Georgia Medicaid Eligibility and Enrollment

Older Georgian residents that find themselves struggling with medical bills may be able to get assistance through Georgia Medicaid. As of October 2022, over 2 million people have enrolled in Medicaid and CHIP, a number that has grown by 30% since 2013, when targeted enrollment strategies were adopted. People wishing to enroll in Medicaid must meet certain eligibility criteria in order to gain access to the wide range of benefits. These benefits may help them obtain needed medical treatments and age independently. 

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What Is Georgia Medicaid?

Georgia's Medicaid program is jointly funded by the state and federal governments in an effort to help low-income people get access to health care. In Georgia, the program has not been extended to low-income adults; therefore, it only helps certain categories of people. These include children, pregnant women, disabled people and older adults. It is administered by the Georgia Department of Community Health. 

Georgia Medicaid has different programs for different segments of the population. Programs aimed at older adults include Long Term Services and Support, Waiver Programs and regular Medicaid. 

What Is Covered by Georgia Medicaid?

Medicaid in Georgia covers a wide range of services that support the health of its beneficiaries. This includes doctor’s office expenses, diagnostics, hospital visits and dental treatments. Prescription drugs that are used to cure or treat a medical problem are also covered. For example, insulin or antibiotics are covered but not drugs for hair growth. 

Waiver programs are used to cover additional services. All waiver programs in Georgia include care coordination, personal support for daily living activities, home health services, emergency response systems and respite care. Additional services are available under each program but may differ based on the enrollee. Nursing home care is also covered by Medicaid in Georgia. 

Who Is Eligible for Medicaid in Georgia?

Eligibility is largely based on income, as it's aimed at helping the low-income residents of Georgia. Applicants must meet the eligibility criteria based on residency and citizenship. Depending on the program they are applying for, people may need to be receiving a certain level of care prior to applying.

Financial Eligibility

Financial eligibility differs depending on the program being applied for and marital status. The government looks at a person's income and assets.

For regular Medicaid, the income limit for singles is $914 per month, and the asset limit is $2,000. For married applicants, the maximum income is $1,371 per month, and the asset limit is $3,000. This is applicable whether one or both spouses are applying. 

For people applying for long-term care, whether in a nursing home or through Medicaid waivers, the income limit increases to $2,742 per month. For married couples, the limit is based on each applicant. Therefore, if both spouses are applying, that is $2,742 per person. If only one spouse is applying, the limit only applies to their individual income. In terms of the assets limit, that remains the same. If only one spouse is applying, the asset limit is $2,000; however, the non-applicant spouse can keep $130,380 in assets.

Not all assets are included when making Medicaid calculations. Personal belongings, furniture, a car and a funeral trust are all excluded. A house is not included as an asset if the applicant or the spouse lives there.

Other Eligibility

Applicants must be a Georgia resident and a U.S. citizen (or a legally residing non-citizen) in order to qualify. However, non-citizens may qualify for coverage for emergencies if income limits are met. 

Enrollees requesting long-term care Medicaid must require a nursing home level of care. Some waiver programs may have additional requirements. For example, there are programs only available to people living in their homes. 

Enrollees who require nursing home Medicaid must already be a resident of a nursing home that is certified to accept Medicaid, and the enrollee must have been residing there for at least 30 days. 

What if I Don’t Meet the Eligibility Criteria?

Georgia Medicaid has two pathways available to people who don’t meet the income eligibility criteria. These are the Medically Needy Pathway and Qualified Income Trusts, also called Miller Trusts. In both cases, a person can spend down their excess income until it meets the Medicaid eligibility.

The Medically Needy Pathway allows income to be spent on medical bills. With Miller Trusts, excess income can be put in a trust so that the person meets the income limit. Money in the trust can be spent on a specific set of purposes, such as paying for long-term care or medical expenses. Upon the recipient’s death, money left in the trust will go to the state, up to the amount that the state had paid for care. 

Neither of these pathways assists people who don’t meet the asset limit, however. There are ways to spend down assets as well though. Modifying a home to improve accessibility, such as by adding ramps or a stairlift, are approved expenditures. People can also spend assets on home repairs, paying off debt or by purchasing a funeral trust. It is important not to transfer or sell assets for less than fair market value, as this can make an applicant ineligible for Medicaid for a period of time. Georgia Medicaid looks back five years at any transfers or sales of assets to determine if this has happened. 

How Do I Enroll in Medicaid in Georgia?

Georgia Medicaid recommends that people aged 65 and over apply for Supplemental Security Income by contacting their local Social Security office. If approved, they will automatically receive Medicaid. Local offices can be found by calling (800) 772-1213 or by visiting the Social Security website.

Individuals can also apply for Medicaid in person at their local DFCS county office, or online at the Georgia Gateway.

For those choosing to fill out a form at home, forms can be requested by calling (877) 423-4746.

Applications are generally approved in 45-60 days. 

Contact Information for Georgia Medicaid

If you would like more information about Georgia Medicaid, please call (404) 651-9982.

If you already a member, the member services contact number is (866) 211-0950, and the number for Long-Term Care queries is (404) 232-1411.

Alternatively, email queries can be sent via the online form.