My parent has Medicaid and needs a caregiver. Where do I start?

Start with one phone call

The front door to Georgia’s Elderly and Disabled Waiver Program is your Area Agency on Aging. In the metro Atlanta region that is the Atlanta Regional Commission, and the service you are looking for is called Empowerline. You do not need a referral, a diagnosis in hand, or any paperwork to make that call.

This is the part that surprises most families. You do not apply to a home care company and you do not apply to the waiver program itself. You call the Area Agency on Aging, they ask a set of questions about how your parent is managing, and that conversation is what sets everything else in motion.

What the first call is like

Someone takes basic information: who the person is, where they live, who else is in the house, what is going wrong day to day. Expect questions about bathing, dressing, getting to the toilet, moving around the house, eating, taking medication, and whether the person can be left alone safely. It helps to have a list of diagnoses and medications nearby, and the name of the person’s doctor.

You may hear the word ‘screening’. That is what this is: a short conversation that decides whether the person looks like a candidate for a level-of-care assessment, and which programs beyond the waiver might help in the meantime. Nothing is decided on that call.

The two tests

Eligibility for the waiver has two separate halves, and a person has to clear both.

The first is level of care. Georgia has to find that the person’s needs are at the level a nursing home would meet. This is not about a particular diagnosis. It is about how much help the person needs with everyday activities, what medical care they need, and whether they are safe.

The second is Medicaid financial eligibility, which is decided by the Division of Family and Children Services, not by the Area Agency on Aging and not by any case management agency. There is an income test and an asset test, and the exact figures are set each year.

The two tests are assessed by different people, on different timelines, and neither one waits for the other. Families lose weeks assuming the medical side has to finish before the financial side can start. It does not.

The DON-R assessment

Level of care is measured with an instrument called the DON-R, short for Determination of Need - Revised. An assessor comes to the home, spends an hour or two, and scores how much help the person needs with daily activities and how often they need it. A medical form called the DMA-6 is completed alongside it.

Two things matter about the DON-R. The first is that it measures a typical day, not a good one. Families routinely undersell how much they are doing, because doing it has become normal. The second is that the assessor is documenting need, not grading the household. A house that is struggling is the reason the visit is happening.

Under Georgia’s General Services policy at §602.11, the plan of care and the attestation that the person needs this level of care can be approved by the member’s own physician or by the case management agency’s medical director. Where an agency has a medical director on staff, that step does not have to wait on a busy family doctor’s office.

Where a case management agency comes in

Once a person is enrolled, a case management agency coordinates the care: it builds the plan of care with the family, arranges the providers who actually deliver services, and a nurse case manager reviews how things are going. The agency does not send the helper itself. It arranges and oversees the care that other providers deliver.

You choose that agency, and you may change it later. Medicaid pays it directly, and no bill for case management reaches the member or the family. If you are handed a single name with no alternatives, you are entitled to ask for the full list of approved agencies serving your county.

What it costs the family

Medicaid pays the case management agency directly. No bill for case management ever reaches the member or the family, and anyone suggesting otherwise should be asked to put it in writing.

Services under the waiver are paid for by Medicaid too, though a person’s own income can be counted toward the cost of their care depending on the financial rules that apply to them. That is a question for the Division of Family and Children Services, and it is worth asking early rather than discovering it later.

How long this really takes

Two to six months from the first call to services starting is the honest range, and there is often a wait for a waiver slot on top of that. Some of that time is assessment scheduling, some is the Medicaid financial determination, and some is simply queueing.

What you can do about it is run things in parallel. Make the Area Agency on Aging call now. Start gathering documents now rather than when someone asks. If income looks like it might be over the limit, get advice early rather than after a denial. And if the person’s condition gets worse while you are waiting, report it, because the file is supposed to reflect the person as they are today.

What this page cannot tell you

Nothing here is a determination. Reading a page does not start an application, and no one can tell you from a website whether your parent will be approved. The assessment and the Medicaid determination decide that, and they decide it person by person.

The pages below take each stage of this in turn, in the order you will meet them.