Do I qualify for Georgia's Elderly and Disabled Waiver?

What has to be true for someone to be eligible

Two separate tests, both of which have to be met. The person has to need the level of care a nursing home provides, and the person has to meet Georgia Medicaid’s financial rules. Meeting one without the other is not enough, and the two are decided by different people.

Neither test is decided by a website, and neither is decided by a case management agency. What follows is a self-check, so you can see where your own situation is likely to sit before you spend weeks on the process.

Test one: does the person need nursing-home level of care?

Ask yourself these questions about a typical day, not a good day.

• How much help does the person need bathing, dressing, and using the toilet?
• Can they get out of bed, out of a chair, and around the house safely on their own?
• Do they need reminding, prompting, or hands-on help to eat?
• Who manages their medication, and what happens if nobody does?
• Are there medical needs that require a nurse’s judgment - wounds, catheters, unstable conditions?
• Can they be left alone for a few hours? Overnight? What happens if they cannot?
• Have there been falls, wandering, fires left on, or missed medications in the last few months?

If you answered several of these with ‘they need real help from a person’, the level-of-care test is worth pursuing. If your parent manages their day independently and the concern is loneliness or housekeeping, this waiver is probably not the right tool, and the Area Agency on Aging can point you to programs that are.

The formal version of these questions is an assessment called the DON-R, done in the home by an assessor. Who does that assessment and what they look at is a page of its own.

Test two: does the person meet Medicaid’s financial rules?

There is an income test and an asset test, and both are set by rules that change each year. Georgia’s Division of Family and Children Services decides this, not the Area Agency on Aging.

Ask yourself:

• What is the person’s monthly income from all sources - Social Security, a pension, an annuity, interest, rent?
• What do they own that could be turned into cash - bank accounts, investments, a second property, a vehicle beyond the one they use?
• Is there a spouse still living in the community, and what is in that spouse’s name?
• Have assets been given away or sold below value in recent years?

The home the person actually lives in is generally not counted, and the two delivery models of the waiver treat spouses differently: CCSP offers spousal income and asset protections that SOURCE does not. The income and assets page explains that structure, and says who to ask for this year’s actual figures.

If income looks too high, that is not automatically the end. Georgia recognizes Qualified Income Trusts, sometimes called Miller trusts, and that route is worth understanding before anyone concludes the person is out of range.

What your answers here actually mean

They are an indication of whether it is worth making the call. They are not a determination, and nobody reading them - including a case management agency - can tell you whether your parent will be approved.

Eligibility is decided by the assessment and by Georgia Medicaid, person by person, on the evidence in front of them. People who look like clear cases are sometimes found not to meet the level-of-care standard. People who assume they earn too much sometimes find a route through. The only way to find out is to be assessed.

What to do with an unclear answer

If you are unsure, call anyway. The screening conversation costs you an hour and it is the only way to move from guessing to knowing. Bring the questions above with you, answered honestly about the harder days as well as the easier ones, and say plainly what you are worried will happen if nothing changes.