What should I know about Medicaid waivers for home healthcare in Georgia?

Contents

• What are Medicaid's waiver programs?
• What are my rights with Medicaid?
• What are my responsibilities with Medicaid?

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What are Medicaid’s waiver programs?

Georgia Medicaid offers a number of waiver programs that help people who: 

• Are elderly or have a disability, and

• Need help to live in their home or community instead of a:

  • Nursing home, or

  • Care facility for people with intellectual or developmental disabilities.

 

The waiver programs include:

• New Options Waiver Program (NOW) and Comprehensive Supports Waiver Program (COMP). These programs provide services and support for people with intellectual and developmental disabilities. NOW and COMP are run by the Georgia Department of Behavioral Health and Developmental Disabilities. 

• Independent Care Waiver Program (ICWP). ICWP provides services to adults between ages 21 and 64 with severe physical disabilities or traumatic brain injury. This program is run through Alliant Georgia Medical Care Foundation.

• Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE). These programs provide in-home services to elderly and disabled people who would otherwise be in a nursing home. These programs are run through the Georgia Aging and Disability Resource Connections. 

• The Georgia Pediatric Program (GAPP). This program provides services to children who need in-home medical and personal care. 

 

Be aware that the state may put a lien on the estate of a person over 55 who gets a Medicaid waiver for home care. This is called Medicaid Estate Recovery.

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What are my rights with Medicaid?

• You have the right to apply for any Medicaid program.

• You have the right to have your disability accommodated while you apply and during the review process.

• You have the right to timely notice of Medicaid decisions. If the Medicaid program ends your benefits, you must get notice in writing.

• If you disagree with any Medicaid decision, you have the right to a fair hearing.

• You cannot be denied Medicaid because of your:

  • Race,

  • Age,

  • Sex,

  • Disability,

  • National origin,

  • Political, or 

  • Religions beliefs.

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What are my responsibilities with Medicaid?

• You are responsible for providing true information on your Medicaid application, including:

  • Your complete income,

  • The size of your family,

  • Citizenship,

  • Information about your disability.

• You are responsible for reporting any changes, including:

  • Your income,

  • Resources,

  • Living arrangements,

  • Family size.

• You are responsible for letting Medicaid know if you have any other health or dental insurance. This includes:

  • Private health insurance,

  • Medicare, and

  • TRICARE.

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Contents

• How can I apply for a Medicaid waiver?
• How do I appeal a Medicaid decision?
• What is Medicaid estate recovery?

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How can I apply for a Medicaid waiver?

You should apply either in person or by mail, using the application form for the program, if you are applying for:

• For NOW and COMP: Apply through the Department of Behavioral Health and Developmental Disabilities Services.

• For ICWP, apply through Alliant Georgia Medical Care Foundation.

• For CCSP and SOURCE, apply through the Georgia Aging and Disability Resource Connections.

• For GAPP, contact a GAPP provider agency directly. Find an agency in the GAPP provider manual.

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How do I appeal a Medicaid decision?

You have the right to appeal a decision about Medicaid and request a fair hearing. Times when you may want to ask for a Medicaid fair hearing:

• You apply for Medicaid, but are told you are not eligible.

• You are not allowed to apply for Medicaid when you ask.

• DFCS takes more than 45 days to make a decision on your application (90 days if based on disability).

• Your Medicaid is cut off.

• Your doctor, pharmacist, transportation broker, dentist, or another health care provider tells you Medicaid will not pay for a service you need. If you are in a CMO (care management organization), you may need to file an appeal with the CMO before asking for a fair hearing.

• Medicaid does not pay for a service you have already received.

• The state decides you cannot have nursing home care or services under the Community Care Services Program, SOURCE, the Independent Care Waiver, or another waiver program.

• Services Medicaid has been paying for are stopped and you believe they should not be stopped.

• You have any other problem with Medicaid.

 

You usually have 30 days from the date on the notice to ask for a fair hearing. If you ask for a hearing within 10 days, you can keep getting Medicaid while you appeal. (If you lose, the state could ask you to pay back benefits it paid while you appealed.)

 

Call or visit your county Department of Family and Children’s Services (DFCS) to ask for a fair hearing.

 

You must send DFCS a request in writing within 15 days after you first ask for the hearing if you did not do it in writing at that time.

 

Also, send a copy of your hearing request to the address listed on the notice you received. 

 

What happens at a fair hearing?

A fair hearing is a chance to get state officials to change their decision about your case. An independent judge from the Office of State Administrative Hearings will hear your case. The judge will listen to you, listen to Medicaid workers, read the law, and write a decision. 

 

You can represent yourself or you can take a lawyer or other person to represent you. 

 

You should receive a written decision within 90 days after you ask for the hearing. Sometimes your problem can be solved even before the hearing. Make sure you really agree with what the state is doing before you cancel the hearing. If you are not sure, it is better to go to the hearing and talk to the judge. 

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What is Medicaid estate recovery?

If Medicaid pays for your long-term care, the state could have a claim against your estate after you die. This is meant to recover the costs of your care. Your estate could include:

• A house,

• Land,

• Vehicles,

• Cash,

• Investments,

• Other property.  

 

Your estate might be affected if you:

• Got nursing home care or waivers for home or community services under Medicaid for at least 6 months AND you were 55 years old or older.

• Were a resident of a nursing facility when you died.

• Were a resident of an intermediate care facility or mental institution when you died.

 

Can my heirs avoid estate recovery?

Medicaid will not recover from an estate valued at less than $25,000. 

 

Recovery cannot begin as long as:

• Your are still alive,

• Your spouse is still alive,

• Your child is alive and under the age of 21, or

• Your child is alive and blind or permanently disabled.

 

Your heirs may be able to get a hardship waiver. They must show that estate recovery would be an undue hardship. Your heirs could show undue hardship if:

• The asset to be recovered is an income-producing farm of one or more heirs, and the annual gross income is $25,000 or less; or

• Recovering assets would mean that the heirs become eligible for need-based government public assistance.

 

A lien might be placed on your home, but Medicaid will delay recovery if certain people are still living in the home:

• Your sibling, if they: 

  • Lived in the home for at least one year before you were institutionalized, and

  • Have been living there continually and legally.

• Your child, if they: 

  • Were living in the home for at least two years before you were institutionalized and

  • Provided care to help you stay in that home for a period of time, and

  • Have been living there continually and legally.

 

Can I give away my property now to avoid estate recovery later?

Get legal help before you give away property to try to avoid estate recovery down the road. If you need Medicare later for a nursing home or for community services in your home, the Medicaid agency will look to see if you have: 

• Given away your home (or other property), or

• Sold it for less than it is worth.

 

If you gave away your property before you needed care, you could be denied Medicaid for a period of time. The Medicaid agency will decide your “penalty period.”

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