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A Guide to MedicaidWaiver Programs inGeorgia

Helpful Telephone Numbersand Web SitesTo find out more about Medicaid eligibility and where toapply, log on to the Internet at your local library or otherlocation. The website address iswww.dch.ga.gov/medicaid. This site provides the locationof county Department of Family and Children Servicesoffices which accept Medicaid applications on site.To locate a county health department, call404-657-2700 or look in the government pages.To locate the Area Agency on Aging that serves yourcommunity, call 1-866-552-4464 (1-866-55AGING)To locate the state Health Insurance Program,Georgia Cares, call 1-800-669-8387To locate a Social Security Administration office nearyou call 1-800-772-1213.For questions about your Medicaid card, call770-570-3373 or 866-211-0950.To learn more about your nursing home rights andoptions, contact the Long Term Care Ombudsman at888-454-5826.To learn more about Georgia Medicaid, stop by yourlocal library and log onto the Internet. The web siteaddress is www.mmis.georgia.gov.

Table of ContentsHome and Community Services . 1What is Medicaid? . 3How to Apply for Medicaid Home and Community-based(Waiver) Services . 3Medicaid Home and Community-based (waiver) Programs . 4 Community Care Services Program (CCSP) . 6 Service Options Using Resources in a CommunityEnvironment (SOURCE) . 8 Independent Care Waiver Program (ICWP) . 11 New Options Waiver Program (NOW) and .13Comprehensive Supports Waiver Program (COMP) Georgia Pediatric program (GAPP) .16Medical Day Care Services - Waivered ServiceMoney Follows the Person DemonstrationProgram (MFP) . 23What Other Services Does Medicaid Cover? . 25What’s Not Covered? . 27Your Rights and Responsibilities . 27

COMMUNITY ALTERNATIVES1Home and Community ServicesA Guide to Programs in GeorgiaIf you have been referred for nursing homeor other institutional care, but could stay inyour home or in the community with specialservices, and you meet other requirements,you may be eligible for home andcommunity-based services throughGeorgia’s Medicaid program.Many of these services are called waiverprograms, because the Centers for Medicareand Medicaid Services (CMS) allows states to“waive” certain Medicaid requirements andpay for home and community-based servicesas an alternative to institutions, such asnursing homes or hospitals for people withdevelopmental disabilities. Essentially, thelaw provides you a choice.Under federal regulations, the total cost ofproviding home and community-basedservices may not be more than the cost ofproviding care in a hospital, nursing homeor ICF-MR.A Guide to Medicaid Waiver Programs in Georgia

2COMMUNITY ALTERNATIVESGeorgia has several home and communitybased waivers. Some of the waiver programservices include assistance with daily livingactivities (bathing, dressing, meals, and somehousehold chores), help with arrangingmedical or support services and services torelieve family caregivers. This guide describeswaiver programs for people who are elderly,physically disabled, have developmental orintellectual disability, or are medically fragilechildren.Although different waiver programs offerdifferent services, they have some things incommon. Each program is designed to helppeople who qualify for institutional careremain in the community or return to thecommunity from nursing homes, hospitals orother long term institutions. Each programalso requires that people be eligible forMedicaid. To qualify for a waiver program, youcan have higher income and resources thanpermitted in the regular Medicaid program.In addition to the waiver programs, Georgiaoffers other services through the regularMedicaid program designed to support peoplein their homes and communities. Some ofthose are described in this guide and includethe Georgia Pediatric Program’s in-homeservices for medically fragile children andbehavioral or mental health services.HOME AND COMMUNITY SERVICES

WHAT IS MEDICAID?/ HOW TO APPLY FOR SERVICES3What is Medicaid?Medicaid is a medical assistance programthat helps many people who can’t affordmedical care pay for some or all of theirmedical bills. If you apply and are approvedfor Medicaid, you will receive a plasticMedicaid card in the mail. Medicaid will payparticipating doctors, pharmacists, hospitalsor other providers for your care.If you or someone in your family needshealth care, you should apply for Medicaideven if you are not sure whether youqualify or if you have been turned down inthe past. A list of all county offices thataccept Medicaid applications can be foundat www.dch.ga.gov/medicaid.How to Apply for Medicaid Homeand Community-Based (waiver)ServicesIf you are interested in a waiver program,contact the agency listed. If you qualify,someone will guide you through the nextsteps of the Medicaid application process.You will be notified within 90 days or lesswhether you are eligible for waiver services.If you are told that you do not qualify, youcan ask for a hearing. If you are eligible forwaiver services, you will be advised aboutwhen services will begin.A Guide to Medicaid Waiver Programs in Georgia

4MEDICAID HOME AND COMMUNITY-BASED PROGRAMSMEDICAID HOME ANDCOMMUNITY -BASED (waiver)PROGRAMSWaiver programs help people who areelderly or have disabilities and need help tolive in their home or community instead ofan institution such as a nursing home. Eachprogram offers several “core” services: service coordination (help with managingcare needs and services) personal support (assistance with dailyliving activities, i.e. bathing, dressing,meals and housekeeping) home health services (nursing, homehealth aide, and occupational, physicaland speech therapy) emergency response systems respite care (caregiver relief)Additional services are available under eachprogram. Following are brief descriptions ofthe home and community waivers.Sometimes waiver services are added orchanged. The agencies that handle the waiverprograms can provide more detailedinformation about covered services.HOME AND COMMUNITY SERVICES

