Georgia runs four Medicaid programs that keep people with nursing-facility or institutional needs at home, plus a pediatric nursing program that is often listed with them. They share a logic: someone assesses the applicant, a physician or other clinician signs, and Alliant Health Solutions or a state office decides. They differ in almost everything else, including who does intake, which form carries the level of care, and what medical records the state expects to see. This is each program as its own manual describes it in the October 2026 editions.
The programs at a glance
| Program | Who it serves | Level of care | Who does intake | Instrument | Longest approval |
|---|---|---|---|---|---|
| EDWP, Traditional (CCSP) | Age 21 and over, functionally impaired | Intermediate nursing facility | The Area Agency on Aging screens; a case management agency’s nurse assesses | Form 5588 | 365 days |
| EDWP, Enhanced (SOURCE) | Same waiver; full Medicaid only | Intermediate nursing facility | The enhanced case management agency screens and assesses | Form 5588 | 365 days |
| ICWP | Age 21 through 64 at start, severe physical impairment or traumatic brain injury | Nursing facility or hospital | Alliant Health Solutions | DMA-6 | 365 days |
| NOW and COMP | Intellectual and developmental disabilities | ICF/ID | The DBHDD Field Office | DMA-6 or DMA-6A, then the DMA-7 | 365 days |
| GAPP | Medically fragile children, to the 21st birthday | Medical necessity | A GAPP nursing agency or the hospital’s discharge planner | DMA-6A and the physician’s plan of treatment | Reviewed every 3 to 6 months |
One agency sits behind all of them. The Department of Community Health “administers and operates the EDWP” and operates ICWP directly; it “delegates the day-to-day operation of the NOW/COMP Waiver Programs to the Department of Behavioral Health and Developmental Disabilities”. The Division of Aging Services designates the Area Agencies on Aging, which are the front door for EDWP, but it does not run the waiver.
EDWP: CCSP and SOURCE
The Elderly and Disabled Waiver Program is one waiver with two arms. The manuals now call CCSP “Traditional” case management and SOURCE “Enhanced”, and one case management manual covers both. The waiver “assists individuals who are 21 and over and functionally impaired to continue living in their own homes”, and a member “must meet the level of care criteria for intermediate nursing home placement.”
Intake. For the traditional arm, “a telephone screening specialist at the AAA ADRC completes telephone screening” with the Determination of Need-Revised. For SOURCE, “EDWP screening is performed by the EDWP Enhanced Case Management agencies”, and SOURCE members “must be eligible for full Medicaid”. Case management in both arms “is provided directly through stand-alone agencies”, because “Conflict Free Case Management is required by the federal government”: the agency that plans the care does not deliver it. (Conflict-free case management, explained covers the federal rule.)
The instrument. The nurse assesses with the MDS-HC and the level of care is recorded on Form 5588, the Level of Care and Placement Instrument. It is not the DMA-6; the DMA-6 article sets the two side by side. “The member’s physician signs the Form 5588 … to attest to the member’s need for a nursing home LOC”, and “MD, DO, RNP or PA must sign form 5588.” The agency’s medical director may sign in the physician’s place.
The order of events is not the one most people assume. The nurse assesses and uploads; “Alliant Health Solutions (AHS) provides validation of level of care eligibility for all Georgia Elderly and Disabled waiver clients”; only then does the form go to the physician; and after it returns, the RN certifies “within twenty-four hours or no later than the following business day.” Services “may not begin … until the RN signs the form to certify the LOC.”
The records. This is the part that changed. Both arms’ sections now read: “Medical records are required to be submitted with ALL Initial Assessments.” The manual’s revision record dates the requirement to October 1, 2025. The records must be recent, “most recent medical records dated within 12 months”, and the manual names three cases they have to carry:
- an impairment “not clearly associated with a medical diagnosis”;
- a behavioral health diagnosis where the impairment is not clearly tied to a medical one;
- diagnoses “not typically expected to result in long term functional impairment such as hip fracture or knee replacement”.
Getting them is the case management nurse’s job, by “requesting medical record information from the physician or the agency’s Medical Director, using the EDWP Physicians Evaluation form”. And the reviewer can go further: “Alliant Health Solutions and/or DCH staff may request and/or retrieve additional medical records”, which “may include hospitalization information, medical equipment needs, previous treatment, and medical history.” At reassessment the rule is softer; the manual says “medical record submission is not required for all level of care reviews”.
The clocks are on the agency. Screening “will occur within five (5) business days of referral and be completed within 15 business days”. After the referral reaches the agency, the nurse contacts the member within five business days and “completes initial home visit” within fifteen. The assessment is documented within five business days of the visit, with “five additional business days for upload to Alliant”. Once Alliant approves, the agency has two business days to send the form to the physician, “or 10 business days max” to meet with the medical director. If Alliant issues a technical denial, the agency has thirty days to supply what was missing. “No LOC length of stay may be approved for more than three hundred sixty-five (365) days.” The manuals give Alliant no turnaround of its own.
One change for provider agencies. Structured family caregiving sits inside this waiver, and from September 1, 2026 its providers must hold NCQA accreditation, “Case Management with distinction in Long Term Services and Supports”; existing providers have until September 1, 2027. The requirement is on structured family caregiving providers, not on case management agencies.
ICWP: the Independent Care Waiver Program
ICWP serves adults who “are 21 through 64 years of age when services begin” with “severe physical impairment and/or traumatic brain injury”, “certified for a level of care appropriate for placement in a hospital or nursing facility”.
