Georgia Medicaid covers so much of the state that the post-pandemic unwinding required a review of about 2.7 million members. If you are a family caregiver, an aging Georgian, or a person with a disability trying to make sense of it, the rules differ sharply depending on which of three eligibility pathways applies to you.

Administered by the Georgia Department of Community Health (DCH), Medicaid is the federal-state insurance program that pays for medical care, behavioral health, and long-term services and supports for low-income families, children, pregnant women, older adults, and persons with disabilities. Georgia is one of ten states that has not adopted full Medicaid expansion under the Affordable Care Act (ACA); instead, the state runs Georgia Pathways to Coverage, a limited Section 1115 demonstration for certain adults up to 100 percent of the Federal Poverty Level (FPL). This guide maps every key question about Georgia Medicaid to the article that answers it in full.

What Makes Georgia Medicaid Different

Three structural features distinguish Georgia from neighboring states.

1. Non-Expansion State With a Limited 1115 Alternative

Georgia is one of ten states that has not adopted full Medicaid expansion under ACA Section 2001. As of 2026, the standard Medicaid pathways for adults 19-64 do not include the 138 percent FPL expansion category. Instead, Georgia Pathways to Coverage, a Section 1115 demonstration that launched July 1, 2023, offers coverage to adults 19-64 with household income up to 100 percent FPL who complete at least 80 hours per month of a qualifying activity: employment, education, vocational training, community service, SNAP work-requirement compliance, or caring for a child under age 6 who is enrolled in (or applying for) Medicaid with the parent or legal guardian (added effective October 1, 2025). Members report their hours only at application and annual renewal; Georgia ended monthly reporting effective October 1, 2025. CMS temporarily extended and amended the demonstration through December 31, 2026: the CMS approval letter is dated September 23, 2025, the amended Special Terms and Conditions are stamped September 30, 2025, the Governor's office announced the approval on September 25, 2025, and DCH put the changes into effect October 1, 2025.

2. The SOURCE Care-Coordination Overlay

SOURCE (Service Options Using Resources in a Community Environment) is a Georgia-specific care-coordination model that operates as an alternative to the Community Care Services Program (CCSP), coordinating physician-led managed care with home and community-based services (HCBS). It is one of the most distinctive Medicaid long-term-services designs in the Southeast.

3. Three CMOs With Statewide Operations

Acute care for Family Medicaid runs through Georgia Families managed care, contracting with three statewide Care Management Organizations (CMOs): Amerigroup Community Care, CareSource, and Peach State Health Plan. WellCare of Georgia is no longer a separate Georgia Families CMO. A 2024 reprocurement proposing a different slate of plans remains in the protest phase; DCH extended the current three-CMO contracts through June 30, 2027.

Who Georgia Medicaid Covers

Georgia Medicaid covers:

There is no broad ACA-expansion adult category for non-disabled, non-pregnant, non-parent adults 19-64; Pathways partially fills this gap with conditions.

The Three Eligibility Pathways for Adults

Which pathway applies depends on your age, disability status, and whether you are seeking long-term care.

Pathway Income Test Asset Test Population
MAGI Income only (no asset test); pregnant women up to 220% FPL, parents at low thresholds None Pregnant women, parents, and caretaker relatives
ABD $994 single / $1,491 couple (SSI Federal Benefit Rate) $2,000 single / $3,000 couple Adults 65+, blind, or disabled, not seeking long-term care
LTC $2,982 single (Special Income Limit; Miller Trust required at or above it) $2,000 single Nursing-facility residents and HCBS waiver applicants

1. MAGI (Modified Adjusted Gross Income)

For pregnant women, parents, and caretakers, using ACA-style income-only rules with no asset test. Pregnant women qualify up to 220 percent FPL.

2. ABD (Aged, Blind, Disabled)

For adults 65+ or with an SSA-defined disability who are not seeking long-term care. The 2026 income limit is $994 single / $1,491 couple (the SSI Federal Benefit Rate), and the asset limit is $2,000 single / $3,000 couple. Georgia's ABD Medicaid is SSI-linked: the state covers SSI recipients automatically, so an SSI check is itself the eligibility route.

