50 States of Care: Georgia
50 States of Care: Georgia — SOURCE Waiver, CCSP, and How Georgia’s Dual Waiver System Creates Unique Valuation Opportunities
Georgia is one of those home care markets that looks simple until you actually try to understand where the patients come from.
There is Georgia Medicaid.
There is the Elderly and Disabled Waiver Program.
Then underneath that umbrella you keep hearing two names:
CCSP.
SOURCE.
And then someone tells you that the county matters.
That is where it gets interesting.
Because Georgia does not simply operate 159 completely independent county Medicaid waivers. SOURCE and CCSP are components of Georgia's statewide Elderly and Disabled Waiver Program (EDWP), a federally approved Section 1915(c) Medicaid waiver.
But particularly on the CCSP side, Georgia's aging network has historically administered access through regional Area Agencies on Aging (AAAs) serving defined groups of counties.
That distinction matters.
For an owner, buyer, or investor, I would not look at a Georgia Medicaid home care agency and ask only:
"How much Medicaid revenue does it have?"
I would ask:
Where does the Medicaid revenue come from?
Because $3 million of revenue concentrated in one referral ecosystem can be very different from $3 million spread across multiple Georgia regions.
That is where Georgia becomes an interesting M&A market.
First: What Exactly Are CCSP and SOURCE?
Georgia's Elderly and Disabled Waiver Program (EDWP) serves elderly and physically disabled individuals who meet the applicable institutional level-of-care requirements but can instead receive services in their homes and communities.
The federal government currently lists Georgia's Elderly and Disabled Waiver as an approved 1915(c) waiver, with the current waiver period running through November 8, 2027.
Source: Centers for Medicare & Medicaid Services (CMS)
The two major components are:
CCSP — Community Care Services Program
CCSP provides community-based services designed to keep eligible individuals out of nursing facilities.
Services can include:
Personal support
Adult day health
Alternative living services
Home-delivered meals
Respite
Emergency response
Certain home health services
Case management
SOURCE — Service Options Using Resources in a Community Environment
SOURCE serves a similar elderly and disabled Medicaid population but adds a more integrated case-management model.
Georgia describes SOURCE as providing enhanced coordination for members who may require greater integration between their medical care and long-term services and supports.
Enhanced Primary Care Case Management can involve coordination between the member, case manager, primary care physician, caregivers, and waiver providers.
Source: Georgia Department of Community Health
So at a very high level:
CCSP = traditional HCBS waiver structure.
SOURCE = HCBS + more integrated medical/case-management coordination.
But here is where operators sometimes misunderstand Georgia.
Georgia Does Not Really Have 159 Separate "County Waivers"
This is probably the most important clarification.
You may hear operators say:
"I have the waiver in Fulton County."
Or:
"We're trying to get into three more counties."
That makes it sound like every Georgia county operates its own Medicaid waiver.
Technically, that isn't what's happening.
CCSP and SOURCE sit under the statewide EDWP waiver.
What changes geographically is the administrative and referral infrastructure surrounding the member.
For CCSP especially, Georgia's aging system divides the state into regional Planning and Service Areas administered through Area Agencies on Aging.
Georgia currently lists 12 Area Agencies on Aging, each responsible for groups of counties.
Source: Georgia Department of Human Services, Division of Aging Services
For example:
The Atlanta Regional Commission AAA covers:
Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry and Rockdale counties.
The CSRA Area Agency on Aging covers 14 counties around Augusta.
The Northwest Georgia AAA covers another group of counties.
The Coastal Georgia AAA covers counties including Chatham, Glynn, Camden and others.
And the same structure continues across the state.
Source: Georgia Division of Aging Services
This creates something that looks a lot like regional Medicaid micro-markets inside one statewide program.
That is the part buyers need to understand.
The Funding Question: Why Counties and Regions Matter
Here's where it gets even more interesting.
Historically, CCSP funding wasn't simply an unlimited pool where every eligible applicant immediately began receiving services.
Georgia's published CCSP policy explains that the Division of Aging Services allocated CCSP benefit funds to each AAA, and the AAA managed the service-benefit allocation for its Planning and Service Area.
The policy also states that when funding was unavailable, otherwise eligible applicants could be placed on a waiting list.
In other words:
Eligibility did not necessarily equal immediate service availability.
The number of participants, utilization and available benefit funding could affect how many individuals moved into services within a region.
Source: Georgia Division of Aging Services, CCSP Care Coordination Policy
This is why I would be careful using the phrase "county-funded waiver."
The better way to describe it is:
A statewide Medicaid waiver with regional administration and historically regionally managed CCSP service allocations.
That's a huge distinction.
Counties aren't necessarily writing the Medicaid checks.
Georgia Medicaid ultimately reimburses enrolled providers for authorized Medicaid services.
