Georgia Medicaid Self-Directed Services 1915(j) (2026)

Georgia has not adopted Section 1915(j), the federal Medicaid self-directed personal assistance State Plan option, as a standalone authority. Georgia families who want to direct their own Medicaid care budget or pay a relative reach self-direction through other vehicles instead: Participant-Directed Services in the New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP), some direction of a personal care worker under the Community Care Services Program (CCSP), and Structured Family Caregiving under CCSP and SOURCE. This guide explains the federal Section 1915(j) framework, the Georgia vehicles that actually exist, and which path fits which family.

In This Guide

• What 1915(j) Is, and Why Georgia Has No Standalone Program
• How Section 1915(j) Self-Directed Services Compare to Other HCBS Authorities
• Why Some States Adopt 1915(j) and Georgia Has Not
• Georgia Medicaid Self-Directed Services Options
• Can You Be Paid to Care for a Family Member in Georgia?
• Worked Examples
• How to Start
• Frequently Asked Questions
• Learn More

What 1915(j) Is, and Why Georgia Has No Standalone Program

Section 1915(j) of the Social Security Act (42 U.S.C. 1396n(j)), implemented at 42 CFR Part 441 Subpart J, authorizes an optional self-directed personal assistance services State Plan benefit. Within an approved self-directed services plan and budget, participants purchase personal assistance and related services and hold employer and budget authority: they hire, fire, supervise, and manage the people who provide their care.1 That control is what lets a family member be the paid caregiver. Under Section 1915(j), a state may, at its option, permit participants to hire legally liable relatives, such as parents or spouses, as paid providers; a financial management services (FMS) entity makes the payments, withholds and reports taxes, and handles employer-related functions.3

Section 1915(j) traces to the Cash and Counseling demonstration, a consumer-directed personal-assistance experiment funded by the Robert Wood Johnson Foundation that gave Medicaid beneficiaries a cash allowance to hire and direct their own caregivers. The demonstration is commonly reported as having run in Arkansas, Florida, and New Jersey, and it built the evidence base for permanent self-direction. Congress added Section 1915(j) to the Social Security Act through Section 6087 of the Deficit Reduction Act of 2005 (Pub. L. 109-171).5

One point is widely misstated: because Section 1915(j) is a State Plan option, it is often assumed to require statewide availability and to forbid waiting lists. That is not how the statute works. Under 42 U.S.C. 1396n(j), a state may offer Section 1915(j) without regard to statewideness and may limit both the eligible population and the number of people served. A Section 1915(j) program is therefore a State Plan self-direction option, claimable as medical assistance, that the state may still geographically limit and cap.1

Section 1915(j) is also not its own door into Medicaid. A person becomes eligible for it only after qualifying for personal care or HCBS under another authority, such as Section 1905(a)(24) State Plan personal care or a Section 1915(c) waiver. Georgia has never adopted Section 1915(j) as a standalone State Plan authority; its self-direction runs through the Section 1915(c) waivers described below.2

How Section 1915(j) Self-Directed Services Compare to Other HCBS Authorities

Medicaid self-direction lives under several federal authorities, and they differ on who qualifies, whether self-direction is required, and how they are funded. Section 1915(j) is specifically a self-direction authority; Section 1915(k) Community First Choice raises a state's federal medical assistance percentage (FMAP) by 6 percentage points for its attendant services, while Section 1915(j) carries no such enhancement and is paid at the state's standard FMAP.5,3

A state can run several of these at once. Georgia operates Section 1915(c) waivers but has not adopted Section 1915(i), Section 1915(k), or standalone Section 1915(j).2 The funding contrast is one reason: a state seeking to maximize federal dollars for a self-direction expansion gets nothing extra from Section 1915(j), whereas Community First Choice adds 6 percentage points of FMAP.5

Why Some States Adopt 1915(j) and Georgia Has Not

States that adopt Section 1915(j) usually do so to formalize a single self-direction infrastructure, including financial management services and support brokers, and to let participants hold an individualized budget and pay family members as workers. Research from the Cash and Counseling demonstration found higher satisfaction and comparable or better outcomes than agency-delivered care.5

States that skip it tend to weigh four factors. First, there is no enhanced FMAP, so the financial incentive that drives Community First Choice adoption is absent.5 Second, the option requires real infrastructure: an FMS entity, support brokers, individualized-budget methodology, backup plans, and quality assurance.3 Third, states that already offer self-direction inside their Section 1915(c) waivers may see a standalone authority as redundant. Fourth, paying legally responsible relatives, especially spouses, remains a policy concern in many states.

