How Georgia pays for disability services
Georgia ranks 39 of 51 on Medicaid waiver funding for people with intellectual and developmental disabilities, with a score of 51.4 out of 100.
Medicaid waivers in Georgia
Waiver inventory
| Program name | Authority | Population served | Enrollment (year) | Residential covered? | Official URL |
|---|---|---|---|---|---|
| New Options Waiver (NOW), 0175 | 1915(c) | People with intellectual and developmental disabilities needing less intensive support; lower annual cost cap | 4,505 (cited in FY2027 budget analysis, 2026) | Limited. NOW funds Community Living Support and in-home services; Community Residential Alternative is a COMP service | medicaid.georgia.gov |
| Comprehensive Supports Waiver Program (COMP), 0323 | 1915(c) | People with I/DD needing intensive support, including out-of-home residential placement and people leaving institutions | 9,789 (cited in FY2027 budget analysis, 2026) | Yes: Community Residential Alternative (group homes of 4 or fewer, foster homes, host home/life sharing), plus Specialized CRA tiers (Behaviorally-Focused, Specialized Transitional, Intensive) | medicaid.georgia.gov |
| Katie Beckett Deeming Waiver (TEFRA option) | State plan eligibility option administered as a "deeming waiver" | Children with significant disabilities living at home whose parental income would otherwise disqualify them | Not published in sources retrieved | No. It is an eligibility pathway, not a residential benefit | mmis.georgia.gov |
| Georgia Pediatric Program (GAPP) | State plan / 1915 authority per DCH listing | Medically fragile children with multiple system diagnoses; overlaps heavily with the I/DD population | Not published in sources retrieved | No. In-home nursing and personal care support | medicaid.georgia.gov |
| Independent Care Waiver Program (ICWP) | 1915(c) | Adults 21-64 with severe physical disabilities or traumatic brain injury. Included for completeness; it is not Georgia's DD vehicle | Not published in sources retrieved | Alternative Living Services | medicaid.georgia.gov |
| ICF/IID services | State plan institutional benefit | People with intellectual disabilities meeting ICF/IID level of care | Not published in sources retrieved | Yes, institutional | mmis.georgia.gov |
Georgia has not adopted 1915(k) Community First Choice or 1915(i) for this population in any source retrieved. CCSP and SOURCE are aging and physical-disability programs and are excluded.
State-only funded programs
- DD State-Funded Services. DBHDD funds a parallel, non-Medicaid service array for people who meet DD eligibility but do not hold a waiver. Covered services: Community Access, Supported Employment, Community Living Support, Community Residential Alternative, Respite, Behavioral Supports Services, and Community-Based Crisis Services including intensive in-home and out-of-home supports. Eligibility requires a DD diagnosis originating before age 22, meeting "most in need" prioritization criteria, and lawful presence. Priority goes first to people on the DD Waiver planning list and second to people with urgent, complex needs and no other support. Administering agency: DBHDD Division of Developmental Disabilities, through Regional Field Offices. Appropriation: not broken out as a single line; it sits inside the Adult Developmental Disabilities Services program. Official URL: dbhdd.georgia.gov
- Adult Developmental Disabilities Respite Services. FY2026 appropriation $2,100,000, 100 percent state general funds, zero federal match. Administering agency: DBHDD. Official URL: legis.ga.gov
- Child and Adolescent Developmental Disabilities. FY2026 total $20,675,670, of which $17,390,174 is state general funds against only $3,285,496 federal Medicaid, making it predominantly state-financed. Includes $600,000 added in FY2026 for autism centers. Same source as above.
- Citizen Advocacy. $100,000 state funds added in FY2026. Same source as above.
