Nursing Homes in Georgia
In Georgia, around 14.7% of the state's nearly 11 million population is aged 65 and over, which is slightly lower than the U.S. average of 16.8%. As of 2022, 28,291 older adults and people with disabilities or complex health needs receive care in one of Georgia's 360 certified nursing homes. Living in a nursing home allows older adults to receive high-quality health care, social support and personal assistance if their needs can no longer be safely met at home. However, many seniors and their caregivers are unsure what financial support is available to help fund their nursing home placements.
Understanding which state programs cover nursing home care in Georgia and how to access support can help simplify the transition to a residential setting and provide financial peace of mind. Many people also find it reassuring to understand how the state ensures high-quality, dignified provisions for nursing home residents.
This guide explores Medicaid and Medicare coverage for nursing home care in Georgia and explains how the state regulates its certified care providers.
Cost of Georgia Nursing Homes
The average cost of nursing homes in Georgia is $183 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Georgia?
Georgia's Medicaid program pays for nursing home care via two programs: Nursing Home Medicaid and Supplemental Security Income Medicaid. However, these programs only cover residential care for people meeting Medicaid eligibility criteria if their physicians verify they need a nursing facility level of care. Eligible seniors must contribute their entire income toward their care, minus a $70 monthly allowance, and Medicaid pays the remaining costs. Medicaid coverage only kicks in after the first 30 days following admission.
Around 2,464,523 people are currently enrolled in Georgia's Medicaid and CHIP programs, some of whom will qualify for long-term care benefits. Georgia covers various long-term services and supports, and the program covers several care options to suit individual health, social and psychological needs and preferences. Some people's needs may be best met in a residential nursing home, but the state Medicaid program also covers certain home health services for those who prefer to live in their own homes. For example, Georgia's Elderly and Disabled Waiver Program covers nursing at home, home health aide services and other benefits designed to help older adults remain living in their communities.
Eligibility for Medicaid in Georgia
Each of Georgia's Medicaid programs has its own eligibility criteria. Generally, applicants need to have a low income, which the state defines as a percentage of the Federal Poverty Level. However, the income limit is often higher for people requiring long-term care than the general Medicaid eligibility limit. Income from sources such as wages, pensions and stocks count toward the financial determination. Some income sources are uncountable, such as Holocaust restitution payments. The state also sets asset limits for savings and second homes, but belongings, primary residences and cars are usually exempt.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 |
| Two-Person Household | $65,784 (dual application) |
|
*Per year
During an application for nursing home coverage, prospective enrollees must undergo an assessment to determine whether they need a nursing home level of care. This means they must have a physical or mental disability requiring significant medical care and support that they and their family caregivers cannot provide. As a rule, they must have at least one medical need, such as vital signs monitoring or catheter care, and at least one mental or functional impairment. Other eligibility criteria for Georgia's Medicaid program include the following:
- People aged 65 or older
- People who are blind or disabled
- Applicants must be legal U.S. citizens or qualified immigrants
- Applicants must be Georgia residents
Applying for Medicaid in Georgia
The fastest way to apply for Medicaid in Georgia is by using the state's online application portal. The portal also provides downloadable paper application forms for mail applications. Applicants should send their completed and signed paper application to:
Division of Family and Children Services Customer Contact Center
P.O. Box 4190
Albany, GA 31706
Georgia Medicaid also operates telephone helplines for support with Medicaid applications. Applicants can access help by calling one of the following numbers:
- 1-877-423-4746
- 1-800-225-0135 (TTY users)
What Information You Will Need
- Social Security number or legal immigrant documentation numbers
- Income information for each household member
- Pay stubs
- W-2 forms
- Wage and tax statements
- Health insurance policy numbers
Additional Medicaid Support & Resources in Georgia
Medicaid eligibility and benefits can appear confusing, and there's support available for seniors who need help applying for coverage or accessing benefits. Several state and charitable organizations offer Medicaid support and resources in Georgia:
| Contact | Service | |
|---|---|---|
| Georgia Gateway | (877) 423-4746 | Offers a pre-screening tool to check Medicaid eligibility and enables existing enrollees to manage, renew and apply for benefits. |
| Georgia Health Services Network | (888) 466-7780 | Provides a free placement service to help Medicaid recipients find affordable residential care placements. |
| Georgians for a Healthy Future | (404) 569-5016 | Provides free health policy information and resources and advocates to improve access to care and health coverage in Georgia. |
Can You Use Medicare to Pay for Nursing Home Care in Georgia?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support and Resources in Georgia
Several organizations offer free support and counseling to help older adults and their caregivers understand their Medicare eligibility and coverage and navigate the process. The following resources provide various Medicare-related services, including application and claims support, links to community services and beneficiary education sessions.
