EDWP Guide
What Does 'Nursing Home Level of Care' Mean in Georgia?
Nursing home level of care in Georgia means needs high enough for intermediate nursing facility care. It is required for EDWP, even for care at home.
In Georgia, "nursing home level of care" means a person's health and daily needs are serious enough that they would qualify for an intermediate level of care in a nursing facility, even if they choose to get that care at home. It is a medical and functional test, not a money test. Every person applying for EDWP, which includes CCSP and SOURCE, has to meet it. That covers families seeking Structured Family Caregiving too.
The phrase scares many families. It sounds as if a parent must be ready to move into a nursing home. They do not. The test only asks whether their needs reach the level a nursing home would serve. The waiver then pays for that help at home instead.
This guide explains what the test looks at, who decides, how often it is checked and how to prepare.
Nursing home level of care at a glance
- What it is: a test of whether someone needs the intermediate care a nursing facility provides
- Who must meet it: everyone in Georgia's Elderly and Disabled Waiver Program (EDWP)
- What it looks at: medical needs, memory and thinking, and help with daily activities
- Who decides: an EDWP nurse assesses, a physician certifies, and Alliant Health Solutions validates
- How long it lasts: an approval runs for up to a year, then needs a new review
- Does it mean moving to a nursing home? No. Your loved one can choose care at home
Who has to meet nursing home level of care in Georgia?
Anyone who wants Medicaid to pay for long-term care at home through EDWP. The DCH EDWP fact sheet lists physician approval of an intermediate nursing home level of care as a core requirement. The EDWP general services manual says members must meet the same level of care needed for nursing facility admission.
That one test sits alongside the others. Your loved one must also:
- Be 21 or older and functionally impaired
- Have Georgia Medicaid, or be likely to qualify after the financial review
- Choose care at home or in the community instead of a nursing facility
- Have needs that EDWP can meet within the program's cost rules
The same test applies whether care comes from an agency aide or a relative through SFC. Our checklist of Structured Family Caregiving requirements shows the extra rules that apply when a family member will be the paid caregiver.
The rule comes from federal law. Under 42 CFR 441.302, a state must check that each waiver member would otherwise need institutional care. It must also offer a choice between institutional care and care at home.
What does nursing home level of care mean in Georgia?
Georgia uses an "intermediate" nursing home level of care for EDWP. The general services manual, Section 601.2, describes three groups of criteria.
| Column | What it covers | Examples from Georgia's criteria |
|---|---|---|
| A: Medical status | A stable condition that needs intermittent skilled nursing under a doctor's direction | Medication management, skin care, monitoring of vital signs or weight, restorative nursing |
| B: Mental status | Memory loss or thinking problems beyond occasional forgetfulness | Documented memory deficits, trouble making daily decisions, wandering or other behaviors that need supervision |
| C: Functional status | Help needed with everyday physical tasks | Help with transfers or walking, help staying continent, setup and supervision with activities |
Georgia's published level of care criteria explain how the columns work together. A person needs a doctor-managed condition plus at least one other Column A service. They also need at least one item from Column B or Column C. In plain terms, a medical diagnosis alone is not enough. It must come with real problems in thinking or in daily functioning.
Does dementia count?
Yes, it can. The EDWP case management manual says Alzheimer's disease and other dementias are treated as physical conditions for EDWP. Memory loss can also meet Column B when it is documented with a diagnosis.
What does not qualify on its own?
The general services manual says EDWP is not the right fit when a person's main diagnosis or main need is psychiatric or developmental. There is an exception. If that condition comes alongside a more serious medical disorder, the person may still qualify.
What are ADLs, and why do they matter here?
ADLs are activities of daily living. They are the basic tasks of looking after yourself. A federal long-term care guide from LTCFEDS.gov lists them as:
- Bathing or showering
- Getting dressed
- Eating
- Moving from bed to chair, called transferring
- Bladder and bowel control
- Using the toilet
IADLs, or instrumental activities of daily living, are the tasks needed to live on your own. They include managing medicines, preparing meals, handling money, shopping and getting to appointments.
The EDWP general services manual describes the waiver's target group as people with "late loss" ADL impairment, or with cognitive loss that requires help with ADLs. So the assessor pays close attention to the hands-on tasks above.
Who decides whether my parent meets the level of care?
Several people play a part. The case management manual, Sections 1853 and 1855, sets out the order.
Phone screening
The Area Agency on Aging screens your loved one by phone at 866-552-4464 and places them on the EDWP list if they appear eligible.
Home assessment
An EDWP registered nurse visits and assesses medical needs, thinking and daily functioning.
Functional scoring
The nurse completes the Determination of Need-Revised (DON-R), which scores impairment and unmet need for care.
Physician certification
Your loved one's doctor, or the agency's medical director, certifies whether they need an intermediate level of care.
State validation
Alliant Health Solutions reviews the file and validates or denies the level of care.