- Family Support Services. DBHDD program page: dbhdd.georgia.gov
County / regional / local funding
None identified. Georgia has no county developmental disability boards, no county DD tax levies, and no regional center allocations. DBHDD administers all public DD funding through six state Regional Field Offices, which are state administrative units, not local taxing bodies. I checked the DCH waiver program inventory, the DBHDD provider manuals for both waiver and state-funded services, and the FY2026 and FY2027 appropriations documents; none reference a county or local revenue stream for I/DD.
Funding scale
- Adult Developmental Disabilities Services, FY2026: $1,075,483,604 total funds. Breakdown: state general funds $545,643,517; federal Medicaid $377,303,445; federal Social Services Block Grant $37,981,142; federal COVID recovery $81,440,362; tobacco settlement funds $10,255,138; agency funds $22,860,000. legis.ga.gov
- Adult DD Respite Services, FY2026: $2,100,000, all state general funds. Same source.
- Child and Adolescent Developmental Disabilities, FY2026: $20,675,670 total; $17,390,174 state general funds; $3,285,496 federal Medicaid. Same source.
- FY2026 program additions: $26,714,565 state funds for NOW/COMP provider rate increases from the rate study; $2,331,025 to annualize 100 existing waiver slots; $2,331,025 for 100 additional slots (House version raised this to 150 slots at $3.5 million); $3.1 million to annualize the Macon Crisis Stabilization and Diagnostic Center for people with I/DD. legis.ga.gov and gbpi.org
- DBHDD department-wide, FY2027: approximately $1.7 billion state funds (about $1.67 billion general funds plus $10.3 million tobacco settlement). DD-specific FY2027 addition: $5.5 million to expand HCBS, funding annualization of 150 existing slots plus 100 new NOW/COMP slots. gbpi.org
- Georgia FMAP, FY2027: 66.63 percent federal, so roughly 33.37 percent state share on matched spending. Note the state general fund share of the Adult DD program (about 51 percent) far exceeds the state FMAP share, reflecting the large volume of state-only DD services. kff.org
- People served in DD waivers: 14,294 (NOW 4,505 plus COMP 9,789), cited in 2026 budget analysis. gbpi.org
- Spending per participant: approximately $75,200 all funds, derived from FY2026 Adult DD Services total divided by 14,294 waiver participants. This overstates per-waiver cost because the Adult DD program also funds state-only services, crisis centers, and administration. Derived, not published.
- Waiting list (Georgia calls it the "planning list"): 7,891 people, 2026. Of those, 1,217 are in urgent need because of risk of institutionalization, homelessness, medical crisis, or loss of a primary caregiver. gcdd.org
- Cost to clear the urgent-need tier: approximately $132 million by state estimate for 1,217 waivers. gcdd.org
- Average wait time: not published in any source retrieved.
Residential funding detail
Georgia's out-of-home residential benefit is Community Residential Alternative (CRA), procedure code T2033, a COMP waiver service. It is deliberately small-setting: group homes of four residents or fewer, foster homes, and host home/life sharing arrangements.
Payment structure: per diem, tiered on two dimensions simultaneously.
- Home size. Separate rate schedules for 3-bed, 4-bed, and 5-bed residences. Smaller homes get higher per diems because fixed staffing is spread across fewer people. The 5-bed schedule was held flat in the 2024 rate study.
- Acuity category. Four categories mapped to Supports Intensity Scale levels: Category 1 (Level 1), Category 2 (Level 2), Category 3 (Levels 3-4), Category 4 (Levels 5-7).
Host home / life sharing is priced on a separate two-category schedule (Category 1 covering Levels 1-4, Category 2 covering Levels 5-7) at roughly half to two-thirds the group home per diem, reflecting a family-home cost structure rather than a staffed-facility one.
Specialized CRA was created in the 2024 rate models as three customized services above the standard schedule: Behaviorally-Focused at a monthly rate of $34,424.63, Specialized Transitional at a monthly rate of $37,121.50, and Intensive at a daily rate of $1,296.31 customized per individual. The shift to monthly pricing for two of the three is unusual and signals these are individually negotiated placements.
