Overview of the Georgia Medicaid SOURCE Program
Georgia’s Services Options Using Resources in Community Environments (SOURCE) Program provides long-term home and community based services (HCBS) for state residents who are aged and disabled. Intended for persons who are functionally impaired and require assistance with Activities of Daily Living, (i.e., bathing, dressing, mobility, eating), a Nursing Home Level of Care is required. Availability of long-term services and supports vary based on the specific needs and circumstances of a program participant, but might include in-home personal care assistance, home delivered meals, adult day care, out-of-home respite care, and homemaker services. “Enhanced” case management, in which a program participant’s home and community based services are coordinated with their primary medical care, is a central focus of this Medicaid program.
Persons can reside in their own personal home or the home of a loved one and receive benefits via SOURCE. They can also live in a personal care home, which is similar to an assisted living residence.
Program participants who reside at home, as opposed to a personal care home, have the option to self-direct some of their care services. Formally called “Consumer Directed Personal Support Services”, this option allows persons to hire the caregiver of their choosing to provide personal care assistance, light housecleaning, and preparation of meals. 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.
SOURCE 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 Services Options Using Resources in Community Environments 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, Community Care Services Program (CCSP), 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 SOURCE Program
This program integrates primary medical care, case management, and long-term home and community based services (HCBS). An individual care plan determines which HCBS a program participant receives, but may include the following.
– Adult Day Health Care – supervised daytime medical care and specialized therapies (physical, occupational, or speech) in a group setting
– Alternative Living Services – around the clock supervision and personal care assistance in a personal care home
– Assistive Technology
– Financial Management Services – for program participants directing their own personal care
– Home Delivered Services – home health aides, skilled nursing, and specialized therapies (physical, occupational, or speech)
– Meal Delivery
– Personal Emergency Response Services
– Personal Care Assistance – assistance with daily living activities
– Personal Support Services – in-home assistance with bathing, dressing, mobility, meal preparation, laundry, shopping for groceries, light housecleaning, etc.
– Out-Of-Home Respite Care – allows a primary caregiver a break from caregiving duties
– 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.
– 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)
Eligibility Requirements for the Medicaid SOURCE Program
SOURCE 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
Applicants must be eligible for Supplemental Security Income (SSI) Medicaid. In GA, persons who receive SSI are eligible for Medicaid automatically. In 2024, this means a single applicant can have income up to $943 / month, and married couples can have up to $1,415 / month.
Program participants who reside in a personal care home are not able to retain income up to the limits mentioned above. This is because SOURCE does not cover the cost of room and board. Program participants must pay this cost by contributing a portion of their monthly SSI payment to the personal care home. A single applicant must pay $741 / month towards room and board and can keep the remaining $202 / month kept as a Personal Needs Allowance. Married couples (with both spouses on Medicaid) must pay $1,024 / month towards room and board. They are allowed $317 / month as a Personal Needs Allowance.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, it is $3,000.
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 home, 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 could be 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 on the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require an intermediate Nursing Facility Level of Care (NFLOC). For SOURCE, 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
The SOURCE Program operates under GA’s Elderly and Disabled Waiver Program, as does another program, the Community Care Services Program (CCSP). Rather than reproduce the content of how to qualify when over Medicaid’s income and / or asset limits, we are linking to the CCSP webpage here. This is because CCSP provides the same home and community based services as does SOURCE, but does not limit eligibility to SSI Medicaid recipients. This allows applicants to have a higher monthly income. Non-applicant spouses are also entitled to an income allowance from their applicant spouse, formally called a Monthly Maintenance Needs Allowance, as well as to a higher portion of the couple’s assets, called a Community Spouse Resource Allowance. Furthermore, there are a variety of planning strategies that can be used to help persons who would otherwise be ineligible for Medicaid to become eligible.
How to Apply for the SOURCE Program
Before You Apply
Prior to applying for SOURCE, 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 SOURCE Program is not an entitlement program, there may be a waitlist for program participation. The Elderly and Disabled Medicaid Waiver, under which SOURCE is authorized, is approved for a maximum of 105,111 beneficiaries per year. Of these spots, 100 are reserved for persons diagnosed with Alzheimer’s disease or a related dementia and 125 are reserved for persons transitioning from an institutional setting back into the community. If there is a waitlist, priority is established based on one’s need for care. In some cases, persons who submitted 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 Services Options Using Resources in Community Environments Program, persons should contact GA’s Aging & Disability Network at 1-866-552-4464. Persons can also contact their local Aging and Disability Resource Connection (ADRC) site. A functional assessment will be completed as part of the application process. Learn more about SOURCE here.
The SOURCE program is administered by the Georgia Department of Community Health (DCH). Financial eligibility 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 (90 days for disability applications) to approve or deny one’s application. Despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months waiting to receive benefits.