The DON-R matters for getting in. The case management manual says initial eligibility needs an impairment score at or above the level set in the manual, plus an unmet need for care. The Atlanta Regional Commission describes the DON-R as a standard tool for measuring functional capacity.
The doctor also signs the Level of Care and Placement Instrument. The manual says this approves the care plan and confirms whether EDWP can safely meet your loved one's needs.
How often is level of care checked?
At least once a year. The case management manual says the care coordinator reassesses each member and redetermines level of care at least annually. The general services manual says an Alliant approval runs for up to one year.
The DFCS Medicaid manual, Section 2240 adds the financial side. The level of care form must be renewed before it expires, and a copy goes to DFCS. DFCS uses the new form to keep waiver Medicaid going.
Needs can also change between reviews. If your loved one's health gets worse, tell the care coordinator. A new assessment may change the care plan.
What happens if my loved one does not meet the level of care?
DFCS cannot approve waiver Medicaid without it. Section 2240 says DFCS must then check whether your loved one qualifies for Medicaid in another way.
The case management manual's process chart shows two paths after a denial. The nurse can help refer your loved one to the Area Agency on Aging for other services. The nurse can also submit an appeal request to DCH. Ask for the decision in writing, and ask how to appeal and by when.
Other help may still be available. Our guide to Georgia caregiver programs covers support that does not require a nursing home level of care.
How can families prepare for the assessment?
The assessor can only score what they see and hear. Families often help most by preparing facts in advance.
Gather these before the nurse visits:
- A list of diagnoses, including any memory or dementia diagnosis
- A current medication list, and who sets up the doses
- Recent hospital stays, falls or emergency visits, with dates
- Your doctor's name and contact details
- Notes on which daily tasks your loved one needs help with, and how often
Be honest and specific. Do not exaggerate, and do not play down needs out of pride. Many older adults say "I'm fine" to a stranger. It helps to have a family member present who sees the daily routine.
How A1-GA Healthcare Agency helps
A1-GA Healthcare Agency is a Georgia DCH-approved Medicaid home care provider in Norcross, serving metro Atlanta. We have provided in-home care since 2008 and staffed caregivers since 2004. Once your loved one is approved for EDWP, they can choose us for EDWP services such as in-home personal support and respite. Relatives who live with their loved one can ask about Structured Family Caregiving.
We do not decide level of care. That is the role of the EDWP nurse, the physician and Alliant. We can explain the process, help you think through what to gather, and tell you early if another option may fit better. To learn how SFC works, read What Is Structured Family Care?
- Phone: 678-446-1832
- Hours: Monday to Friday, 8am to 6pm
- Email: [email protected]
- Office: 4505 Peachtree Industrial Blvd, Suite K, Norcross, GA 30092
- Quick check: fill in our eligibility form or visit our eligibility page
Frequently asked questions
Does nursing home level of care mean my parent has to move into a nursing home?
No. It means your parent's needs are at the level a nursing facility would serve. Through EDWP, they can choose to get services at home or in the community instead, and federal waiver rules require that this choice be offered.
Who decides if someone meets nursing home level of care in Georgia?
For EDWP, an EDWP registered nurse assesses your loved one and completes the DON-R functional assessment. Their doctor or the agency's medical director certifies the need for intermediate care. Alliant Health Solutions then validates or denies the level of care for the state.
Can someone with dementia meet nursing home level of care in Georgia?
Yes, they can. Georgia's EDWP manual treats Alzheimer's disease and other dementias as physical conditions. Documented memory loss or trouble making daily decisions can also count under the mental status part of the criteria.
What are ADL services?
ADL services are hands-on help with activities of daily living, such as bathing, dressing, eating, using the toilet and moving from bed to chair. In Georgia's EDWP, personal support services provide this kind of help at home once level of care and other rules are met.
How often is level of care reviewed for EDWP?
At least once a year. The care coordinator reassesses each EDWP member and redetermines level of care annually, and the form must be renewed before it expires. If needs change sooner, ask the care coordinator for a new assessment.
What can we do if level of care is denied?
Ask for the decision in writing, and ask how to appeal and by when. The EDWP nurse can submit an appeal request to DCH or refer your loved one to the Area Agency on Aging for other services. DFCS will also check whether your loved one qualifies for Medicaid in another way.
Sources
- Georgia DCH: Elderly and Disabled Waiver Program (EDWP) fact sheet
- Georgia Medicaid: EDWP CCSP and SOURCE General Services manual (July 2026)
- Georgia Medicaid: EDWP CCSP and SOURCE Case Management manual (July 2026)
- Georgia Division of Aging Services: Appendix 500, Level of Care Criteria
- Georgia DFCS Medicaid manual, Section 2240: Level of Care
- Georgia DFCS Medicaid manual, Section 2131: Elderly Disabled Waiver Program
- 42 CFR 441.302: State assurances for home and community-based waivers
- Atlanta Regional Commission: Determination of Need-Revised
- LTCFEDS.gov: ADLs vs. IADLs
This article is for education only. It is not legal, medical or financial advice. Speak to a qualified professional about your situation before you act.
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