Georgia fits that pattern. It already provides self-direction through NOW and COMP Participant-Directed Services and runs Structured Family Caregiving for live-in relatives, so a standalone Section 1915(j) authority would add infrastructure cost without enhanced federal funding, and the Georgia General Assembly has not directed its adoption.2,4

Georgia Medicaid Self-Directed Services Options

Georgia operates five Section 1915(c) HCBS waivers, each with its own administering agency, population, and level-of-care test. Three are run by the Georgia Department of Community Health (DCH) and two by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD).2

Participant-Directed Services in NOW and COMP

Georgia's most developed self-direction sits in the NOW and COMP waivers, administered by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), where it is offered as Participant-Directed Services. Eligibility for NOW or COMP requires an intellectual disability, or a closely related developmental disability such as autism, cerebral palsy, or epilepsy, that substantially impairs intellectual or adaptive functioning, with onset by age 18 for an intellectual disability or by age 22 for a developmental disability. The person must meet an institutional intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care and be Medicaid-eligible under the Medicaid Cap special income standard of 300% of the Supplemental Security Income (SSI) federal benefit rate ($2,982 per month in 2026).6

Under Participant-Directed Services, the participant or their representative directs the workers, and the federal self-direction model applies: an FMS entity handles payroll, tax withholding, and employer-related tasks. Whether a legally responsible relative, such as a spouse or a parent of a minor child, can be paid is a state option that varies by program, so families should confirm the current rule with DBHDD before counting on it.3

CCSP, SOURCE, and Personal Care Direction

CCSP and SOURCE, both administered by the Georgia Department of Community Health (DCH), serve older adults and adults with physical disabilities.2 CCSP participants can have some say over their personal care worker; the current scope of that direction is best confirmed directly with DCH, since it is narrower than the structured Participant-Directed Services in NOW and COMP. For older adults and adults with physical disabilities, the clearest documented Medicaid pathway to pay a relative is Structured Family Caregiving, covered next.

Structured Family Caregiving Under CCSP and SOURCE

Structured Family Caregiving is a service under Georgia's Elderly and Disabled Waiver, offered through the CCSP and SOURCE programs, that supports a live-in family caregiver providing care to the waiver member. A spouse, legal guardian, parent of a minor child, or conservator is not eligible to be the paid Structured Family Caregiver.4 Adult children, siblings, and other relatives who live with the member and are not in those excluded categories are the typical fit. Because rules on the payment amount and its tax treatment are set by the program and the IRS, families should confirm the current terms with DCH and ask a tax professional how the payment would be treated in their situation.

Can You Be Paid to Care for a Family Member in Georgia?

The honest answer depends on three things: your relationship to the person, which waiver they are enrolled in, and whether you live with them.

• Caring for a parent or other adult relative. If your relative has an intellectual or developmental disability and is on NOW or COMP, you may be paid as a worker under Participant-Directed Services if you are not a legally responsible relative and you meet the program's worker requirements.3 If your relative is an older adult or has a physical disability and is on CCSP or SOURCE, and you live with them, Structured Family Caregiving is usually the most accessible path.4
• Caring for a spouse. Through Georgia Medicaid, generally no. A spouse cannot be the paid Structured Family Caregiver, and self-direction programs treat spouses as legally responsible relatives whose payment is a state option Georgia has not broadly opened.4,3 If your spouse is a veteran, VA Aid and Attendance and VA-Directed Care may allow spousal payment in some circumstances.
• Other routes. Private pay and long-term care insurance can compensate a family caregiver outside Medicaid entirely. For a full map of every Georgia path to get paid as a family caregiver, including the VA programs that do pay spouses, see our Georgia paid-caregiver guide.

Worked Examples

These examples are illustrative. Names and circumstances are hypothetical, and eligibility always turns on an individual assessment.

Example 1: A daughter caring for her mother on CCSP

Patricia, 72, is enrolled in CCSP and needs help with bathing, dressing, and meals. Her daughter Sarah wants to be paid for the care she provides. Because Patricia is an older adult on CCSP, Sarah's clearest Medicaid path is Structured Family Caregiving: if Sarah lives with Patricia and is not an excluded relative (spouse, legal guardian, parent of a minor, or conservator, none of which apply), she may qualify as the paid live-in caregiver.4 If Sarah cannot live with Patricia, she should ask DCH what direction of a personal care worker CCSP currently allows.

Example 2: A sibling caring for an adult brother on NOW

David, 25, has Down syndrome, lives with his parents, and is on the New Options Waiver (NOW). His parents want his older sister Maria to be his paid worker. Under Participant-Directed Services, Maria can be considered because she is an adult sibling rather than a legally responsible relative; David's parents, who serve as his representatives, generally cannot be paid for the same reason.3 The family should confirm the current relative rules and worker requirements with DBHDD.7

Example 3: A spouse caring for her husband on ICWP

Henry, 50, has multiple sclerosis and is on the Independent Care Waiver Program (ICWP); his wife provides full-time care and wants to be paid. Through Georgia Medicaid, the path is narrow: a spouse cannot be the paid Structured Family Caregiver, and self-direction programs treat spouses as legally responsible relatives.4 If Henry is a veteran, VA Aid and Attendance or VA-Directed Care may help; otherwise private pay or long-term care insurance are the realistic options.

Example 4: An older adult who wants more control on CCSP

Margaret, 78, is on CCSP and has had scheduling conflicts with an agency-assigned worker. She wants to choose and direct her own worker. Margaret should ask DCH directly what personal-care direction CCSP currently permits, since its scope is narrower than the Participant-Directed Services available in NOW and COMP.2 If a non-spouse relative could move in with her, Structured Family Caregiving may be the stronger option.4

How to Start

Which step you take depends on the waiver your relative is enrolled in. Work through the path that fits your situation.

Where to Get Help

Learn More

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.