Intellectual Disability Caregiver GA: Waivers, Pay, and Guardianship

If you care for a family member with an intellectual disability in Georgia, the state offers a specific set of tools: two Medicaid waiver programs (NOW and COMP) that pay for in-home services, ways for you to be paid directly as a family caregiver, respite programs, a small state tax credit, and legal options ranging from full guardianship to lighter alternatives like power of attorney. Most services run through the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), which operates six regional field offices and a provider network of more than 600 organizations statewide.

What follows walks through what each of those pieces does, who qualifies, and how to reach them.

The NOW and COMP Medicaid Waivers

The backbone of Georgia’s support system is a pair of Medicaid waiver programs administered by DBHDD: the New Options Waiver (NOW) and the Comprehensive Supports Waiver Program (COMP). Both are designed to keep people in their homes or communities rather than in institutional care.¹

NOW is for individuals who can live in a family home or independently with support. COMP is for people with more intensive needs who primarily require residential care.² Between them, the waivers cover most of the services caregivers rely on:

Personal support with bathing, dressing, meals, and housekeeping
Community living support to build or maintain skills for living at home
Planned and emergency respite care
Behavioral supports consultation for people with intensive behavioral challenges
Supported employment and community access, including job coaching
Natural support training for unpaid family caregivers (NOW only)
Adult occupational, physical, and speech-language therapy
Home and vehicle modifications for accessibility and safety
Specialized medical equipment and supplies³⁴

These services are written into an individual service plan developed with a support coordinator.

Who Qualifies

To be eligible, the person you care for must have an intellectual disability diagnosed before age 18, or a closely related developmental disability such as severe autism, cerebral palsy, or epilepsy diagnosed before age 22, that substantially impairs intellectual or adaptive functioning. They must also be Medicaid-eligible and require the level of care provided in an intermediate care facility.¹

How to Apply

Applications go through the IDD Connects web portal or on paper to one of the six DBHDD regional field offices. Within 14 business days of submission, DBHDD schedules a screening assessment. A psychologist reviews the case, and Alliant-Georgia Medical Care Foundation, an external contractor required by the Centers for Medicare and Medicaid Services, makes the final eligibility determination.⁵

The Waiting List

Be prepared to wait. As of March 2025, more than 7,800 people were on the planning list for NOW and COMP services.⁶ Slots are prioritized by objective measures of unmet need, with weight given to the individual’s health and safety and the status of their caregiver or support system, not simply by how long someone has been on the list.⁷

In December 2025, DBHDD proposed restructuring the list into three tiers based on urgency: immediate needs, needs expected within one to five years, and needs further out. The state’s IDD Advisory Council also recommended creating a new waiver category for people who don’t currently qualify for NOW or COMP. Georgia’s FY 2027 budget, signed by Governor Brian Kemp in May 2026, added 100 new NOW and COMP slots after the Senate had proposed 1,217 slots at $20.9 million.⁸

Getting Paid as a Family Caregiver

Georgia offers three main pathways for family members to be compensated, each with different rules.

Participant Direction (Self-Direction)

People enrolled in NOW or COMP who live in their own home or a family home can self-direct their services. The waiver participant, or their representative, can hire, manage, and pay their own workers, including relatives. To hire a family member, you submit a Participant Direction Family Hire Request Form to the DBHDD Participant Direction Team for review.⁹

A Financial Support Services provider acts as fiscal agent, handling payroll, tax withholding, and criminal background checks on prospective workers. The participant (or representative) is the employer, responsible for writing job descriptions, screening candidates, and making sure workers keep current CPR and First Aid certifications. Wages must stay within Medicaid-approved rates and units, and the employer covers payroll costs above the hourly wage, including Social Security, Medicare, and unemployment contributions.¹⁰

Structured Family Caregiving

Structured Family Caregiving (SFC) is a separate option for Medicaid beneficiaries enrolled in a home and community-based services waiver. Two conditions apply: the caregiver must live in the same home as the person receiving care, and the caregiver must be unable to work outside the home because of caregiving responsibilities.¹¹

SFC runs through designated agencies, typically home health providers. The agency receives a per diem rate of $90.20 (temporarily raised to $99.22 during the public health emergency) and is required to pass at least 60 percent of the per diem to the caregiver as a stipend. The agency also provides at least eight hours of individualized training per year and arranges monthly home visits by a registered nurse and a care coordinator. A participant receiving SFC cannot also receive separate personal support services.

Natural Support Training

Unpaid family and friend caregivers can access Natural Support Training under the NOW waiver. It provides training tailored to the person’s needs, delivered in 15-minute increments at a maximum rate of $20.78 per unit, with an annual cap of 86 units (roughly $1,787 per year). You add it to the individual service plan through the support coordinator.¹²

Respite Care and Where to Call for Help

Respite gives you temporary relief while someone else provides care. In Georgia it comes from several channels.