Deaf and hard of hearing variants mirror the standard group home structure at higher rates to fund ASL-fluent direct support staff.
Utilization limits. CRA is capped at 27 daily units per month and 324 daily units per year, meaning the waiver does not pay for every calendar day.
Supported living and in-home settings. Community Living Support (T2025 U5 for 15 minutes, T2025 U6 daily) funds support for people in their own or family homes, priced at Basic and Extended tiers by staffing ratio, with a daily maximum of $138.09 and an annual cap of 6,032 fifteen-minute units.
Room and board. Not funded by the waiver. The CRA rate models contain no room and board, occupancy, rent, or food component in any line item, and neither the COMP general services overview nor the DD provider manual retrieved contains a room and board policy statement. The operative policy sits in COMP Part III (Chapters 1300-3900) on the GAMMIS portal, which I could not retrieve. Room and board therefore falls to the individual's own income, principally SSI. Flag this as inferred from rate-model structure, not directly quoted.
Rate structure link: healthmanagement.com
Comparable service rates
Rates below are the final rate models effective July 1, 2024, except Community Access Group, which was revised effective September 1, 2025.
| Service (national label) | State's service name | Unit | Current rate | Effective date | Source URL |
|---|---|---|---|---|---|
| Residential group home 24-hour | Community Residential Alternative (CRA), T2033 | Day | 3-bed: Cat 1 $294.16, Cat 2 $323.26, Cat 3 $382.32, Cat 4 $507.05. 4-bed: Cat 1 $248.35, Cat 2 $292.42, Cat 3 $341.79, Cat 4 $447.57. Specialized CRA: Behaviorally-Focused $34,424.63/month, Specialized Transitional $37,121.50/month, Intensive $1,296.31/day | 7/1/2024 | healthmanagement.com |
| Supported living / host home / shared living | CRA Host Home (life sharing) | Day | Category 1 $163.33; Category 2 $220.11 | 7/1/2024 | same as above |
| Day habilitation | Community Access Group (CAG), T2025-HQ; Community Access Individual, T2025-UB; Prevocational, T2015 | 15 minutes | CAG facility-based, all levels $3.65. CAG community-based: Cat 1 $3.65 (T2025-HQ-U1), Cat 2 $4.18 (U2), Cat 3 $5.23 (U3), Cat 4 $7.42 (U4). Community Access Individual $10.55. Prevocational $3.33. CAG annual cap 6,000 units (1,500 hours) | CAG 9/1/2025; Individual and Prevocational 7/1/2024 | dbhdd.georgia.gov and healthmanagement.com |
| Community supports / personal assistance (hourly) | Community Living Support (CLS), T2025 U5 | 15 minutes | Basic 1:1 $9.98, 1:2 $5.49, 1:3 $3.99. Extended 1:1 $9.28, 1:2 $5.10, 1:3 $3.71. Daily max $138.09 | 7/1/2024 | healthmanagement.com |
| Respite | Respite Services | 15 minutes; day | 15-min: 1:1 $9.38, 1:2 $5.16, 1:3 $3.75. Daily: Category 1 $184.72, Category 2 $248.94 | 7/1/2024 | same as above |
| Supported employment | Supported Employment, T2019-UB (individual) / T2019-HQ (group) | 15 minutes | Individual Job Developer $17.92; Individual Job Coach $15.06. Group: 1:2 $8.95, 1:3-1:4 $5.37, 1:5-1:7 $3.38, 1:8-1:10 $2.47 | 7/1/2024 | same as above |
| Case management / service coordination | Support Coordination; Intensive Support Coordination | Month | Support Coordination $209.97; Intensive Support Coordination $515.67 | 7/1/2024 | same as above |
Georgia does not publish NOW/COMP rates on a static public URL. The authoritative live tables are the Provider Rate Tables in GAMMIS, which are behind a postback-driven portal; the rate models above are the DBHDD-commissioned source those tables were built from. Treat the rate-model figures as the published rate basis, but verify against GAMMIS for any line where exact current pricing matters.
