Navigating the Medicaid System in Georgia
We understand that working out the details of your health care plan can be complicated and frustrating. It doesn’t have to be. We’re here to help. Once enrolled in our program, our members receive step-by-step assistance in walking through your health care coverage. Because we do this all the time, there’s no situation too difficult for us.
If you’re looking for quick information, here is a basic overview of how Medicaid covers citizens of Georgia while in a personal care home or assisted living facility:
Medicaid is a joint Federal and State program to help low-income families pay for medical care and long-term custodial-care. The Federal government funds up to 50% of the cost of each state’s program, with less affluent states receiving the majority of the funding. Because Medicaid is managed by individual states, each state has its own version of the program.
In Georgia, Medicaid supports two primary sub-programs to help people in assisted living situations: SOURCE and CCSP. Depending on your situation, you could fit into one of the two programs.
The SOURCE program pays for room and board, food, and bi-monthly nursing check-ups for qualified residents of SOURCE approved personal care homes. SOURCE stands for Service Options Using Resources in a Community Environment, and is designed to help the frail elderly or disabled who are eligible for SSI (Supplemental Security Income).
Here’s how it works: SSI enrollees receive a monthly check for $721. The SOURCE program deducts $609 out of that check to cover the cost of living (board, food, and nursing visits), and then sends the remaining $112 to the resident for personal expenses.
Every SOURCE enrollee is assigned a case manager who works closely with the enrollee’s Primary Care Physician to coordinate care. At the time of enrollment, the case manager conducts an assessment with the enrollee which gathers extensive information for physicians and medical professionals involved in the enrollee’s care plan (called a “Care Path”). The case manager stays in regular contact with the enrollee (once per month) to ensure that their living and medical needs are being taken care of.
Generally people utilizing the CCSP Program through Georgia Health Services are elderly and unable to live alone. They do not need the level of care found in a nursing home but do require some assistance with everyday living. CCSP recipients have a monthly income between $400 and $1809 per month.
Persons served through the CCSP Program must be eligible for Medicaid and meet the following requirements:
- Have limitations which make it difficult to perform normal daily living activities and live independently
- Have health needs that can be met in the community with services offered by the program and within established individual cost guidelines.
What does this mean? If your loved one has Medicaid (or qualifies for Medicaid), meets the above criteria, and has an income between $400 and $1809 dollars per month, they may qualify for the CCSP Program and obtain residency in a licensed personal care home.
How much does it cost? Residents using CCSP pay the personal care home $609 per month (a rate established by the Georgia Department of Human Services, Division of Aging (01/01/14) and a cost share (based on income) determined by a CCSP Staff Member.
Why do we have to pay a Cost Share? Cost Shares are used to offset the amount not paid by the State of Georgia for ALS Services. CCSP and DFCS determine the cost share.
How long does it take to become enrolled in the CCSP Program? It typically takes 2-4 months from start to finish for a client to be enrolled in CCSP. Clients can still move into the PCH while their application is in process. If you are moving in during the middle of the month, the room and board rate amount due is pro-rated based on the number of days left in the month.