Medicaid Waivers

What is a Medicaid Waiver?

In Georgia, certain individuals with developmental disabilities and physical disabilities can qualify for supports through a Medicaid Waiver (also called home and community based services).  Medicaid Waivers are for individuals who need long term supports and prefer to receive the services at home rather than in a nursing facility or institution for developmental disabilities.

Medicaid Waivers can provide a wide range of services, including personal supports, nursing, residential services, respite, and employment assistance (in Georgia, this is limited to individuals with developmental disabilities).

Historically, Medicaid Waivers have not been available for individuals whose sole disability is a mental illness, although the federal government has made this a little easier for states to consider.

The Good and Bad of Medicaid Waivers

There are positives and negatives to Medicaid Waivers.  One positive is that a state can provide a wide range of services that can be tailored to meet the needs of individuals.  Also, most of the Waivers have a participant direct option that allow participants to hire and fire their caregivers.

On the negative side, a state can limit the number of people who can receive a Medicaid Waiver.  This can result in long waiting lists.  Georgia currently has over 9,000 people on the waiting list for its developmental disability waivers!  The state has been allowed to limit eligibility in other ways.  One physical disability Waiver, ICWP, is only available to individuals who apply for it prior to age 65.  Also, two of the physical disability Medicaid Waivers, CCSP and SOURCE, have a cost share that only allows individuals to keep a small amount of their income (around $735) for non-medical expenses.  The rest of their income must be used to help pay for the Waiver services.

Basic Eligibility for Medicaid Waivers

The different Medicaid Waivers have different eligibility criteria.  The two most important criteria, though, are (1) that the person has a low income and (2) the person has a disability significant enough to qualify the person to receive care  in a nursing facility or institution for developmental disabilities.

The income limit for most Medicaid Waivers is 300% of the federal payment standard for SSI.  This is approximately $2,215.  Individuals whose incomes are higher than this can sometimes use a qualified income trust to qualify for a Medicaid Waiver.  Unfortunately, two of the Medicaid Waivers, SOURCE and CCSP, require individuals with incomes above the SSI payment standard to contribute the income that exceeds SSI (around $735) to help pay for their Waiver services.

Georgia's Medicaid Waivers

Developmental Disabilities/Intellectual Disabilities:  Georgia has two Medicaid Waivers for people with developmental disabilities:  The NOW Waiver and The COMP Waiver.  The NOW Waiver is mostly for individuals living with family or other non-paid caregivers who need less than 24/7 supports.  The COMP Waiver is mostly for individuals who need supports 24 hours a day 7 days a week. It can also be available to people with substantial medical or behavioral needs.  Because there is a waiting list with over 9,000 people for these Waivers, it is important to apply for it as soon as possible.  It is also important to ensure that comprehensive assessments are completed during school years relating to IQ and adaptive functioning because these assessments will be needed when applying for the Waiver.  KEEP A COPY OF ALL PSYCHOLOGICAL ASSESSMENTS.  One can still qualify for the Waiver without these assessments but it may require substantial advocacy and additional testing.  To apply for the NOW and COMP Waivers, contact the intake and evaluation team in your regional office of DBHDD.

Physical Disabilities:  There are three Medicaid Waivers for people with physical disabilities.  The Independent Care Waiver Program, The Community Care Services Program, and The SOURCE Medicaid Waiver.  The Independent Care Waiver Program is only available to individuals who apply prior to age 65, although there is some question as to whether such limitation violates federal law.  The SOURCE Waiver has traditionally been limited to individuals whose income do not exceed the federal standard for SSI (approximately $735), but that is reportedly changing.  Both CCSP and SOURCE have a significant cost share as discussed above.

To apply for ICWP, contact the Georgia Medical Care Foundation (GMCF) at 678-527-3619 or 800-982-0411, ext. 3619.

To apply for SOURCE, you can apply through a SOURCE provider.

To apply for CCSP, you can apply through a local AAA office.