Overview of the Community Care Services Program
Georgia’s Community Care Services Program (CCSP) provides home and community-based services (HCBS) for state residents who are elderly and / or disabled, functionally impaired, and at risk of nursing home admittance. Designed to prevent and / or delay the need for nursing home care, the exact supports a program participant receives is based on their needs and circumstances. Potential benefits include personal emergency response systems, adult day care, respite care, and assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as mobility, eating, personal hygiene, shopping for groceries, and meal preparation.
In addition to one’s home and the home of a loved one, program participants can reside in a personal care home, which is similar to an assisted living residence. An adult foster care home is not a permittable setting.
The services offered under CCSP may be provided by licensed care workers, or program participants have the option to self-direct their personal care services via Personal Support Consumer Direction. This option allows a program participant to choose their own caregiver. While some relatives, such as adult children can be hired to provide care, spouses and parents of minor children are prohibited from this role. A financial management services agency handles the financial aspects of employment responsibilities, such as background checks, tax withholding, and caregiver payments. Persons residing in personal care homes cannot self-direct their care.
CCSP is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. There are a limited number of participant enrollment slots, and when they are full, a waitlist for program participation forms.
The Community Care Services Program operates under Georgia’s Elderly and Disabled Waiver Program (EDWP), which is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. Another program, Service Options Using Resources in a Community Environment (SOURCE), also operates under the Elderly and Disabled Medicaid Waiver.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of the Community Care Services Program
The following long-term services and supports may be provided via CCSP. An individual care plan determines which services and supports a program participant receives. Personal care assistance may be self-directed, allowing one to select the caregiver of their choosing.
– Adult Day Health Care – supervised daytime medical care and specialized therapies (physical, occupational, or speech) in a community group setting
– Alternative Living Services – around the clock supervision and personal care assistance in a personal care home
– Assistive Technology
– Case Management & Enhanced Case Management – with enhanced case management, HCBS are coordinated with one’s primary medical care
– Financial Management Services – for program participants directing their own personal care
– Homemaker Services – assistance with shopping for essentials, preparing meals, and light housecleaning
– Meal Delivery
– Personal Emergency Response Services
– Personal Care Assistance – assistance with daily living activities
– Respite Care – out-of-home care to give a primary caregiver a break from caregiving duties
– Skilled Nursing / Home Health Aides – provided in-home
– Structured Family Caregiver – financial and supportive services (i.e., over-the-phone counseling, health education) for live-in family caregivers. The caregiver must be related by marriage or blood, but cannot be a spouse.
– Therapy Services – in-home physical, occupational and speech therapies
– Transitional Services – for persons transferring from an institution to a community setting (pre-discharge coordination, case management in the community, services and supports to establish a beneficiary’s new living setting, and supportive services, like training / education, to help one maintain their independence rather than require institutionalization again)
CCSP will not cover the cost of room and board in personal care homes.
Eligibility Requirements for the Community Care Services Program
CCSP is for Georgia residents who are elderly (aged 65+) or physically disabled and under the age of 65. Persons who enroll before the age of 65 can continue to receive benefits upon turning 65. Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases annually in January. In 2024, an applicant, regardless of marital status, can have a monthly income up to $2,829. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance.
In GA, in 2024, the maximum amount of income that can be transferred to the non-applicant spouse is $3,853.50 / month. This is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA). In 2024, the CSRA allows the non-applicant spouse to keep up to $154,140.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. Georgia Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Georgia Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “Intent” to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a dependent relative living in the home. This may include the applicant’s child, grandchild, in-law, parent, aunt, uncle, sibling, niece, nephew, or cousin.
While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. More about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require an intermediate Nursing Facility Level of Care (NFLOC). For CCSP, one must be functionally impaired due to a physical condition and have an unmet need for care. The tool used to make this determination is the Determination of Need Functional Assessment-Revised (DON-R). One’s ability / inability to independently complete their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is considered. These activities include transferring from the bed to a chair, mobility, eating, toileting, meal preparation, money management, and housework. Cognitive impairment, such as memory issues, which is often seen in persons with dementia, is also a consideration. The tool used to determine if the NFLOC need is met is the Minimum Data Set Home Care (MDS-HC) and is completed in-person by a nurse. With the MDS-HC, ADLs, IADLs, and cognitive ability are also considered. Furthermore, a physician must agree that a NFLOC is required. While Alzheimer’s disease and related dementias are considered qualifying physical conditions, a diagnosis of dementia in and of itself does not mean one will meet the criteria for NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limits, Miller Trusts, also called Qualified Income Trusts, can help. “Excess” income is deposited into the trust, no longer counting as income.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. They are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option, but for persons with a significant amount of “extra” assets, are Medicaid Asset Protection Trusts. With this type of trust, assets no longer count towards Medicaid’s asset limit, but the trust must be implemented well in advance of the need for Medicaid long-term care. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Georgia to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial criteria, but can also protect assets for family as inheritance. These strategies often violate Medicaid’s 60-month Look-Back Rule and should only be done with careful planning. Medicaid Planners are aware of some workarounds, and therefore, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for the Community Care Services Program
Before You Apply
Prior to applying for CCSP, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Since the Community Care Services Program is not an entitlement program, there may be a waitlist for program participation. The Elderly and Disabled Medicaid Waiver, under which CCSP is authorized, is approved for a maximum of 49,398 beneficiaries per year. Of these spots, 100 are reserved for persons with a diagnosis of Alzheimer’s disease or a related dementia and 125 are reserved for persons transitioning from an institutional setting back into the community via Money Follows the Person. If there is a waitlist, an applicant’s placement on the waitlist is based on one’s need for supportive services. In some cases, persons who submit an application at a later date than other applicants may be awarded a participant slot first if their needs are greater.
Application Process
To apply for the Community Care Services Program, persons should contact their local Area Agency on Aging (AAA), or alternatively, persons can call 866-552-4464. A telephone screening will be done to establish if eligibility criteria might be met, and if so, an in-home functional needs assessment will be scheduled.
Applicants who are not already enrolled in GA Medicaid must apply for Medicaid via the Department of Human Services’ Division of Family and Children Services. An application can be downloaded here or one can apply online at Georgia Gateway. One’s local AAA should be able to assist with the Medicaid application process. Learn more about CCSP.
The Georgia Department of Community Health (DCH), along with GA’s Area Agencies on Aging (AAA), administer the Community Care Services Program. Financial eligibility for CCSP is determined by GA’s Department of Human Services’ Division of Family and Children Services (DFCS).
Approval Process & Timing
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. If there is a waitlist for CCSP, approved applicants may spend many months waiting to receive benefits.