Georgia Medicaid is a health insurance program funded by federal and state dollars, providing medical and health-related services to low-income individuals, including children, pregnant women, parents, seniors, and disabled individuals.
This guide outlines the 2025 eligibility criteria, income limits, asset rules, and application process for Georgia Medicaid, based on federal and Georgia Department of Community Health (DCH) guidelines, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups.
Georgia Medicaid Programs
Georgia Medicaid offers coverage for various groups, with specific eligibility requirements based on income, assets, age, and medical needs. The main programs include:
- Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Requires a Nursing Facility Level of Care (NFLOC).
- Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, offering services like in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Programs like the Community Care Services Program (CCSP) may have waiting lists.
- Regular Medicaid (Aged, Blind, and Disabled): Covers low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
- Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women with higher income limits through PeachCare for Kids (Georgia’s CHIP program).
- Medicaid for Parents and Caretaker Relatives: Covers low-income parents or caretakers of dependent children.
Georgia has not fully expanded Medicaid under the Affordable Care Act (ACA), but the Georgia Pathways to Coverage program (introduced in 2023) provides limited coverage for adults aged 19–64 with incomes up to 100% FPL who meet work or activity requirements, leaving some low-income adults in a coverage gap.
Eligibility for Georgia Medicaid
Eligibility varies by program and population. General requirements include:
- Residency: Must be a resident of Georgia.
- Citizenship: Must be a U.S. citizen, national, permanent resident, or legal alien with qualifying immigration status (e.g., refugees, asylees, or lawful permanent residents with 5+ years in the U.S.).
- Income: Varies by program, often based on a percentage of the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR).
- Assets: Limits apply for long-term care and aged/blind/disabled programs.
- Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).
Categorical Eligibility
Individuals receiving Supplemental Security Income (SSI) or certain means-tested benefits are often categorically eligible for Regular Medicaid, bypassing some income and asset tests.
Income Limits for Georgia Medicaid
Income limits vary by program and household status. Below are the 2025 income limits for Georgia, based on federal guidelines and state policies, expressed as monthly amounts unless noted.
| Eligibility Category | Single | Married (Both Applying) | Children (0–18) | Pregnant Women | Parents/Caretakers | Adults (19–64, Pathways) |
|---|---|---|---|---|---|---|
| Seniors/Disabled (Nursing Home/HCBS) | $2,901 (300% FBR) | $5,802 (300% FBR) | N/A | N/A | N/A | N/A |
| Regular Medicaid (Aged, Blind, Disabled) | $967 (100% FBR) | $1,450 (100% FBR) | N/A | N/A | N/A | N/A |
| Pathways to Coverage (19–64) | $1,304 (100% FPL) | $1,762 (100% FPL) | N/A | N/A | N/A | $1,304 (100% FPL) |
| Children/PeachCare for Kids | N/A | N/A | $3,260 (200% FPL) | N/A | N/A | N/A |
| Pregnant Women | N/A | N/A | N/A | $3,260 (200% FPL) | N/A | N/A |
| Parents/Caretakers | N/A | N/A | N/A | N/A | $604 (46% FPL) | N/A |
Additional Notes on Income Limits
- Seniors/Disabled (Nursing Home/HCBS): Income above $2,901/month must go toward care costs, except for a Personal Needs Allowance ($65/month for nursing home), Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse. A Qualified Income Trust (QIT) can redirect excess income to meet eligibility.
- Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $3,948/month if their housing and utility costs exceed $793.13/month (effective 7/1/25–6/30/26).
- Children/PeachCare for Kids: Limits may extend to 252% FPL ($3,294/month for one) for children under 6.
- Pregnant Women: Coverage extends 12 months postpartum.
- Parents/Caretakers: Income limits are notably low, at 46% FPL ($604/month for one).
- Pathways to Coverage: Adults aged 19–64 with incomes up to 100% FPL must complete 80 hours/month of work or qualifying activities (e.g., education, volunteering). Those above 100% FPL but below 138% FPL remain in a coverage gap unless eligible for other categories.
2025 Federal Poverty Level (FPL) Guidelines for Reference (48 States & D.C.)
| Household Size | 100% FPL | 138% FPL | 200% FPL |
|---|---|---|---|
| 1 | $15,650 ($1,304/month) | $21,597 ($1,799/month) | $31,300 ($2,608/month) |
| 2 | $21,150 ($1,762/month) | $29,187 ($2,432/month) | $42,300 ($3,525/month) |
| 3 | $26,650 ($2,221/month) | $36,777 ($3,064/month) | $53,300 ($4,441/month) |
| 4 | $32,150 ($2,679/month) | $44,367 ($3,697/month) | $64,300 ($5,358/month) |
Note: Use the FPL Calculator to estimate your household’s FPL percentage.
Asset Rules for Georgia Medicaid
Asset limits apply primarily to long-term care and aged/blind/disabled programs.
Long-Term Care Medicaid (Nursing Home and HCBS Waivers)
- Single Applicant: $2,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
- Married, Both Applying: $3,000 total.
- Married, One Applying: $2,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, or CSRA).