| Contact | Service | |
|---|---|---|
| Action Pact | (912) 285-6083 | Action Pact's Georgia SHIP program provides free advice and support to seniors and their families to help them navigate Medicare claims and other Medicare-related issues. Advisors can also offer impartial advice on choosing the right supplemental plans and carriers to suit each person's needs. |
| Legacy Link | (866) 552-4464 | Legacy Link offers free online and in-person counseling to help Medicare enrollees. This can include providing assistance with accessing funding support as well as helping Medicare enrollees understand their benefits and file claims. |
| Athens Community Council on Aging | (706) 549-4850 | Athens Community Council on Aging provides free Medicare counseling to seniors and their caregivers. This organization also helps seniors by connecting them with other resources and services within the community. |
Other Financial Assistance Options for Nursing Home Care in Georgia
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Georgia
| Licensing Requirements | All Georgia nursing homes accepting Medicare and Medicaid must be licensed by the Healthcare Facility Regulation Division and have a licensed administrator. The HFRD monitors nursing homes to ensure compliance with Georgia’s rules and regulations. |
| Staffing Requirements | All homes must employ a registered nurse as the director of nursing services. There must be at least one registered or licensed nurse on each shift and sufficient staff to care for all residents. Residents should receive at least 2 hours of nursing care daily. |
| Staff Training Requirements | The director of nursing must provide an in-service education program for nurses and other staff members to ensure safe practices and professional development. The home must keep detailed records of each staff member’s training attendance and progress. |
| Admission Restrictions | Nursing homes can only admit residents if they can care for them safely and meet their medical, social and psychological needs. The home must receive a referral from each resident’s physician before agreeing to admit them. |
| Care Planning Requirements | Facilities must obtain a written physician’s statement for each new resident within 48 hours of admission. Their physician must create a care plan detailing medications and treatment. Reviews should occur every 30 days for the first 90 days |
| Dietary and Nutritional Services Requirements | Each home must employ a registered dietician for at least 8 hours per month. Residents must receive healthy, balanced meals designed to meet their unique health needs every 5 hours and nutritious snacks. Menus must be planned in advance and kept on record. |
| Specialized Rehabilitative Services | Nursing homes may offer rehabilitative services, such as physical, occupational and speech therapies. These services can only be delivered by a licensed therapist, and the home must maintain detailed treatment plans and progress records for each patient. |
| Medication and Pharmaceutical Services | Medication must only be administered by a physician, nurse or certified medication aide. Homes must store and administer medications according to state and federal laws. A licensed pharmacist must perform quarterly medication reviews for each resident and monitor compliance with regulations. |
| Activities Requirements | Each home must have a designated person responsible for designing and delivering activity programs. This person should have experience or qualifications in leading group activities. Activity schedules should be tailored to suit the needs and interests of all residents. |
| Infection Control Requirements | Nursing homes must design and implement an infection control program. The program should include policies and procedures to prevent the spread of infectious diseases and ensure staff receive infection control training. |
| Medicaid Coverage | Georgia's Medicaid program pays for nursing home care for eligible enrollees. Nursing homes do not have to accept Medicaid funding, but most do. Coverage begins 30 days after admission. |
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