Who Qualifies for Medicaid in Georgia: Limits, Pathways, and Waivers

To find out who qualifies for Medicaid in Georgia, start with the category test, not the income test. Georgia Medicaid covers children, pregnant women, parents and caretaker relatives of minor children, seniors, people who are blind or have a disability, former foster youth, people who need long-term care, and a limited group of low-income adults enrolled in Georgia Pathways to Coverage. Each category uses its own income rules, and some add an asset limit on top. Georgia has not adopted full Medicaid expansion, so adults without children, a disability, or a Pathways slot generally cannot qualify no matter how low their income is.¹

The Eligibility Categories You Have to Fit

Low income alone is not a qualifying condition in Georgia. You must also fall into one of the groups the state recognizes:

Children under 19, covered through the Right from the Start Medical Assistance Group (RSM), with income thresholds that vary by age.²
Pregnant women, also covered through RSM, at the highest income cutoff among adult groups.
Parents and caretaker relatives of minor children, under the Section 1931 category, at a very low income threshold.³
People who are 65 or older, legally blind, or have a total disability, covered through the Aged, Blind, and Disabled (ABD) category.⁴
Former foster youth who were in care and enrolled in Medicaid when they turned 18. Coverage lasts until age 26 with no income test.⁵
People who need nursing home care or qualify for a home and community-based services waiver.
Adults aged 19 to 64 enrolled through Georgia Pathways, up to 100% of the Federal Poverty Level and meeting a monthly work requirement.⁶

Which category you fall into determines which financial test applies to you, so figure that out first.

Income Limits for Children, Pregnant Women, and Parents

These groups are tested using Modified Adjusted Gross Income (MAGI), which looks at household taxable income and household size. The 2026 Federal Poverty Level is $15,960 for one person, $27,320 for a family of three, and $33,000 for a family of four.⁷ Georgia sets each group’s cutoff as a percentage of those figures.

Pregnant women qualify with household income up to 220% of the Federal Poverty Level, which works out to roughly $35,112 a year for a household of one in 2026.⁸ Coverage includes prenatal visits, labor and delivery, and postpartum care.

Children qualify at different thresholds depending on age. Infants under one qualify at the highest levels (around 210% FPL), and older children at lower cutoffs. Children in families with income above the Medicaid line but below roughly 247% FPL can get low-cost coverage through PeachCare for Kids, Georgia’s separate CHIP program.²

Parents and caretaker relatives of minor children face a much steeper bar. Georgia’s limit for this group is roughly one-third of the Federal Poverty Level, tied to welfare-era standards the state never raised significantly. For a family of three, that is less than $10,000 a year. It is one of the lowest parent eligibility thresholds in the country and the main reason Pathways exists as an alternative route.

Income and Asset Limits for Seniors and People with Disabilities

The ABD category tests both income and countable resources. You must be 65 or older, legally blind, or have a total disability as determined by Social Security or the state.⁹

The income limit is tied to the federal Supplemental Security Income (SSI) benefit rate. For 2025, that was $967 a month for an individual and $1,450 for a couple, with a small cost-of-living adjustment expected for 2026.¹⁰ Only countable income, after certain deductions, applies.

On top of income, ABD applicants face a resource cap of $2,000 for an individual or $3,000 for a couple.¹⁰ Countable resources include bank accounts, stocks, and investment accounts. Your primary home does not count. One vehicle per household is exempt, and you can set aside a limited amount for burial expenses.⁴ The asset limit catches people off guard more than the income limit does, because even modest savings can push someone over.

Medically Needy Spend-Down

If your income is slightly above the ABD limit, Georgia’s Medically Needy program can still get you to coverage. You subtract qualifying medical expenses from your excess income until the remainder falls below the state’s Medically Needy Income Level. Once that spend-down figure reaches zero, you are eligible for Medicaid for the rest of that month.¹¹

Qualifying expenses include doctor visits, prescriptions, hospital bills, medical equipment, and out-of-pocket health insurance premiums. Bills from a spouse, dependent child, or deceased spouse can count if you remain responsible for the debt. If a month’s medical expenses don’t add up, your case stays in suspense until they do. The program is most useful for people with ongoing medical costs who consistently exceed the standard limit by a modest amount.

Georgia Pathways to Coverage: Adults Up to 100% of Poverty

Pathways is Georgia’s alternative to full Medicaid expansion. It covers adults 19 through 64 who earn up to 100% of the Federal Poverty Level and do not qualify for any other Medicaid category. For 2026, that cap is $15,960 a year for a single person and $27,320 for a family of three.⁶⁷

Pathways also requires 80 hours of qualifying activity every month to keep coverage. The list of what counts is broader than many people realize:¹²

Employment or self-employment
On-the-job training or job readiness programs
Community service, including caregiving for a relative
Vocational education or enrollment in higher education
Georgia Vocational Rehabilitation Agency programs
SNAP Works Program participation
Parenting a child under age six

You can combine activities to reach the 80-hour threshold. Hours must be reported through the Georgia Gateway portal, and falling short in any month can lead to suspension of benefits until you demonstrate compliance. Losing track of the reporting is the most common way Pathways enrollees lose coverage.