- Home Equity Limit: $730,000 for the primary residence (if applicant/spouse resides there or intends to return).
Non-Countable Assets
- Primary home (if applicant/spouse resides there or intends to return)
- One vehicle
- Household goods and personal effects
- Irrevocable Funeral Trusts (up to $15,000)
- Medicaid Compliant Annuities
- Life insurance with a face value of $1,500 or less
Medicaid’s Look-Back Rule
Georgia enforces a 60-month look-back period for Nursing Home Medicaid and HCBS Waivers, reviewing asset transfers within 5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility. No look-back period applies for Regular Medicaid.
Estate Recovery
Georgia’s Medicaid Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Consult a Certified Medicaid Planner to safeguard assets.
Regular Medicaid (Aged, Blind, and Disabled)
- Asset Limit: $2,000 for an individual; $3,000 for a couple.
- No home equity limit or look-back period.
Medicaid for Children, Pregnant Women, Parents, and Pathways
- No Asset Test: These programs focus solely on income.
Medical/Functional Requirements
For Nursing Home Medicaid and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:
- Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
- Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
- Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia, though diagnosis alone does not guarantee eligibility.
Regular Medicaid for the aged, blind, or disabled requires proof of disability or blindness per Social Security Administration criteria but not necessarily NFLOC.
Changes Due to Federal Policy and Georgia Pathways
As of 2025, federal policy changes and Georgia’s unique Pathways program affect Medicaid:
- Work Requirements (Starting January 2027): Federal work requirements may apply to Pathways adults (19–64) but not to seniors, disabled individuals, pregnant women, or children. Georgia’s Pathways program already requires 80 hours/month of work or qualifying activities for adults up to 100% FPL.
- Reduced Retroactive Coverage (Starting January 2027): Medicaid will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
- More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
- New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.
- Georgia Pathways: Adults aged 19–64 with incomes above 100% FPL but below 138% FPL remain ineligible unless they qualify for other categories, due to Georgia’s partial ACA expansion.
Options if Over the Income or Asset Limit
If your income or assets exceed the limit, consider:
- Qualified Income Trusts (QITs): Redirect excess income to meet limits for Nursing Home or HCBS Waivers. The trust is irrevocable, and Georgia Medicaid must be designated as the beneficiary upon the recipient’s death.
- Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses (up to $15,000) are exempt from asset limits.
- Spend Down: Convert countable assets into exempt ones (e.g., home repairs, purchasing a vehicle, or paying off debt).
- Certified Medicaid Planners: Professionals can help with financial strategies to achieve eligibility, such as Medicaid Compliant Annuities or asset restructuring.
Application Process
To apply for Georgia Medicaid:
- Online: Use the Georgia Gateway portal at gateway.ga.gov. Check eligibility with the Medicaid Eligibility Calculator.
- Phone: Call the Georgia Medicaid Customer Contact Center at 1-877-423-4746 for assistance.
- In-Person or Mail: Complete and submit an application to a local Department of Family and Children Services (DFCS) Office. Download the application from dch.georgia.gov.
- Assistance: Contact the Georgia Division of Aging Services or a local Area Agency on Aging for program-related questions. Call 1-866-552-4464 for long-term care support.
Required documents include proof of income, assets, residency, citizenship, and medical records (for long-term care or disability programs). An interview may be required.
Processing Time
- Standard applications: Up to 45 days (90 days for disability-based applications).
- Expedited processing: May apply for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).
Frequently Asked Questions
How do I apply for Medicaid in Georgia?
Apply online at gateway.ga.gov, by phone at 1-877-423-4746, in person at a DFCS Office, or by mail with a downloaded application from dch.georgia.gov.
What are the 2025 Medicaid income limits for Georgia?
For seniors/disabled (Nursing Home/HCBS), the limit is $2,901/month (single) or $5,802/month (couple). Regular Medicaid (aged, blind, disabled) is $967/month (single) or $1,450/month (couple). Children and pregnant women qualify up to 200% FPL ($2,608/month for one). Parents/caretakers qualify up to 46% FPL ($604/month for one). Pathways adults qualify up to 100% FPL ($1,304/month for one).
Are there asset limits for Georgia Medicaid?
Yes, for long-term care and aged/blind/disabled programs: $2,000 (single), $3,000 (couple, both applying), or $157,920 for a non-applicant spouse. No asset tests for children, pregnant women, parents, or Pathways adults.
What is the Medicaid look-back period in Georgia?
A 60-month look-back period applies to Nursing Home Medicaid and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medicaid.
Can I qualify for Medicaid if my income or assets are too high?
Yes, through Qualified Income Trusts (QITs), Irrevocable Funeral Trusts (IFTs), or spending down assets on exempt items. Consult a Certified Medicaid Planner for assistance.
How does Georgia’s Pathways program affect eligibility?
Georgia’s Pathways to Coverage program covers adults aged 19–64 with incomes up to 100% FPL who meet work/activity requirements, but those between 100%–138% FPL remain in a coverage gap unless eligible for other categories.
This guide is based on 2025 federal and Georgia Department of Community Health guidelines. Verify details with the Georgia Medicaid program for accuracy.