The Division of Aging Services, working through 12 Area Agencies on Aging, offers respite along with adult day care, nutrition services, and telephone counseling for caregivers. These services are reached through Georgia’s Aging and Disability Resource Connection (ADRC), branded as Empowerline, at 1-866-552-4464.¹³

For IDD caregivers specifically, the Bobby Dodd Institute runs a family support program under contract with DBHDD, serving caregivers of individuals aged three and older in Clayton, DeKalb, Fulton, Gwinnett, and Rockdale counties. It offers in-home and out-of-home respite, intensive family support with nursing for high-acuity needs, and general family support covering dental, medical, and vision care, therapies, specialized supplies, and social activities. Intensive support is targeted at individuals on the DBHDD planning list, those transitioning into waiver services, or those with the highest assessed need, and is provided as a last resort with approval required.¹⁴

Community organizations fill gaps as well. Connectability holds free monthly events for children and adults with special needs, Hope House Children’s Respite Center operates in Union City, and A Mother’s Rest focuses on affordable respite for caregivers of people with disabilities or chronic illness.¹⁵

For general navigation, Empowerline counselors provide person-centered planning, eligibility screenings, options counseling, referrals, and crisis intervention. You can search local resources at findservices.empowerline.org or reach a counselor at 1-866-552-4464.¹⁶ For families of children and young adults up to age 26, Parent to Parent of Georgia (P2PGA) serves as the state’s Parent Training Information Center and Health Information Center and offers a provider database, a “Roadmap to Success” guide, and trainings.¹⁷ DBHDD’s own provider search covers more than 600 providers, and calling or texting 988 also connects to local resources.¹⁸

Legal Authority: Guardianship and the Alternatives

When an adult with an intellectual disability cannot make or communicate significant decisions about health, safety, or finances, Georgia law provides several tools. State law under O.C.G.A. § 29-4-1(f) directs probate courts to encourage self-reliance and to consider less restrictive alternatives before granting guardianship.¹⁹

Guardianship and Conservatorship

Guardianship is a court-appointed status granting authority over an adult’s personal affairs, including medical treatment, residence, and contracts, when a court finds the person lacks sufficient capacity. Petitions are filed in the probate court of the adult’s county of residence and must include an examination statement from a physician, psychologist, or licensed clinical social worker obtained within the previous 15 days. If the adult does not have an attorney, the court appoints one.²⁰

Conservatorship is the parallel process for managing an adult’s property and finances when they lack capacity for significant financial decisions. It also requires a probate court petition.²¹

Guardianship removes legal rights and is treated as serious. It can be reversed through a Petition for Restoration of Rights, supported by affidavits from two qualified professionals and filed in the county where it was established. If a guardianship petition is denied, a new one cannot be filed for two years unless circumstances have changed.

Less Restrictive Alternatives

A financial power of attorney lets someone manage financial and property matters without stripping the individual’s rights. It requires a written document with two witnesses and can be revoked at any time.
An advance directive for health care, which in 2007 replaced the Durable Power of Attorney for Health Care, appoints an agent for medical decisions. It requires the individual’s signature and two witnesses.
A representative payee, approved by the Social Security Administration or Veterans Administration, manages federal benefits on someone’s behalf and files an annual accounting.
Supported decision-making is not codified in Georgia statute, but courts may consider it as a less restrictive alternative under existing law. Sample agreements are available through organizations like supporteddecisionmaking.org.

The Georgia Caregiver Tax Credit

Georgia’s Qualified Caregiving Expense Credit under O.C.G.A. § 48-7-29.2 equals 10 percent of qualified caregiving expenses, up to a maximum of $150. The family member receiving care must be at least 62 years old or determined disabled by the Social Security Administration. Eligible expenses include home health agency services, personal care, adult day care, respite care, and medically necessary equipment and supplies. One important limit: the services must be obtained from someone not related to the taxpayer or the qualifying family member, so paying a relative does not count toward this credit.²²

What’s Changing

Two developments are worth watching. First, federal Medicaid funding cuts enacted in mid-2025 have added uncertainty to Georgia’s ability to expand waiver services further, even as the state adds slots in modest numbers.⁶ Second, DBHDD’s proposed three-tier restructuring of the planning list, if adopted, would change how families are prioritized for available slots. If you are on the list or considering applying, keep in contact with your regional field office so any change in your family member’s health, safety, or your own capacity to provide care is on record.

1
Georgia.gov. Apply for New Option Waiver Program (NOW) and Comprehensive Support Waiver Program (COMP)
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DBHDD. Be Compassionate
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Georgia Collaborative ASO. Intellectual Developmental Disabilities Services Offered
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GCDD. Home and Community-Based Services Fact Sheet
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DBHDD. How Do I Apply for DD Services
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Georgia Recorder. Georgia Agency Proposes Changes to Waiting List for Services for People With Disabilities
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DBHDD. DD Planning Lists
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Healthy Future Georgia. Legislative Update Week 11
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DBHDD. Participant Direction
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GCDD. Self-Directing Guide for Families
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NASHP. Medicaid Structured Family Caregiving: Enabling Family Members to Make Caregiving Their Primary Focus
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North Central Health District. NOW COMP Waiver Detailed Information
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Georgia Division of Aging Services. Caregiving
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Bobby Dodd Institute. Family Support
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FOCUS-GA. Respite Resources
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Empowerline. Coordinating Care for Adults With Disabilities
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Parent to Parent of Georgia. Parent to Parent of Georgia
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DBHDD. How Do I Find DBHDD Services
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Rockdale County Probate Court. Guide on Supported Decision-Making
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Georgia Legal Aid. What Should I Know About Guardianship and Alternatives for Adults
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GCDD. Guardianship Guide
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Georgia Department of Revenue. Qualified Caregiving Expense Credit