Official rate schedule links
- healthmanagement.com
- healthmanagement.com
- healthmanagement.com
- dbhdd.georgia.gov
- dbhdd.georgia.gov
- mmis.georgia.gov
- mmis.georgia.gov
- dbhdd.georgia.gov
- dbhdd.georgia.gov
Notable features and flags
- July 11, 2024: DBHDD and DCH announced CMS approval of NOW/COMP waiver amendments carrying what both agencies called historic rate increases, retroactive to July 1, 2024. The underlying rate study produced an average 43.6 percent increase across services and lifted the modeled direct support professional wage from $10.63 to $16.70 per hour, a 57 percent jump. Fiscal scale: $107 million state investment, more than $320 million total funds. dbhdd.georgia.gov and nasddds.org
- Structural rate redesign, effective July 1, 2024: the study introduced tiered Support Coordination, differentiated group home versus host home pricing, customized rates for very high needs residential programs, differentiated center-based versus community-based day programs, and separate pricing for short versus long in-home service encounters. This is a genuine payment-model change, not a percentage bump. nasddds.org
- September 1, 2025: Community Access Group rates revised, with facility-based flattened to $3.65 per 15 minutes for all assessment levels and community-based tiered from $3.65 to $7.42. Staffing ratios tightened for community-based delivery (1:5 to 1:2) versus facility-based (1:10 maximum), an explicit push toward community integration. dbhdd.georgia.gov
- May 13, 2026: The enacted FY2027 budget funded only 100 new NOW/COMP waivers. Governor Kemp's budget disregards had included $9,274,016 that would have funded 400 slots; that money was not carried into the final budget. Against a planning list of 7,891 with 1,217 in urgent need, 100 slots is roughly 8 percent of the urgent tier. gcdd.org
- Growth trend: DD services grew 55 percent since FY2020, the largest growth among all DBHDD behavioral health service categories, driven mainly by the rate increases rather than by slot expansion. gbpi.org
- Self-direction: Participant direction is available in both NOW and COMP through fiscal intermediaries, with roughly 2,400 people self-directing services. Participant-directed rates were updated separately in a November 2024 provider meeting. stateofthestates.ku.edu and dbhdd.georgia.gov
Confidence
Solid: the FY2026 appropriation breakdown by fund source, taken line by line from the Senate Budget Office analysis of the House FY2026 Health and Human Development budget; the 2024 final rate models, which are the DBHDD-commissioned source document for every NOW/COMP rate; the September 2025 Community Access Group rates from DBHDD's own post-rate-study training; and the FY2027 enrollment and planning list figures. Reasonably solid but secondary: enrollment of 4,505 NOW and 9,789 COMP and the planning list of 7,891, which come from Georgia Budget and Policy Institute and GCDD reporting on the FY2027 budget rather than from a DBHDD data publication. Estimated: the $75,200 per-participant figure, which is my own division and inflates true per-waiver cost because the Adult DD program funds more than waivers. Could not find: current live GAMMIS Provider Rate Tables, because the portal serves manuals and fee schedules only through ASP.NET postbacks that reject scripted sessions, so I could not confirm whether any line has moved since July 2024 apart from Community Access Group; an explicit room and board policy statement for CRA, which lives in COMP Part III on that same inaccessible portal; average wait time on the planning list; ICF/IID census and rates; and enrollment figures for Katie Beckett and GAPP. The state-funded DD services program has no separately published appropriation, only the $2.1 million adult respite line.