3. LTC (Long-Term Care)

For adults seeking nursing-facility care or HCBS waiver enrollment. The 2026 Special Income Limit is $2,982 single (300 percent of the SSI Federal Benefit Rate) and the asset limit is $2,000 single. Georgia is an income-cap state, so an applicant whose gross income is at or above the cap and who has not set up a Qualified Income Trust is income-ineligible for every long-term-care class of assistance and is instead budgeted under Georgia's Medically Needy pathway, which measures excess income as a spend-down rather than paying for waiver or nursing-facility care. Establishing the trust is what opens the long-term-care door. A 60-month look-back applies to asset transfers.,,

When one spouse enters a nursing facility, federal spousal impoverishment rules set a Community Spouse Resource Allowance that runs from a floor of $32,532 to a ceiling of $162,660 in 2026, and each state elects its own standard inside that range. The $162,660 figure is the federal maximum, not an amount every state grants, so confirm Georgia's operative standard with DFCS or see the Georgia spousal-impoverishment guide below before you plan around a number.

For the operational detail on each pathway, see Georgia Medicaid Eligibility and Income Limits, Georgia Medicaid Long-Term Care, and Georgia Medicaid Spousal Impoverishment.

Georgia's HCBS Waivers

Georgia operates four Section 1915(c) HCBS waivers.

  • Elderly and Disabled Waiver Program (EDWP): for frail elderly and disabled Georgians who meet nursing-facility level of care and need services to remain in the community. Administered by DCH; slot-capped with waitlists. EDWP is delivered through two service models, not two waivers: the Community Care Services Program (CCSP) and SOURCE (Service Options Using Resources in a Community Environment), a physician-coordinated model for high-need members that adds enhanced case management through a primary care physician.
  • Independent Care Waiver Program (ICWP): for adults who apply between the ages of 21 and 64 with severe physical disabilities or traumatic brain injury who would otherwise need hospital or nursing-facility care. Administered by DCH; slot-capped with significant waitlists.
  • NOW (New Options Waiver) and COMP (Comprehensive Supports Waiver): for people with an intellectual disability or a closely related developmental disability that began at birth or during the developmental years (by age 18 for an intellectual disability, by age 22 for a developmental disability). Administered by DCH, which delegates day-to-day operation to the Department of Behavioral Health and Developmental Disabilities (DBHDD) through six regional field offices; long waitlists.

While You Wait for a Waiver

EDWP (through both its CCSP and SOURCE models), ICWP, NOW, and COMP are all slot-capped, so a level-of-care-eligible applicant may sit on a waitlist. In the meantime, an older or disabled adult who meets the ABD financial limits can still receive standard Medicaid for acute care (doctor, hospital, and prescription coverage) while waiting for a waiver slot.

Georgia Families Managed Care: The Three CMOs

Most Family Medicaid members receive care through Georgia Families managed care. The three 2026 CMOs all operate statewide:

  • Amerigroup Community Care (Elevance Health affiliate), which also administers Georgia Families 360, the specialty plan for foster children, former foster youth, and adoption assistance
  • CareSource Georgia
  • Peach State Health Plan (Centene affiliate)

A new member is enrolled into a plan automatically and then has 90 days from that plan's start date to switch to a different one. Georgia Families, the state's enrollment broker, can walk you through the plans and their provider networks at 1-888-423-6765 (TDD 1-877-889-4424) or at georgia-families.com. See Georgia Families Managed Care Plans for details.

