How to Apply for Structured Family Caregiving in Georgia

To apply for Structured Family Caregiving (SFC) in Georgia, your loved one first needs Georgia Medicaid and a place in the Elderly and Disabled Waiver Program (EDWP); SFC is then added to their EDWP care plan, and you choose an approved SFC provider to enroll the caregiver. You do not apply for SFC on its own. It is a service inside EDWP, so the application follows the EDWP process.

Where you start depends on what your loved one already has. Some families begin with a Medicaid application. Others are already on EDWP and only need to ask for SFC. This guide shows each path, who to call, and what to say.

SFC application at a glance

• SFC is part of EDWP: it is offered through CCSP and SOURCE, the two paths of the waiver
• Step one for most families: a screening call to the Area Agency on Aging at 866-552-4464
• If your loved one has no Medicaid yet: apply through Georgia Gateway, by phone, or at a county DFCS office
• Who adds SFC to the plan: your loved one's EDWP care coordinator
• Who enrolls the caregiver: the DCH-approved SFC provider you choose
• If something is denied: Medicaid rules require a written notice of your right to a fair hearing

Who can apply for Structured Family Caregiving in Georgia?

The application is made for the person who needs care, not for the caregiver. That person must qualify for EDWP. The DCH EDWP fact sheet says EDWP serves adults 21 and older who are elderly or functionally impaired. They must need a nursing-home level of care and be Medicaid eligible, or potentially eligible.

The caregiver must be a relative who lives in the home. DCH's SFC waiver notice describes a live-in family caregiver, for members who need at least five hours of personal support a day. The Georgia Council on Developmental Disabilities notes that a spouse or legal guardian cannot be the paid caregiver. Our post on whether a spouse can be paid covers that rule.

Where does your family start?

Find the row that matches your loved one today. Then skip to that step below.

Step 1: How do you apply for Georgia Medicaid?

Georgia.gov lists four ways to apply for Medicaid:

• Online: at gateway.ga.gov, under Apply for Benefits, then Medical Assistance
• By phone: call DFCS at 877-423-4746
• In person: at your county DFCS office
• By mail: call 877-423-4746 to ask for the forms

Georgia.gov also lists what to gather. Have these ready if you can:

• Proof of identity, and citizenship or immigration status
• Your loved one's Social Security number
• Income letters, such as Social Security, VA or pension statements
• Health insurance information
• Bank statements, life insurance policies, the latest tax return and other asset records

Georgia.gov says applicants should get a decision by mail within 45 days, or up to 60 days if a disability decision is needed. Do not wait for that decision to make the EDWP screening call. The two can run side by side.

Step 2: How do you get your loved one on EDWP?

Call the statewide Area Agency on Aging line at 866-552-4464. Georgia.gov says a staff member will screen your loved one by asking about their situation. The screening looks at eligibility and how urgent the need is.

In metro Atlanta, the Area Agency on Aging is the Atlanta Regional Commission. Its information line, Empowerline, is 404-463-3333.

There is often a waitlist. Georgia.gov says urgency of need affects your loved one's place on it. When their name comes up, a nurse or care coordinator visits the home for an assessment. They then build a care plan with your loved one and the caregiver.

Step 3: How is SFC added to the care plan?

SFC is ordered through the care plan, like every EDWP service. Georgia's EDWP provider manual says providers deliver services as ordered on the care plan authorized by the care coordinator. So the care coordinator is the person to ask.

Tell the care coordinator three things:

1. A relative lives in the home and gives daily care.
2. The family wants SFC to be considered as part of the plan.
3. Which approved SFC provider you would like to use.

The manual says care coordinators refer members to enrolled providers based on the member's choice. It also notes that enrollment in EDWP does not guarantee a referral to any one provider. If you have a provider in mind, say so early.

Step 4: What happens once you choose an SFC provider?

The SFC provider takes over the caregiver's side of the application. This is where the caregiver is enrolled.

• Intake: the provider reviews whether the caregiver meets the SFC rules, such as living in the home.
• Background check: the caregiver completes a fingerprint check through Georgia's GCHEXS system. DCH's SFC applicant instructions explain how to register and book fingerprints.
• Health coach: the provider assigns a health coach who supports the caregiver by phone or online.
• Daily notes: the caregiver learns to send daily notes about the member's condition, as DCH's SFC notice describes.

Services begin once the care plan and the provider's onboarding are both in place. How long that takes varies by family and by waitlist.

The SFC application steps in order

Here is the full sequence for a family starting from scratch.

1. 1

   Apply for Medicaid

   Apply through gateway.ga.gov, by phone at 877-423-4746, or at your county DFCS office.

2. 2

   Call for the EDWP screening

   Dial 866-552-4464. Describe your loved one's daily needs and who lives in the home.

3. 3

   Complete the assessment

   When a slot opens, a nurse or care coordinator visits and builds the care plan.

4. 4

   Ask for SFC

   Tell the care coordinator a live-in relative gives care. Name the SFC provider you choose.

5. 5

   Enroll the caregiver

   The provider completes intake and the background check, and assigns a health coach.

What should you say when you call?

Clear details help the screener and the care coordinator. Before each call, have these answers ready:

• Your loved one's full name, date of birth and Medicaid number, if they have one
• Their main diagnoses and the daily tasks they need help with
• Who lives in the home, and who gives care each day
• Recent falls, hospital stays or changes in memory
• That a relative in the home wants to be considered for SFC

Keep a notebook. Write down the date, the person you spoke to and what they said. It saves time if you need to follow up.

What if the application is denied?

You have the right to ask for a fair hearing. Federal Medicaid rules at 42 CFR 431.206 require the state to tell you about this right in writing. That notice must come when you apply, and again when eligibility, benefits or services are denied.

The notice must explain how to request a hearing. It must also say that you can speak for yourself or bring a relative, friend, lawyer or other spokesperson. Read any denial letter as soon as it arrives. It tells you the deadline for asking for a hearing.

Can you switch SFC providers later?

Yes. The member keeps the right to choose. Georgia's EDWP manual says the care coordinator will arrange services with another provider when the current one cannot meet the member's needs. If you want to change, start by calling the care coordinator.

For a full overview of the program itself, read our guide to Structured Family Caregiving in Georgia. To understand how the caregiver's amount is decided, see How Is Structured Family Caregiving Pay Set in Georgia?

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. As an approved Structured Family Caregiving provider, we help families through each step of this application.

We can help you work out your starting point and prepare for the screening call. Once your loved one's care coordinator refers you, we handle caregiver intake and the background check. If your loved one is on EDWP and SFC does not fit, we also offer EDWP in-home services.

• 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