M EDICAID HOME AND COMMUNITY -BASED P ROGRAMS 5Sometimes people may meet the criteria toreceive Medicaid services under a waiverprogram, but may not receive servicesimmediately. Funding for the programs islimited, and only a certain number of peoplecan receive services based on availablefunds. This means there are nearly alwayspeople on the waiting lists for the home andcommunity-based waivers.A person may be selected from the waitinglist based on the severity of need, theavailability of informal/family support, thelength of time on the waiting list and aperson’s continued eligibility for the level ofcare provided in a nursing home or ICF-MR.It is important to be sure thatinformation about your condition andsituation is accurate. You have the rightto correct or update information that mayaffect your placement on the waiting list.A Guide to Medicaid Waiver Programs in Georgia

6COMMUNITY CARE SERVICES PROGRAMCommunity Care Services ProgramThis program provides home andcommunity-based services to people whoare elderly and/or functionally impaired orhave disabilities. The program helpseligible recipients return to the communityfrom nursing homes or remain in their ownhomes, the homes of caregivers or in othercommunity settings as long as possible.Individuals served through the Elderly andDisabled Waiver must be eligible forMedicaid and meet these criteria:Qualify for the level of care provided by anursing home;Have limitations which make it difficult toperform normal daily living activitiesand live independently; andHave health needs that can be met in thecommunity with services offered by theprogram and within establishedindividual cost guidelines. The individualcost is estimated based on theprojected care plan.Elderly and Disabled Waiver services offeredin the CCSP include: Adult Day Health Care,Alternative Living Services (personal carehome), Emergency Response System (24hour access to medical services), HomeDelivered Meals, Home Delivered Services(home health), Personal Support, and Out ofHome Respite Care.H O M E A N D C O M M U N I T Y S E R V I CE S

COMMUNITY CARE SERVICES PROGRAM7To apply for Community Care Services, contact theArea Agency on Aging serving your area, toll free at:1-866-552-4464 or at the number listed below:Atlanta Regional Commission . (Atlanta) 404-463-3333Central Savannah River Regional Commission(Augusta) 1 888 922-4464Coastal Regional Commission (Brunswick) 1-800 580-6860Georgia Mountains/Legacy Link (Gainesville) 1-800-845-5465Heart of Georgia/Altamaha RegionalCommission (Baxley) 1 888 367-9913Middle Georgia Regional Commission (Macon) 1-888-548-1456Northeast Georgia RegionalCommission (Athens) 1-800-474-7540Northwest Georgia Regional Commission(Rome) 1-800-759-2963River Valley Regional Commission (Columbus) 1-800-615-4379Southern Crescent (Franklin) . 1-866-854-5652Southern Georgia Regional Commission(Waycross) 1-888-732-4464Southwest Georgia (Albany) . 1-800-282-6612A Guide to Medicaid Waiver Programs in Georgia

8SOURCESOURCESOURCE (Service Options Using Resourcesin Community Environment) is a statewidePrimary Care Enhanced Case ManagementService under the Elderly and DisabledWaiver that links primary medical care withmany long-term health services in a person’shome or community setting to preventunnecessary emergency room visits andhospital stays and avoid institutionalization.SOURCE serves aged, blind and disabledGeorgians who are SSI/Medicaid eligible.An assessment helps to determine how muchcare a participant needs. An individual careplan is designed based on the need for medicalmonitoring and assistance with functionaltasks. Family members and other informalcaregivers as well as staff from supportagencies participate in care plans. In additionto the core services, SOURCE offers homedelivered meals, adult day health care,personal care home and 24-hour medicalaccess.HOME AND COMMUNITY SERVICES

SOURCE9To apply for SOURCE, call the number listed below for the programserving your county:Albany ARC . 1-229-883-2334Counties: Baker, Calhoun, Clay, Colquitt, Decatur, Dougherty, Early,Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth,Crisp Care Management . 1-229-276-2126Counties: Crisp, Dooly, Macon, Turner , Wilcox and SumterColumbus Regional Healthcare System . 1-706-571-1946Counties: Chattahoochee, Harris, Marion, Muscogee, Talbot, Troup,Meriweather, Upson, StewartCrossroads Community SOURCE . 1-478-988-1294Counties: Houston, Peach, Bibb, Dooly, Pulaski, Wilcox, Bleckley, TwiggsDiversified Resources Inc. . 1-800-283-0041Counties: Atkinson, Ben Hill, Berrien, Brantley, Brooks, Camden,Charlton, Clinch, Coffee, Cook, Echols, Glynn, Irwin, Lanier,Lowndes, Pierce, Tift, Turner, Ware and WilcoxFaith Health Services . 678-624-1646Counties: Clayton, Cobb, Dekalb, Forsyth, Fulton, Gwinnett, RockdaleLegacy Link 770-538-2650Counties: Banks, Barrow, Cherokee, Clarke, Dawson, Elbert, Forsyth,Franklin, Gwinnett, Habersham, Hall, Hart, Jackson, Lumpkin, Madison,Rabun, Stephens, Towns, Union, WhiteSOURCE Care Management 1-888-762-2420Statewide availability in all countiesSOURCE Partners Atlanta .404-463-3248Counties: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett,Henry, RockdaleSt. Joseph‛s/Candler Health System . .912-819-1520Counties: Bryan, Bulloch, Candler, Chatham, Evans, Baxley - Appling,Bacon, Jeff Davis, Liberty, Long, McIntosh, Montgomery, Tattnall,Toombs, WayneFor more information, please call 404-463-6570.A Guide to Medicaid Waiver Programs in Georgia

10SOURCE(SOURCE locations continued)UniHealth Solutions SOURCE-Corporate Office . 770-925-4788Counties Served: Statewide availability in all countiesH O M E A N D C O M M U N I T Y S E R V I CE S