Pathways to Coverage (Section 1115 Demonstration)

Georgia Pathways to Coverage is a limited Medicaid expansion alternative that launched July 1, 2023. It covers adults 19-64 with household income up to 100 percent FPL who complete at least 80 hours per month of a qualifying activity (employment, education, vocational training, community service, SNAP work-requirement compliance, or caring for a child under age 6 who is enrolled in or applying for Medicaid with the parent or legal guardian, added October 1, 2025). Members report only at application and annual renewal. Coverage is effective the first day of the month in which you applied, but payment for services back to that date is available only once you have actually been determined eligible, including meeting the qualifying-hours requirement, so filing alone does not lock in the retroactive month. Members pay the same copayments as other Georgia Medicaid members for certain services, with none required for those under 21 or for members enrolled in HIPP. CMS temporarily extended and amended the demonstration through December 31, 2026 (approval letter dated September 23, 2025; amended terms stamped September 30, 2025; effective in Georgia October 1, 2025). Comprehensive Medicaid benefits are delivered through Georgia Families CMOs. Pathways is the only Georgia coverage route for adults 19-64 who are not parents, pregnant, disabled, or 65+.

See Georgia Pathways to Coverage for the full rules and how to enroll.

How to Apply

Applying for Georgia Medicaid follows a defined sequence.

1
Step 1

Gather your documents

Collect proof of income, citizenship, and Georgia residency, plus insurance cards. Long-term-care applications also need 60 months of bank statements and asset records (deeds, titles, retirement accounts, life insurance), and a functional assessment through your Area Agency on Aging for CCSP or SOURCE.

2
Step 2

Set up a Miller Trust if your income reaches the cap

For long-term care, if your gross monthly income is $2,982 or more, establish a Qualified Income Trust before or alongside your application and deposit the excess each month. The trigger is income equal to or greater than the cap, not merely above it. Without the trust, the applicant is income-ineligible for every long-term-care class.

3
Step 3

Submit the application

Apply online at gateway.ga.gov, by phone at 1-877-423-4746, or in person with Form 700 at a county Division of Family and Children Services (DFCS) office.

4
Step 4

Complete any level-of-care screening

Long-term-care applicants receive a clinical level-of-care assessment in addition to the financial review, determining whether they meet the nursing-facility level of need.

5
Step 5

Respond to requests and await the decision

Federal timeliness rules cap the agency at 45 calendar days for most applications and 90 calendar days for applications made on the basis of disability, measured from the application date to the date you are notified of the decision. Once you are found eligible, coverage reaches back to the third month before the month you applied for services you would have qualified for then. Plan around one change: for applications filed on or after January 1, 2027, federal law shortens that window to a maximum of two months before the application month for most enrollees. If unpaid care is already sitting on the table, that makes the filing date worth acting on now.

See How to Apply for Georgia Medicaid for the full document checklist and what to expect after submission.

Estate Recovery in Georgia

Georgia's Medicaid Estate Recovery Program is governed by O.C.G.A. § 49-4-147.1 and applies to Medicaid long-term-care recipients age 55 and older who received nursing-facility, HCBS waiver, or related services. Federal law (42 U.S.C. § 1396p(b), OBRA 1993) requires every state to seek recovery from the estate of such a recipient.

Federal law lets a state stop at the probate estate or reach further, and Georgia reaches further. Implemented by DCH rule at Ga. Comp. R. & Regs. Chapter 111-3-8, Georgia uses an expanded estate definition: all real and personal property in the probate estate, plus property passing by joint tenancy, right of survivorship, life estate, trust, annuity, Individual Retirement Account, homestead, or any other arrangement. Do not assume a jointly held house, a survivorship deed, or a retirement account with a named beneficiary is out of reach in Georgia.

Two Georgia protections are worth knowing. An estate with a gross value of $25,000 or less is exempt from recovery outright, and for members dying on or after July 1, 2018 the Commissioner must waive any claim against the first $25,000 of a larger estate. Federal limits apply on top: recovery may be made only after the death of a surviving spouse, which postpones the claim rather than cancelling it, and only when there is no surviving child who is under 21, blind, or permanently and totally disabled. Every state must also have a procedure to waive recovery for undue hardship.

See Georgia Medicaid Estate Recovery for the full rules, exceptions, and hardship process.

