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

There is no standalone Section 1915(j) program in Georgia's Medicaid program inventory. Section 1915(j) is the federal Medicaid State Plan option for self-directed personal assistance, and 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), Personal Support Consumer Direction 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 States Adopt 1915(j), and What Georgia Runs Instead
• Georgia Medicaid Self-Directed Services Options
• Can You Be Paid to Care for a Family Member in Georgia?
• Worked Examples
• How to Start with Georgia Medicaid Self-Directed Services
• 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).6

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) also governs how services are delivered rather than who qualifies for them. Self-direction is a service-delivery model that gives the person receiving care, or their representative, control over the budget, planning, and purchase of their services.3 Georgia delivers its home and community-based waiver programs, including the Elderly and Disabled Waiver, under Section 1915(c) authority.7 Its self-direction runs through the Section 1915(c) waivers described below, and the Department of Community Health's program inventory lists no standalone Section 1915(j) State Plan program a Georgia family could apply to.2

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

Medicaid self-direction lives under several federal authorities that differ on who qualifies, whether self-direction is required, and how they are funded. Section 1915(k) Community First Choice raises a state's federal medical assistance percentage (FMAP) by 6 percentage points for its attendant services; Section 1915(j) carries no such enhancement and is paid at the state's standard FMAP.8,3 They also differ on reach: Community First Choice must be available statewide with no enrollment cap or waiting list, and its attendant services must be self-directed.9 Section 1915(j) carries neither requirement.1

A state can run several of these at once. Georgia runs the Section 1915(c) route; no Section 1915(i), Section 1915(k) Community First Choice, or standalone Section 1915(j) program appears in its published Medicaid program inventory.2 That is an absence of documentation, not proof the state runs none, so ask DCH if one would change your plan.

Why States Adopt 1915(j), and What Georgia Runs Instead

Section 1915(j) gives a state one formal self-direction structure: an approved plan and budget for each participant, a financial management entity that pays the workers and handles tax withholding and reporting, and the option to let participants hire legally liable relatives such as parents or spouses.3 The Cash and Counseling demonstration built the evidence base for making self-direction permanent.6

Two things weigh against adopting it. There is no enhanced FMAP, so the financial pull behind Community First Choice adoption is absent.8 And the option requires infrastructure: a financial management services entity to make payments and handle tax withholding and reporting, plus an approved self-directed services plan and budget for every participant.3,1

Georgia already runs self-direction through NOW and COMP Participant Direction and Structured Family Caregiving, so a standalone Section 1915(j) authority would add that infrastructure cost without enhanced federal funding.2,4

Georgia Medicaid Self-Directed Services Options

Georgia operates four Section 1915(c) HCBS waivers, each with its own population and level-of-care test. The Georgia Department of Community Health (DCH) administers all four as the single state Medicaid agency; for NOW and COMP it delegates day-to-day operation to the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) through six regional field offices.2

Participant-Directed Services in NOW and COMP

Georgia's most developed self-direction sits in the NOW and COMP waivers, operated day to day by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), where it is offered as Participant Direction.5 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).10

Under Participant Direction, 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.3 Hiring a family member is handled through NOW and COMP's separate Family Hire rules, and it is not automatic: Family Hire is approved case by case with documented hardship, regional review, and annual renewal. Spouses, parents of a minor child who is the Medicaid recipient, legal guardians, and conservators are barred, and the person named as the participant's Representative for Participant-Directed Services cannot be hired as paid staff. Parents of an adult recipient are allowed under Family Hire. The COVID-era Appendix K flexibilities ended November 11, 2023, and the original Family Hire rules in the COMP/NOW Provider Manual were reinstated the following day.5

CCSP, SOURCE, and Personal Care Direction

CCSP and SOURCE, the two service-delivery models inside the Elderly and Disabled Waiver Program administered by the Georgia Department of Community Health (DCH), serve older adults and adults with physical disabilities.2 CCSP's participant-direction service is Personal Support Consumer Direction (PSCD). Under PSCD the participant directs their own personal support workers, and adult children, siblings, grandchildren, and other adult relatives may be hired. SOURCE and ICWP allow participant direction of their personal support services too. Across all three, Georgia applies the same relative bar: a spouse, a parent of a minor recipient, a legal guardian, or a conservator cannot be hired as the paid worker.5 Ask the member's case manager to start PSCD or its equivalent on their program; for a live-in relative, Structured Family Caregiving, covered next, usually pays more.

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. Holding power of attorney for the member is not one of Georgia's published disqualifiers, so if you hold POA, ask the case manager how it affects your case rather than assuming you are barred.5

In 2026 the stipend runs roughly $80 a day, about $560 a week, or roughly $1,987 to $2,400 a month. The caregiver typically receives 50% to 65% of the per diem Medicaid pays the SFC agency, which keeps the balance for nurse visits, coaching, 24/7 support, training, and backup respite. The payment is treated as a difficulty-of-care payment excludable from federal income tax under IRS Notice 2014-7 when the caregiver lives in the recipient's home.5 Rates are set by the waiver and the SFC agency and can change, so confirm the current per diem before you plan around it.

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

The answer depends on three things: your relationship, which program 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 Direction, through Family Hire: approved case by case with documented hardship, regional review, and annual renewal.5 An adult child, sibling, or the parent of an adult recipient is eligible; a spouse, the parent of a minor recipient, a legal guardian, and a conservator are not. If your relative is an older adult or has a physical disability on CCSP or SOURCE and you live with them, Structured Family Caregiving is usually the most accessible path; if you cannot live with them, CCSP's Personal Support Consumer Direction (PSCD) lets them hire you as a directed personal support worker instead.5,4
• Caring for a spouse. Not through Georgia Medicaid. A spouse cannot be the paid Structured Family Caregiver,4 and the same spouse bar runs across every Georgia Medicaid self-direction route: CCSP's PSCD, SOURCE participant direction, ICWP self-directed Personal Support Services, and NOW and COMP Family Hire. The routes that can pay a spouse are VA programs and private pay.5 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 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

Names below are hypothetical; 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 that care. 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 move in, her fallback is CCSP's Personal Support Consumer Direction (PSCD), which lets Patricia direct her own worker and expressly permits hiring an adult child.5

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 Direction, Maria can be considered because she is an adult sibling rather than a legally responsible relative.3 David's parents are worth a second look too: because David is an adult, a parent is not barred from Family Hire the way a parent of a minor recipient is. Either way the hire is not automatic. It needs documented hardship, regional review, annual renewal, and a background check, PCA exam, TB screening, and CPR/First Aid certification.5 Start that conversation with DBHDD.11

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. ICWP does offer self-direction of its Personal Support Services, but it excludes spouses, parents of minor children, legal guardians, and conservators from being hired as paid workers, so Henry's wife cannot be paid through it. Power of attorney is not among Georgia's published disqualifiers, and DCH does not publish the ICWP paid-relative rules on a retrievable state page, so a relative in a borderline role should ask the case manager rather than assume. Structured Family Caregiving is not an alternative either: it is a CCSP and SOURCE service, and an ICWP recipient is enrolled in one waiver, not several. An adult child, sibling, in-law, or cousin could be hired under ICWP self-direction instead.5 If Henry is a veteran, VA Aid and Attendance or VA-Directed Care may help; otherwise private pay is the realistic option.

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. The service she wants is Personal Support Consumer Direction (PSCD), which lets her choose and direct her own worker; she should ask her Area Agency on Aging case manager to add it to her care plan.5

How to Start with Georgia Medicaid Self-Directed Services

Which step you take depends on the program your relative is enrolled in.

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.