those are ceilings on the agency, not a promise of how quickly your decision comes back, and Georgia sets its own timeliness standards in its State plan and must tell applicants what they are, so the state's own standard may be tighter than the federal cap. The regulation also lets DFCS run past the standard "in unusual circumstances, for example" a delay or failure to act by the applicant or an examining physician, an administrative emergency beyond the agency's control, or the 30-calendar-day response window an applicant gets after a community-engagement notice of noncompliance. Read "for example" literally: that list illustrates the unusual circumstances rather than closing the set, so a family told the three are exhaustive will escalate over a delay that is lawful.3

Two protections travel with those standards and are worth knowing before you need them. Where the agency does delay, it must document the reasons in the applicant's case record, which you can ask to see. And the agency may not use the time standards as a waiting period before determining eligibility, nor as a reason for denying eligibility because it failed to decide in time. A denial whose stated reason is that DFCS ran out of time is not a lawful denial, and returning every requested document promptly is what keeps the deadline enforceable.3

The three run on different clocks. Level I must be done before admission; Level II, when triggered, takes days to weeks; the DCH assessment usually lands within two weeks; the DFCS application is the slow track at up to 45 days. Starting the slow one first is the central challenge.

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: $0 a day, but that is after the Part A deductible, not instead of it. Medicare.gov states the row as "$0 each day after you pay the $1,736" deductible; a beneficiary who came from the qualifying hospital stay in the same benefit period has normally already paid it and owes nothing further.4,11
• 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 transition point. A family expecting long-term residency must file the Medicaid application during the Medicare SNF window so coverage can start on day 101 without a gap. Filing in week one leaves DFCS its full 45-day limit before Medicare ends, though that limit caps the agency rather than guaranteeing a decision by a 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. Confirm inpatient status with the hospital before relying on the Medicare SNF benefit, and if the parent is in a Medicare Advantage plan, ask whether it waives the three-day stay.5

If the hospital switched your parent to observation status

Do not accept that as the end of the matter, because it is the most common way a family loses a Medicare-covered SNF stay. If your parent was admitted as an inpatient and the hospital then changed the status to "outpatient getting observation services" on or after February 14, 2025, there is a fast appeal, and it does not close at the hospital door. Medicare.gov's own instruction is that filing while still in the hospital is best, but that appeal rights survive discharge: follow the instructions on the Medicare Change of Status Notice (CMS-10868) the hospital should give before you leave, and if you cannot find it, contact your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), which is Commence or Acentra depending on the state. The organization decides about two days after you file. If the appeal succeeds, you owe the Part A inpatient hospital deductible ($1,736 in 2026), and your parent may qualify for a Medicare-covered SNF stay within 30 days of that hospital discharge, which is exactly the coverage the status change took away. A separate, older route for stays between January 1, 2009 and February 13, 2025 closed to new filings on January 2, 2026 and is now open only on a written showing of good cause for filing late.4

Hospital discharge planning: the front door

For most Georgia admissions the hospital is the front door. Under 42 CFR 482.43 every Medicare-participating hospital must have a discharge planning process. The planner, usually a social worker or nurse, coordinates the move to post-acute care: assessing needs, listing area facilities, coordinating PASRR Level I, transferring records, and talking to the family and the Power of Attorney agent. The hospital cannot push a patient toward a specific facility; the choice is the family's.

