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 aged and disabled state residents. Intended for persons who are functionally impaired and require assistance with activities of daily living, such as bathing, dressing, mobility, and 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. This program does not cover the cost of room and board in personal care homes.
Program participants who reside at home, as opposed to a primary 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. However, unlike many state Medicaid waivers that allow persons to hire a relative, SOURCE only allows it in extenuating circumstances, such as when one lives in an area so rural there are no traditional providers available. Even then, while an adult child can be hired, a spouse cannot be hired. 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, which means meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms. A portion of these slots are reserved specifically for persons residing in nursing home facilities who wish to transition back to community living. Some slots are also reserved for persons with Alzheimer’s disease and related dementias.
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 will determine which HCBS a program participant will receive, but may include the following.
– Adult Day Health Care – supervised 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
– 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
– 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 – supportive services for family caregivers, such as over-the-phone counseling and health education
Eligibility Requirements for the Medicaid SOURCE Program
SOURCE is for Georgia residents who are elderly (65+) or younger if physically disabled that are at risk of nursing home placement. Physically disabled persons who enroll in the program prior to the age of 65 can continue to receive services via this program upon reaching 65. Additional eligibility criteria can be found below.
Financial Criteria: Income, Assets & Home Ownership
Applicants must be eligible for Supplemental Security Income (SSI) Medicaid. In GA, persons who receive SSI are eligible for Medicaid automatically. In 2021, this means a single applicant can have income up to $794 / month in income, and married couples can have up to $1,191 / month.
Program participants who reside in a personal care home are not able to retain income up to the limits mentioned above. A single applicant must pay $666 / month towards the cost of room and board, with the remaining $128 / month kept as a personal needs allowance. Married couples in which both spouses are on Medicaid must pay $949.00 / month towards room and board. The remaining $243.00 / month is retained as a personal needs allowance.
In 2021, the asset limit is $2,000 for a single applicant. For married couples, the asset limit 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. This is because Georgia Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, 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 to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse resides in the home.
– The applicant has a dependent relative living in the home.
To learn more about the potential of Medicaid taking the home, click here.
Medical Criteria: Functional Need
An applicant must require an intermediate level of nursing facility level of care (NFLOC). For SOURCE, an applicant must have a physical condition that results in a functional impairment and have an unmet need for care. Alzheimer’s disease and related dementias are considered qualifying physical conditions. The tool used to determine if one has an unmet need for care is the Determination of Need Functional Assessment-Revised (DON-R). One’s ability / inability to independently complete their activities of daily living (i.e., transferring from the bed to a chair, mobility, eating, toileting, eating) and instrumental activities of daily living (i.e., meal preparation, money management, housework) is considered when making this determination. 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, activities of daily living, instrumental activities of daily living, and cognitive ability are also considered. Furthermore, a physician must agree that a nursing home level of care is required. 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 free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, 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 34,826 beneficiaries per year. At the time of this writing, there was no waitlist. However, if there is a waitlist, priority is established based on one’s need for care. This means that 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.
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. Contact information by region can be found here. A functional assessment will be completed as part of the application process. For additional information about SOURCE, click 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 even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, 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.