Medicare Savings Programs and Dual Eligibility

Georgia Medicaid administers three Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries, processed by DFCS through Georgia Gateway. The 2026 monthly income limits (single) are:

  • QMB (Qualified Medicare Beneficiary): up to $1,350, covering Medicare premiums plus Medicare Part A and Part B cost-sharing,
  • SLMB (Specified Low-Income Medicare Beneficiary): up to $1,616, paying the Part B premium only, with no Medicare cost-sharing protection attached,
  • QI (Qualifying Individual): up to $1,816, paying the Part B premium

The resource limit for all three is $9,950 single / $14,910 couple in 2026. Federal law bars every Medicare provider, supplier, and pharmacy from billing a QMB enrollee for Medicare Part A or Part B cost-sharing, including deductibles, coinsurance, and copayments, even when Georgia Medicaid pays nothing toward it. That protection is specific to Parts A and B, so it does not by itself cover a Part D drug copay or a charge for a service Medicare does not cover at all.

Dual eligibles in Georgia can use Original Medicare with Medicaid as secondary, or a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) coordinated with Medicaid. See Georgia Medicare Savings Programs for full details.

What Long-Term Care Costs in Georgia

Medicaid becomes essential because long-term care is expensive. A semi-private nursing-home room in Georgia runs about $105,850 per year, or roughly $290 a day, according to the 2025 CareScout Cost of Care Survey, which builds that annual figure on 365 days of care. Medicaid covers the full cost once a resident meets financial and clinical eligibility; the resident then contributes nearly all monthly income toward care, keeping only Georgia's $70 Personal Needs Allowance (well above the $30 federal minimum) plus deductions for health-insurance premiums and any community-spouse allowance.,

Georgia has no confirmed operating PACE (Program of All-Inclusive Care for the Elderly) site as of mid-2026; the state issued a PACE Request for Proposals and remains in the procurement stage.

Frequently Asked Questions

Is Georgia a Medicaid expansion state?

No. Georgia has not adopted full Medicaid expansion under ACA Section 2001. The state runs Georgia Pathways to Coverage, a limited Section 1115 demonstration covering certain adults up to 100 percent FPL who complete 80 hours per month of a qualifying activity.

Do I need a Miller Trust for Georgia Medicaid?

Only for long-term care (nursing facility or HCBS waiver), and only if your gross monthly income is at or above the Special Income Limit of $2,982 in 2026. Georgia is an income-cap state, so an applicant who reaches that figure must establish a Qualified Income Trust (Miller Trust) and deposit the excess each month to qualify. Note that the trigger is income equal to the cap, not just income over it.

What is the asset limit for Georgia Medicaid?

$2,000 for a single applicant and $3,000 for a couple, for the ABD and long-term-care categories. MAGI-category Medicaid (pregnant women, parents, children) has no asset test.

What is the difference between CCSP and SOURCE?

Neither is a separate waiver. Both are service-delivery models inside Georgia's Elderly and Disabled Waiver Program (EDWP). CCSP (Community Care Services Program) provides the community-based services; SOURCE is a physician-coordinated alternative that adds a Care Coordinator and an integrated medical home for high-need members. Both use the same long-term-care financial eligibility.

Does Georgia recover from my non-probate assets after death?

Often yes. Georgia is not a probate-only state: its estate definition is expanded to include property passing by joint tenancy, right of survivorship, life estate, trust, annuity, Individual Retirement Accounts, homestead, or any other arrangement, on top of the probate estate. An estate worth $25,000 or less is exempt, and the first $25,000 of a larger estate is waived for members dying on or after July 1, 2018. Recovery is also postponed until after a surviving spouse's death and barred while a surviving child is under 21, blind, or permanently and totally disabled.

If Georgia Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road, and the deadline to challenge it is usually shorter than people expect.

Georgia's deadline is 30 days, not 90. Georgia DFCS policy directs that a hearing be requested within 30 days of notification of the decision you disagree with. Federal law guarantees every Medicaid applicant and beneficiary the right to that hearing, whether the dispute is about eligibility or about a service being reduced or ended. The 90 days you may have read about is 42 CFR 431.221(d)'s ceiling on what a state may allow, not a floor you are entitled to, and Georgia's shorter window is fully enforceable against you. Go by the date printed on your own notice.