Long-Term Care: Spousal Protections, Waivers, and the Look-Back

Long-term care Medicaid uses the ABD financial rules but adds a few things worth knowing before you apply.

Spousal Impoverishment Rules

When one spouse enters a nursing home or begins receiving home and community-based services, the at-home spouse does not have to be impoverished for the other to qualify. Federal spousal impoverishment rules let the community spouse keep a protected share of the couple’s combined resources. For 2026, the minimum Community Spouse Resource Allowance is $32,532 and the maximum is $162,660.¹³ The exact amount depends on the couple’s total countable resources when the institutionalized spouse enters care; generally the community spouse keeps half, bounded by the floor and ceiling above. The community spouse also receives a monthly income allowance so their partner’s income can go toward the cost of care without leaving them in poverty.

Home and Community-Based Services Waivers

Georgia operates several waivers under Section 1915(c) of the Social Security Act, so people who would otherwise need nursing home placement can receive care at home or in a community setting. These waivers cover personal care aides, adult day health, home health aide visits, respite care for family caregivers, and case management.¹⁴ To qualify you must meet the same financial test as someone entering a nursing facility and show a level of care need equivalent to institutional placement. Slots are limited and most programs maintain waiting lists, so applying early matters.

The Five-Year Look-Back

Giving away assets before applying for long-term care Medicaid triggers a penalty. When you apply for nursing home care or a waiver, the state reviews every asset transfer you made during the previous 60 months to see whether you gave anything away for less than fair market value.¹⁵ If the state finds a disqualifying transfer, the penalty is calculated by dividing the gifted value by the average monthly cost of private-pay nursing home care. Someone who gave away $90,000 where the average monthly cost is $9,000 would face a 10-month penalty, during which Medicaid pays nothing toward their long-term care.

Some transfers are exempt. You can transfer your home to a spouse, a child under 21, or a child of any age who is blind or permanently disabled with no penalty. Transfers between spouses are always allowed because both spouses’ assets already count in the eligibility test. The look-back applies only to long-term care Medicaid, not to Medicaid for children, pregnant women, or Pathways enrollees.

Residency and Citizenship

You must live in Georgia and intend to stay. Federal rules forbid the state from imposing a minimum residency period, so a person who just moved to Georgia can apply right away. Temporary absences do not disqualify you as long as you plan to return.¹⁶

You must also be a U.S. citizen, U.S. national, or a qualified non-citizen as defined by federal law.¹⁷ The qualified non-citizen category includes lawful permanent residents (green card holders), refugees, asylees, Cuban and Haitian entrants, trafficking victims, parolees admitted for more than one year, certain battered spouses and children, and veterans or active-duty military with their families. Lawful permanent residents generally wait five years for full Medicaid benefits. Refugees, asylees, trafficking victims, and veterans are exempt from the waiting period.¹⁸

If You Don’t Fit a Category

Georgia has not adopted full Medicaid expansion. An adult who is not pregnant, not raising a minor child, not aged 65 or older, not blind or disabled, not a former foster youth under 26, and not enrolled in Pathways will not qualify for Georgia Medicaid regardless of how low their income is. For many childless adults between the Pathways work-hour threshold and marketplace subsidies, that leaves subsidized plans through the federal Health Insurance Marketplace as the realistic coverage option.

1
Georgia Medicaid. Georgia Medicaid
2
Georgia Department of Human Services Division of Family & Children Services. Right from the Start Medical Assistance Group
3
Social Security Administration. Social Security Act 1931 – Assuring Coverage for Certain Low-Income Families
4
DFCS. Aged, Blind and Disabled Medicaid – Georgia
5
Medicaid.gov. Medicaid and CHIP FAQs – Coverage of Former Foster Care Children
6
Georgia Pathways to Coverage. Eligibility
7
ASPE. 2026 Poverty Guidelines
8
Georgia Division of Family and Children Services. Pregnant Women Medicaid Eligibility
9
Georgia Division of Family and Children Services. Aged, Blind, Disabled Requirement for ABD Medicaid
10
Georgia Division of Family and Children Services. Appendix A1 ABD Financial Limits 2025
11
Georgia Division of Family and Children Services. ABD Medically Needy
12
Georgia Pathways to Coverage. Qualifying Activities
13
Centers for Medicare & Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
14
Medicaid.gov. Home and Community-Based Services 1915(c)
15
CMS. Transfer of Assets in the Medicaid Program – Important Facts for State Policymakers
16
eCFR. 42 CFR 435.403 – State Residence
17
eCFR. 42 CFR 435.406 – Citizenship and Noncitizen Eligibility
18
Medicaid.gov. Eligibility for Non-Citizens in Medicaid and CHIP