Medicaid Financial Resources for Adult Day Care and Home Care in Georgia

Medicaid Financial Options for Adult Day and Home Care

We talk to a lot of families every month.  Over the course of a year, it’s literally hundreds of families.  The common theme amongst all these families is that they want the best for their moms and dads.  After this basic desire, their stories start to diverge: some care for a loved one with Alzheimer’s disease; some care for someone who is isolated and needs a little socialization and support; and some have plenty of money; and some have very little.

This is for those who face financial challenges.

We served a family several years ago.  They lived in a high-income community.  The lady of the house had a good job.  The man of the house was between jobs.  They had two children in college, and her mother just moved into the house.  The mother made about $600 a month at the time.  The finances while fine were not going to be able to pay for her mother’s care needs.  Since her mother qualified, they enrolled her in a Medicaid program that met her care needs.

Other families care for a loved one who has never had much money and lives only on a small Social Security Income.

So, for those of you looking for a help to care for your loved one, let’s take a look at what Medicaid has to offer.  While Medicaid is broad and complicated, we’re going to look at the Elderly and Disabled Medicaid Waiver which comprises CCSP (Community Care Services Program) and SOURCE (Service Options Using Resources in Community Environments).  Use the acronyms CCSP and SOURCE as very people really know what the initials stand for, but many are familiar with the program.  It’s also complicated, so you might want to give us a call at 404-410-1510 to walk you through the programs.

We summarize the programs below, but this link is a detailed description of the programs developed by the Atlanta Regional Commission.

Services: Both programs have the similar service offerings:

  • Adult Day Health Care
  • Emergency Response Systems (better known from the “Help! I’ve fallen and can’t get up” commercials)
  • Personal Support Services also known as Private In-home Care
  • Home Delivered Meals
  • Skilled Nursing Service
  • Out of Home Respite
  • Alternative Living Services (which is also known as a personal care home or as “assisted living” in the generic non-regulatory fashion.

The main difference between the two services is that the SOURCE program requires a Medicaid member to use a SOURCE contracted physician as their primary care physician.

The other benefit to enrolling in Medicaid is that Medicaid becomes the secondary insurance for Medicare and covers many of the expenses not covered by Medicare.  There is also a valuable transportation benefit available for those who can no longer drive to the adult day center and other medical appointments.

Qualifications: An individual must meet both financial and medical qualifications to participate in CCSP and SOURCE.

  1. Medical: an individual must meet certain medical requirements. The idea is that these programs help the State of Georgia and the Federal Government save money by keeping individuals out of a nursing home who do not absolutely need to be there.  In general, these programs serve individuals with needs with a physical cause such as dementia, Parkinson’s, diabetes, arthritis, heart disease, etc.  There are other programs for individuals with primarily developmental disability and mental health needs.
  2. Financial: The individual must have very limited resources. Qualifications are:
    • Individuals receiving Supplemental Security Income (SSI), which for 2017 the monthly income limits are $735 for an individual and $1,103 for a married couple. This amount changes annually in January of each year.
    • Individuals not receiving SSI, an individual may be qualified for services with an income below about $2,200 or have a Qualified Income Trust established.
    • Individuals and couples may have limited, minimal financial assets such life insurance for burial expenses, a house with limited value.

Application: How do I apply for services?  The best way is to give us a call at 404-410-1510, and we can help refer you to the appropriate agency.

You can also go to AgewiseConnection, which has a searchable database for services across the state of Georgia.  These programs are basically administered by the Area Agencies on Aging, which cover every county in Georgia.  Contact your Area Agency on Aging, and they can help you find the services you need.

One note of caution: this is not a fast process.  It will take a minimum of 2-3 months from start to finish assuming that everything proceeds perfectly.  There will be doctor’s appointments, nursing assessments, and financial evaluations.  The application will need to be approved by the Department of Family and Children Services (DFCS) to verify financial need and the Georgia Medical Care Foundation (GMCF) to verify medical need.

Here are some important recommendations:

  • Try to gather financial resources from family members to start services privately before there is a Medicaid approval. If you can swing it (and many cannot), it will help lower stress levels and help maintain current health conditions of your loved one.
  • Apply to CCSP and SOURCE early in the process. There is no obligation if you decide the program is not for you, but it will be a lengthy wait if you need the services.
  • It will go faster if you apply to DFCS by going to the county office to start the Medicaid application process.
  • Keep meticulous notes with the names and phone numbers of everyone you’ve talked to. It’s easy to forget who the case manager or nurse is, but nothing can get done without the help of these key individuals.

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