A second, much earlier deadline decides whether coverage keeps running while you appeal. Federally, continuation turns on requesting the hearing before the date the action takes effect; Georgia states it as a request for continuation received within 10 days of the date of a timely or adequate notice. Miss the earlier date and you may still appeal, but coverage can stop in the meantime.

The hearing itself is held by the Office of State Administrative Hearings (OSAH), which the state agency transmits your request to; its toll-free line is 1-877-809-0007. See Georgia Medicaid Appeals and Fair Hearings for how to file and what happens after a decision.

Keeping Georgia Medicaid Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency rather than on you. Before it asks you for anything, Georgia Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot. If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Georgia may offer the same windows but is not required to, so ask DFCS what applies to you.

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise). So a MAGI renewal missed by a few weeks is usually recoverable; on any other pathway, ask DFCS before you assume it.

Open anything that arrives from Georgia Medicaid and return a renewal form the week it comes. See Georgia Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Georgia Department of Community Health / DFCS Handles Medicaid eligibility, applications (Form 700), and fair-hearing requests; the Georgia Gateway portal manages Medicaid, SNAP, and TANF cases. 1-877-423-4746https://dhs.georgia.gov/contact gateway.ga.gov
Georgia Families (Managed Care Enrollment) Enrolls new members in a CMO, manages plan choice and just-cause changes. 1-888-423-6765 gafhk.georgia.gov
Area Agency on Aging (Empowerline) Statewide information and referral for older adults, including CCSP and SOURCE intake and the Long-Term Care Ombudsman. 1-404-463-3333
GeorgiaCares (SHIP) Free Medicare and Medicare Savings Program counseling for Georgia seniors. 1-866-552-4464https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship

For free legal help, contact the Georgia Legal Services Program (1-833-457-7529, serving the 154 counties outside metro Atlanta) or Atlanta Legal Aid (1-404-524-5811).

Learn More

MedicaidMedicaid by State: Eligibility, Coverage, and How to ApplyMedicaid works differently in every state, from who qualifies to what's covered and how to apply. See what varies and jump to your state's full guide. MedicaidGeorgia Medicaid Eligibility and Income LimitsGeorgia Medicaid income limits in 2026: the $994 ABD limit, $2,982 long-term-care cap, $2,000 asset limit, Miller Trust, CSRA, and Pathways to Coverage. MedicaidHow to Apply for Georgia MedicaidHow to apply for Georgia Medicaid in 2026: Georgia Gateway, your local DFCS office, Form 700, the documents you need, processing timelines, and how to appeal. MedicaidGeorgia Medicaid Personal Needs AllowanceGeorgia Medicaid's Personal Needs Allowance is $70 a month for nursing facility residents in 2026. Learn how the patient liability calculation protects it. MedicaidGeorgia Medicaid Long-Term CareGeorgia Medicaid long-term care in 2026: nursing facility coverage, four HCBS waivers (EDWP with CCSP and SOURCE, ICWP, NOW, COMP), PACE, and how to apply. MedicaidGeorgia Medicaid Spousal ImpoverishmentHow Georgia Medicaid spousal impoverishment rules protect the at-home spouse in 2026: a CSRA of $32,532–$162,660, an MMMNA income floor, and an income cap. MedicaidGeorgia Medicaid Estate RecoveryGeorgia Medicaid estate recovery in 2026: the expanded estate definition, the $25,000 waiver, federal exemptions, and how to answer a notice of claim. MedicaidGeorgia Medicare Savings ProgramsGeorgia Medicare Savings Programs in 2026: how QMB, SLMB, QI, and QDWI pay Medicare premiums and cost-sharing, the income and asset limits, and how to apply. MedicaidGeorgia Families Managed Care PlansGeorgia Medicaid managed care in 2026: the three Georgia Families CMOs (Amerigroup, CareSource, Peach State), how to choose a plan, and how to switch. MedicaidGeorgia Pathways to CoverageGeorgia Pathways to Coverage in 2026: who qualifies at 100 percent of FPL, the 80-hour monthly activity rule, and reporting at application and annual renewal.

For help making sense of Georgia Medicaid and where to start, visit 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.

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Brevy Care Team

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