Already enrolled: what happens next
noindex.
Every page needs a named approver before it goes live — DCH General Services §605.1.28 makes
each published version a retained advertising record.
Once a person is enrolled in Georgia's Elderly and Disabled Waiver Program, a case manager reviews the care plan on a set cycle, arranges each service with a separate provider agency, and revises the plan when needs change. Members keep the right to choose and change providers throughout.
What enrollment actually looks like day to day
Getting approved is the hard part. What follows is quieter, and it runs on a rhythm most families are never told about in advance.
A care plan is in place. Each service in it is delivered by a separate provider agency – a home care agency sends the helper, a meal provider brings the meals, a day center runs the day program. The case management agency is not any of those. Its job is to arrange the services, watch whether they are actually happening, and change the plan when the person’s needs move.
The plan is reviewed on a cycle, and reassessed in full once a year. In between, life happens: a fall, a hospital stay, a caregiver who moves away, a diagnosis that shifts what someone can manage alone. None of those have to wait for the annual review. A member or family can ask for the plan to be looked at again at any point.
What these pages are for
The pages in this section answer the questions that come up after enrollment rather than before it. They are written so a family can find an answer at nine at night without calling anyone.
Two things are worth saying up front, because they hold for every page here. Medicaid pays the case management agency directly, so no bill for case management reaches the member or the family. And a member’s right to choose their provider does not expire at enrollment – it applies for as long as they are on the waiver.
Everything in this section
- The annual reassessment What Georgia's annual EDWP reassessment reviews, what to have ready, and what happens to the care plan if a member's needs have grown or eased since last year. Draft
- Cost share What a Medicaid cost share is, who decides it, why some waiver members owe one toward their care, and why case management is never billed to the member. Draft
- When needs change How to get an EDWP care plan revised when a member's needs change: who to call, what triggers a revision, what evidence helps, and what needs authorization first. Draft
- Hospital stays What happens to EDWP waiver services during a hospital or nursing facility stay, who to tell, what it means for Structured Family Caregiving, and what to do at discharge. Draft
- Changing a provider How an enrolled EDWP member changes a service provider or their case management agency in Georgia, what the case manager must tell them, and what happens to the care plan. Draft
- When a service is missed A step-by-step escalation route when a waiver service is missed, late or short: the provider first, then the case manager, then a formal complaint. Draft
Questions people ask about this
Who do I call first when something goes wrong with a service?
Call the provider agency that delivers that service first, because most missed visits are a staffing problem the provider can fix the same day. If it happens repeatedly, or the provider does not respond, the case manager is the next call.
How often is the care plan looked at?
The plan of care is reviewed and renewed on a regular cycle set by the waiver rules, with a full reassessment each year. A member whose situation changes does not have to wait for the calendar and can ask for a review sooner.
Will we ever be billed for case management?
No. Medicaid pays the case management agency directly for case management. No bill for case management goes to the member or the family at any point during enrollment.
Can a member change their case management agency after they are enrolled?
Yes. The right to choose an EDWP provider is not a one-time choice made at enrollment. A member may change their Traditional or Enhanced EDWP provider later, and the case manager is obliged to tell them what providers are available in their area.
Related questions
- The case manager's role What an EDWP case manager does month to month, and the Georgia rule that gives a member the right to choose their case management agency and to change it.
- Your rights What a Georgia Medicaid waiver member is entitled to: choosing a provider, appealing a decision, complaining about an agency, and living in the community on your own terms.
- How long it takes Two to six months from first call to services starting is realistic for Georgia's Medicaid waiver, plus a possible wait for a slot. What happens in each stage.
- What Georgia Medicaid covers at home What Georgia Medicaid pays for when an older adult needs help at home: personal support, meals, adult day health, respite, nursing and more.