Named programs in Georgia and how to apply
Every Medicaid waiver and related program the state runs, with its waiting list status and the providers in the Atlas tied to it. Open a program for the steps to apply.
| Program | Authority | Waiting list | Providers in the Atlas |
|---|---|---|---|
| Comprehensive Supports Waiver Program (COMP) | 1915(c) waiver | Has a waiting list | 582 |
| Elderly and Disabled Waiver | 1915(c) waiver | Has a waiting list | 5 |
| Independent Care Waiver Program (ICWP) | 1915(c) waiver | Has a waiting list | 5 |
| New Options Waiver (NOW) | 1915(c) waiver | Has a waiting list | 550 |
Vocational rehabilitation in Georgia
The state agency that pays for job training, job coaching, and help finding work, including Pre-Employment Transition Services for students.
Georgia Vocational Rehabilitation Agency (GVRA)
Combined agency · rank 47 of 73 · score 51.3
Agency profile
Sits inside
Independent Georgia state agency (not housed inside a larger cabinet department) · gvs.georgia.gov
Authority
Rehabilitation Act of 1973, Title I; O.C.G.A. Title 30 (Human Resources) · exact chapter/section not confirmed this session; the Business Enterprise Program's federal basis is the Randolph-Sheppard Act of 1936
Who it serves
Georgians with disabilities, including blind/visually impaired, deaf, deaf-blind, and hard-of-hearing individuals, seeking employment; GVRA also separately administers SSA Disability Adjudication Services (a distinct, non-VR federal function)
Order of selection
Not on OOS, all categories open (reopened 2022, not since reclosed) AS OF 2022-06-28 · gvs.georgia.gov
Waiting list
10,000+ during the 2012 to 2014 funding crisis (historical); no current number published · ajc.com
People served
36,340 (FY2013, historical, down 13% YoY during a funding freeze) · same AJC source; current total not found, though FY2024 counselor caseloads were reported at ~100/counselor (down from ~200) after hiring ~145 counselors · ajc.com
Outcomes
FY2023 employment rate 25% ("among the nation's worst" per the agency's own director); FY2024 78% of clients had work at program exit · note these are likely different metrics (federal WIOA employment-outcome rate vs. an internal "employed at exit" measure) and are not directly comparable · same AJC source
State match and federal drawdown
Georgia draws roughly $4 in federal VR funds per $1 of state appropriation under the standard 78.7%/21.3% match. Historically (2009 to 2012), state VR appropriations fell 22% ($16.6M→$12.8M), driving ≥$82M in relinquished federal funds over four years and a $10.5M federal MOE penalty over three fiscal years · gbpi.org ; ajc.com The current FY2024/FY2025 relinquishments ($27.96M / $42.08M, see below) recur the same structural pattern, compounded by a documented staffing/case-processing capacity shortfall that limited GVRA's ability to obligate funds · ed.gov No current-year (FY24/25) state appropriations line item was located this session to confirm whether match-capacity or spending-capacity was the dominant driver · flagged as a gap.
Pre-employment transition services
not quantified this session (no current 15%-reserve dollar figure found); Pre-ETS categories are each billed at a flat $125 per the FY26 fee schedule (below)
Supported employment
GVRA runs three SE models · Traditional, Customized, and Individual Placement & Support · each paid across a 5-stage milestone sequence (ID/agreement → job development → training/ongoing-support initiation → stabilization → closure/transition). Under the FY26 revised rates, a full Traditional SE case totals ≈$8,125 ($300+$2,000+$2,412.50+$2,412.50+$1,000) · gvs.georgia.gov
State-funded programs outside the federal grant
- Roosevelt Warm Springs / Cave Spring Center · state-operated residential vocational training campuses, recently "revamped" for heavy-machinery training per 2025 reporting · gvs.georgia.gov (appropriation not published this session) - Business Enterprise Program · Randolph-Sheppard vending-facility program · gvs.georgia.gov (appropriation not published) - Georgia Industries for the Blind · gvs.georgia.gov (appropriation not published) - Disability Adjudication Services · SSA disability-determination function housed at GVRA; funded by SSA, not the VR grant, noted for completeness · gvs.georgia.gov