Here Alliant is the front door, not the back office. It is “under contract with DMA to implement the selection process” and “to assess applicants, maintain the waiting list”. The case manager arrives after approval: the member chooses one from Alliant’s list, and the case manager visits “within five (5) working days of selection” and writes the plan of care “within thirty (30) days”.
The instrument is the DMA-6, “the standard form used to document that the individual meets the level of care (LOC) for nursing facility placement”. Once the applicant is approved, “it becomes their responsibility along with the case manager to obtain a DMA-6 signed by their physician, physician assistant, or nurse practitioner.” Two dates hang on that signature: “The signature date should be within 90 days of the start date of service”, and “the date of service starts when Alliant Health receives the completed DMA-6.” Every day the form sits unsigned is a day of service that does not happen.
On records the manual is brief: “AHS may request medical records to determine the level of care.” Alliant’s own clock is the clearest in the state: “Within forty-five (45) days of receiving the completed application … AHS will schedule the assessment, perform the assessment, and make a LOC determination”, subject to a slot being available. The approval lasts a year: “The validity of the DMA-6 expires 365 days from the date it is approved by Alliant Health”.
NOW and COMP
The New Options Waiver and the Comprehensive Supports Waiver serve a person with an intellectual or developmental disability “who resides in or is at risk of an Intermediate Care Facility for Persons with Intellectual Disabilities (ICF/ID) placement”.
Entry is through “the Department of Behavioral Health and Developmental Disabilities (DBHDD) Field Office”, where “the Intake and Evaluation (I&E) Team is responsible for the screening process” and “the DBHDD I&E psychologist reviews the available information and makes a recommendation”. Applicants found pre-eligible go on the planning list, which DBHDD reported at 7,833 people as of March 31, 2025. Ongoing case management is support coordination, from a support coordination agency.
The record that decides eligibility here is not a hospital record. “A psychological assessment for intellectual functioning and/or adaptive behavior is required”, and the collecting falls on the family: “The DBHDD Field Office requests the individual or family participant to provide copies of any previous psychological evaluations or adaptive behavior testing.” DBHDD’s application guide is blunt about the consequence: “All required information must be received before an application can be sent to a DBHDD psychologist”. For an adult, the manual sets no maximum age on the evaluation.
The level of care goes on the “DMA-6/DMA-6A for initial level of care and DMA-7 form for level of care re-evaluations”. The clinician’s signature is a concurrence: “The signatures of the physician, nurse practitioner, or physician assistant on the DMA 6/DMA-6A form indicate concurrence”. The Health Risk Screening Tool and the Supports Intensity Scale shape the service plan; they are not the eligibility instrument. Two clocks apply: “LOC service approval may not exceed 365 days”, and “initial service must begin within 60 days of DBHDD Field Office approval”.
GAPP: not a waiver, and a different kind of packet
The Georgia Pediatric Program is in-home nursing and personal support for medically fragile children, and it is usually listed with the waivers. Its own manual says members “are no longer required to meet the same level of care as for admission to a hospital or skilled nursing facility”; approval rests on “a medical necessity determination”. Other state manuals still describe GAPP with an institutional level of care, so expect to meet both versions.
There is no case management agency. Families “must apply via a nursing agency participating in the children’s program”, or the hospital applies through discharge planning, and Alliant reviews the packet.
The packet is the most records-heavy in the state. The DMA-6A here is nearly a formality: “The member’s physician DOES NOT HAVE TO SIGN THE DMA-6A.” The physician’s document is the plan of treatment, which “must be developed, signed, and dated by the attending physician”. Since April 1, 2024, “a copy of the physician’s last office visit notes must be submitted with each initial and/or recertification request.” The checklist adds the “most recent 3 months of Narrative Nursing notes”, a medical necessity statement, the nursing care plan and, for a child coming home from the hospital, the manual allows that “providers can accept the latest progress notes and/or the discharge summary” as the plan of treatment when the hours are stated. A letter of medical necessity “may also be submitted but is not required”.
The clocks are short. “Alliant has 7 days … from the submission of a complete packet”; a technical denial gives ten days to cure; and the request should arrive “at least 30 days prior to the intended date of initiation of services”.
Katie Beckett is often confused with GAPP. It is an eligibility category, not a service: a way for a child with institutional-level needs to qualify for Medicaid without counting the parents’ income. Its form is the pediatric DMA-6A, signed by the physician and “valid for a period of 90 days from the signature date.”
What the manuals do not ask for
It is as useful to know what is not written down. No manual in this set names a history and physical as a required document. Hospital discharge records are examples of what Alliant “may request”, not a universal requirement. EDWP puts no day count on the age of the physician’s signature; the ninety-day rules belong to ICWP and Katie Beckett. And apart from GAPP’s seven days and ICWP’s forty-five, the reviewer’s turnaround is not stated.
The pattern
Across the four programs the dependency is the same one. The level-of-care form is short, and the person signing it is certifying a history that sits in other organizations’ charts. The agency’s clocks are in business days. The records that support the signature are at a hospital, a specialist and a primary care office that have no clock at all.
Since October 2025 that dependency is written into the EDWP manual: records with every initial assessment, dated within twelve months, requested by the nurse. Vivlio retrieves those records for a case management agency under the release the applicant signs at application, and returns them organized the way Form 5588 and the DMA-6 read: diagnoses, medications, hospital stays, functional findings. The nurse uploads a complete packet the first time, and the physician is asked to sign for what is already in front of them.
