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Georgia - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Georgia Department of Community Health (DCH), through its Healthcare Facility Regulation (HFR) division, licenses Assisted Living Communities (ALCs) to provide housing, personal services, and medication administration to adults. For Medicaid reimbursement, approved facilities enroll to provide Alternative Living Services under the Community Care Services Program (CCSP) or the Service Options Using Resources in a Community Environment (SOURCE) waivers.

Before applying for Medicaid enrollment via the GAMMIS portal, prospective providers must secure an active ALC license from HFR, which requires passing a physical plant inspection and architectural plan review. Georgia does not subject assisted living facilities to Certificate of Need (CON) review; therefore, securing the HFR license through architectural and operational inspections stands as the mandatory structural prerequisite before any Medicaid application is accepted.

1. Service Definition and Scope

In Georgia, an Assisted Living Community (ALC) is a distinct licensure category separate from smaller Personal Care Homes. ALCs are designed to serve 25 or more adults who require assistance with activities of daily living but do not need continuous nursing care.

Medicaid covers the care portion of this service through the CCSP and SOURCE waivers under the service name Alternative Living Services (ALS). Medicaid funds personal care, supervision, and health-related services, while the resident remains responsible for room and board costs.

2. Regulatory and Oversight Agencies

The Georgia Department of Community Health (DCH) serves as the umbrella agency for both facility licensure and Medicaid administration. Within DCH, the Healthcare Facility Regulation (HFR) division handles all licensing, inspections, and physical plant approvals.

Medicaid provider enrollment and claims processing are managed through the Georgia Medicaid Management Information System (GAMMIS). Waiver care coordination is often handled by designated Area Agencies on Aging (AAAs) or SOURCE care management organizations.

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia does not require a Certificate of Need (CON) for Assisted Living Communities, meaning market demand and local zoning are the primary determinants for new construction. However, a facility cannot apply for Medicaid enrollment until it is fully built, inspected, and licensed by HFR.

There are currently no statewide moratoria or closed RFP procurement windows blocking new ALC Medicaid enrollments. Providers must secure local municipal or county zoning and fire marshal approvals before the state will conduct its architectural review.

4. Licensure and Certification Requirements

Obtaining an ALC license requires a multi-step process beginning with architectural plan approval by the DCH Office of Health Planning. Once the physical plant is approved and constructed, HFR conducts an initial on-site survey to verify operational readiness.

Applicants must submit the HFR Assisted Living Community Licensure Application along with the required fee. The facility must demonstrate compliance with life safety codes, disaster preparedness, and staffing ratios before a license is issued.

5. Medicaid Provider Enrollment

Once licensed, the facility must enroll as a Medicaid provider using the GAMMIS Enrollment Wizard. The application requires an active National Provider Identifier (NPI) and taxonomy code appropriate for assisted living.

Institutional providers are subject to an application fee unless they have already paid it to Medicare or another state's Medicaid program. Providers must also adhere to revalidation schedules to maintain active billing status.

6. Staffing, Training and Background Checks

ALCs in Georgia must be managed by a licensed administrator and maintain sufficient direct care staff to meet the needs of all residents. Unlike standard Personal Care Homes, ALCs are permitted to employ Certified Medication Aides (CMAs) to administer medications.

All staff must undergo fingerprint-based criminal background checks through the Georgia Criminal Background Check System (GCHEXS). Direct care staff must also hold current CPR and First Aid certifications.

7. Documentation, Policies and Records

Facilities must maintain comprehensive records for both residents and staff. Resident files must include a written admission agreement, an individualized care plan, and detailed medical histories.

Operational policies must cover emergency management, infection control, and medication administration. Medication Administration Records (MARs) must be kept current and signed for every resident receiving medication assistance.

8. Billing, Rates and Claims

Medicaid claims for Alternative Living Services are submitted through the GAMMIS portal. Reimbursement rates are established by DCH and are published in the quarterly fee schedules available on the GAMMIS website.

It is critical to note that Medicaid waiver funds only cover the cost of care and supervision. The facility must collect room and board payments directly from the resident, typically funded by the resident's Supplemental Security Income (SSI) or other personal funds.

9. Approval Sequence and Timeline

The timeline to become an approved ALC Medicaid provider is heavily dependent on construction and local approvals. Local zoning and fire marshal clearances must be obtained before state architectural review begins.

Once the physical plant is approved, the HFR licensure process typically takes 60 to 90 days, including the initial survey. Medicaid enrollment through GAMMIS adds an additional 30 to 60 days post-licensure.

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently delayed or denied due to mismatched information between the HFR license, the NPI registry, and the GAMMIS application. Failure to pay the required institutional application fee within 30 days will also result in rejection.

During HFR surveys, common citations include incomplete staff background checks, missing CPR certifications, and errors in Medication Administration Records (MARs).

11. Key Contacts and Resources

Prospective providers should utilize the DCH website for all licensure forms and fee schedules. The GAMMIS portal is the central hub for Medicaid enrollment, policy manuals, and billing resources.

For specific questions regarding physical plant requirements, providers should contact the HFR division directly.

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