Discharge is the most time-pressured part of the process, because hospitals and utilization review push to move patients out, sometimes before the family has chosen a facility. Engage the discharge planner within the first 24 to 48 hours to begin facility selection, PASRR coordination, and 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, and $2,000 is not the number for a married applicant whose spouse stays home: Georgia's own 2026 Appendix A1 resource chart states that case as "$162,660 + 2000 = $164,660," the community spouse's protected share plus the applicant's own $2,000.6 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 And equity above the limit is not a permanent bar even where no such relative lives there: 42 U.S.C. 1396p(f)(3) provides that nothing in the subsection prevents an individual from using a reverse mortgage or a home equity loan to reduce their total equity interest in the home, so the equity can be brought below the line. The Secretary must also maintain a process for waiving the limit in a demonstrated hardship.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 for less than fair market value during the 60-month look-back can trigger a penalty period during which Medicaid will not pay for long-term care.12 Medicaid paid for nursing facility care is also subject to estate recovery after death, and only assistance correctly paid is recoverable at all: recovery may be made only after a surviving spouse has died, and only when there is no surviving child under 21 or blind or permanently and totally disabled. Every state must also waive recovery for 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. Do not assume coverage starts on the first day of that third month. The regulation fixes only the outer boundary: 42 CFR 435.915(b) says the agency may make eligibility effective on the first day of a month in which the individual was eligible at any time, and 435.915(c) requires the State plan to specify the date eligibility actually takes effect. The window is federal; the precise start date inside it is a state-plan choice.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

Quality varies widely across Georgia facilities, and three free public tools let families compare.

Other selection factors

Beyond those three, confirm Medicaid bed availability (not every facility accepts every payer) and dual Medicare/Medicaid certification, which is what prevents a forced transfer at day 101. Weigh specialized programs (dementia care, behavioral health units, hospice partnerships), location, and visitation policies. An in-person tour with as many family members as possible reveals more than any report: how staff speak to residents, how clean the place is, and how the residents themselves look.

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 resident and facility, and its most consequential clause is the responsible-party or financial-guarantor language. Federal law at 42 CFR 483.15(a)(3) bars a facility from requiring a third-party guarantee of payment as a condition of admission or continued stay. It may ask a resident representative who has legal access to the resident's funds to agree to pay from those funds, but signing as agent under Power of Attorney creates no personal liability when signed clearly as "Agent for [Principal]." Do not sign as personally liable unless you 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. names a healthcare agent and sets treatment preferences, and should be on file before admission, as should a HIPAA authorization naming who may receive the resident's health information and the PASRR documentation. The financial agreement specifies the payment source; a Medicaid-pending resident may be charged private-pay rates with a refund if Medicaid is approved retroactively, so confirm that refund provision is clear. Within 14 days the facility must complete a Minimum Data Set 3.0 assessment under 42 CFR 483.20 and an initial care plan, and the family has the right to take part.

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 $1,800 a month in Social Security, paying the standard 2026 Part B premium of $202.90 and a Part D premium of $30, owes $1,800 minus $70 (PNA) minus $202.90 minus $30, which is $1,497.10.4,13 The facility receives that plus the Medicaid daily rate, and the figure is recalculated whenever income, premiums, or spousal allocation change. 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, a sudden stroke with no POA, forces a guardianship detour that takes weeks and costs thousands, 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 as the community spouse, but reaching the incapacitated person's individual assets may need emergency guardianship under O.C.G.A. §29-7-1 et seq. first. 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.

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

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

Days 15 to 30: Follow up with DFCS on application status, confirm the level of care determination is approved, schedule the 30-day care plan review, connect with the Long-Term Care Ombudsman, and check 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 the applicant to request a hearing within thirty days of notification of the decision they disagree with, and an oral request must be followed by a written one within fifteen days. Federal rules cap any state's request window at 90 days rather than guaranteeing one, so the date on the notice governs.16

If you have already missed that thirty-day deadline, file anyway rather than assuming the appeal is lost. Under the same Georgia policy, every hearing request is forwarded to the Office of State Administrative Hearings regardless of when it was received; for an untimely request the DFCS hearing representative puts the timeliness policy into evidence and an Administrative Law Judge decides whether good cause exists. Ask for that good-cause determination. The hearing is conducted by the Georgia Office of State Administrative Hearings (OSAH).16

These are also the weeks for second chances. If the facility is not a good fit, transfer: residents choose their facility, and Medicaid coverage continues when the new one is Medicaid-certified. If the care plan is inadequate, ask for 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.