Notable
- FY2025: GVRA relinquished $42,082,249 in federal VR funds · the largest of any state that year · ed.gov - FY2024: GVRA relinquished $27,957,344 · same source - 2009 to 2012: GVRA relinquished ≥$82M over four years and was assessed a $10.5M federal MOE penalty over three fiscal years after state VR appropriations fell 22% · ajc.com - December 2012: GVRA discovered its VR division had spent 80% of its annual budget by mid-year (a ~$90M pace against a $70M budget), triggering a ~1-year admissions freeze that ended February 1, 2014 · same source - By FY2024/2025: GVRA reported hiring ~145 counselors (cutting average caseload from ~200 to ~100) and revamping two training campuses, coinciding with reported employment-at-exit rising from 25% (FY2023) to 78% (FY2024) · ajc.com - October 1, 2025: GVRA's FY26 CRP fee/rate schedule took effect, restructuring SE milestone payments (e.g., "Service Stabilization" cut from $1,500 to $1,000 while "Job Development/Placement" raised from $1,500 to $2,000) · gvs.georgia.gov
Confidence
Relinquishment figures are solid, sourced directly to the U.S. Department of Education's own reallotment accounting, and match the figures given in the task exactly ($42.1M/$28.0M). The "why" is well documented historically (2009 to 2014, via GBPI and two AJC investigations) but not for the specific FY2024 to 25 relinquishment years · no current Georgia budget document could be located this session confirming the actual state VR appropriation for those years, so whether match-capacity or spending/staffing-capacity is now the dominant driver is inferred from the historical pattern plus the AJC's staffing-crisis reporting, not confirmed from a current fiscal document. Current OOS status (2026) is not reconfirmed beyond 2022. The fee schedule is current and strongly sourced (effective Oct 1, 2025).
VR service rates: Georgia Vocational Rehabilitation Agency (GVRA)
rank 48 of 78 · 6 of 7 priced
GVRA prices nearly all purchased CRP services as flat milestone/unit fees tied to specific procedure codes · job placement is paid in two installments (at referral, then at 90-day retention), and supported employment is paid across a five-stage milestone sequence · rather than open-ended hourly billing. An out-of-service-area (>61 miles) differential of roughly 25 to 50% is added to many hourly assistive/support services.
| Comparable service | Agency’s own service name | Unit | Current rate | Effective | Source |
|---|---|---|---|---|---|
| Vocational assessment and discovery | Comprehensive Vocational Evaluation (code 00020) | per service (2 units, +1 if >61 mi) | $450.00 | Oct 1, 2025 | gvs.georgia.gov |
| Job development and placement | Individual Job Placement Services (referral + 90-day closure) | $750 at referral + $2,000 at 90-day closure | $750 / $2,000 | Oct 1, 2025 | same as above |
| Job coaching | Job Coaching (Individual), code 00171 | hourly, max 100 hrs | $40.00 | Oct 1, 2025 | same as above |
| Supported employment | Traditional SE · Job Development/Placement milestone (code 05521-NEW) | per milestone | $2,000.00 | Oct 1, 2025 | same as above |
| Pre-employment transition services | Job Exploration Counseling (code Pre-3240), and 4 parallel categories | flat rate, 30 to 60 min min. | $125.00 | Oct 1, 2025 | same as above |
| Benefits counseling | Not published in FY26 fee schedule · no benefits/work-incentives-counseling line item appears; likely delivered via SSA WIPA referral rather than fee-for-service | , | Not published | , | gvs.georgia.gov |
| Retention and extended services | SE Service Stabilization milestone (code 05524-NEW) | per milestone | $1,000.00 | Oct 1, 2025 | same as above |
Find services in Georgia
Providers that take Medicaid waivers How to apply in Georgia
From ConnectIDD's State Disability Funding Atlas research (August and September 2026). Waiting list status and program steps updated October 2026. Every figure carries its fiscal year.