But the path that gets a member from:
eligible → assessed → authorized → referred → serviced → billed
can involve regional organizations.
And that makes geography matter.
Think of Georgia as 12 Medicaid Micro-Markets
This is probably the simplest way I'd explain Georgia to a buyer.
Don't think:
159 independent county programs.
Think:
One statewide EDWP waiver + 12 regional aging ecosystems + SOURCE/CCSP case-management infrastructure + individual provider service areas.
Now M&A gets interesting.
Imagine Agency A generates $4 million from Medicaid personal care.
Almost all of its clients are concentrated in Fulton, DeKalb and Gwinnett.
Agency B also generates $4 million.
But Agency B has established operations across Atlanta, Northwest Georgia and Middle Georgia.
On the P&L:
$4M = $4M.
Operationally?
Those businesses may be completely different.
Agency B potentially has more geographic diversification.
Agency A may have significantly more concentration risk.
Neither automatically deserves a higher valuation.
But a buyer should understand the difference.
Why This Can Create a Valuation Premium
At Acquire Care, this is one of the things I would dig into before taking a Georgia Medicaid agency to market.
Buyers will usually start with:
Revenue.
EBITDA.
Census.
Payer mix.
Caregiver count.
All important.
But those numbers don't necessarily show the distribution network underneath the revenue.
I want to know:
Which counties are active?
Which AAA regions?
CCSP or SOURCE?
Who controls case management?
Where do referrals originate?
How long has the agency been receiving those referrals?
How concentrated is census by county and referral source?
Where is the agency enrolled versus where is it actually producing revenue?
That last question is especially important.
A provider might technically be positioned to service a broad geographic footprint.
That doesn't mean it has built referral density there.
There is a huge difference between:
"We can service this county."
and
"We have 37 active clients, 48 caregivers and established referral relationships in this county."
Buyers pay for the second one.
CCSP vs. SOURCE: Don't Just Lump Them Together
Another mistake I see in Medicaid businesses is putting everything into one line:
Medicaid Revenue — $3,800,000
That's not enough.
In Georgia I would want the Medicaid revenue broken down at minimum by:
CCSP
SOURCE
Other Medicaid
Then I would break CCSP and SOURCE down again by:
county → region → service → client count → hours → referral/case-management source.
That tells the buyer what they're actually buying.
Because SOURCE and CCSP may ultimately reimburse many of the same types of services, but the care-management and member-access infrastructure can be different.
Georgia itself describes both programs as part of EDWP and lists services such as personal support, adult day care, alternative living, home-delivered meals and respite. SOURCE adds enhanced case-management capabilities for members requiring additional coordination.
Source: Georgia Medicaid
That diversity can become valuable.
Georgia Reimbursement Rates Matter Too
Georgia has also made meaningful changes to certain EDWP reimbursement rates.
For example, Georgia's published EDWP reimbursement schedule lists:
Structured Family Caregiver — $110.39/day
effective July 1, 2024.
Adult Day Health Level I full-day service increased to:
$82.49/day
And Level II full-day Adult Day Health increased to:
$108.23/day.
Georgia also reimburses Personal Support Services under T1019, with EVV requirements applying to personal support services under both CCSP and SOURCE.
Source: Georgia Medicaid / GAMMIS EDWP reimbursement schedule and EVV guidance
For investors, rate history matters.
A business growing because it added 100 clients is different from a business growing because reimbursement increased.
When Jake at Acquire Care reviews a Medicaid provider, I want those two things separated.
Volume growth.
Rate growth.
Otherwise buyers can mistake inflation in reimbursement for actual operating growth.
Structured Family Care Is Especially Interesting
Georgia's Structured Family Caregiver model deserves its own diligence.
Under the current published EDWP reimbursement schedule, Structured Family Caregiver is reimbursed at $110.39 per day, with at least 60% of the applicable amount required to go to the live-in family caregiver under the program's reimbursement structure.
Source: Georgia GAMMIS EDWP reimbursement schedule
That creates a very different economic model than traditional hourly personal care.
Instead of recruiting an outside caregiver to drive to someone's house for a four-hour shift, the model can involve an existing live-in family caregiver.
That can potentially change:
labor dynamics,
caregiver turnover,
gross margin,
scheduling complexity,
and geographic scalability.
But again, I wouldn't value an SFC-heavy company just by looking at revenue.
I'd want to know:
How many members?
Average length of stay?
Caregiver stipend?
Administrative cost?
Case-management relationships?
Concentration?
And how durable are those cases after ownership changes?
The Yellow Flag: Geographic Concentration
Georgia's regional structure can create an advantage.
It can also create concentration risk.
Suppose 75% of an agency's census originates from one geographic area or one case-management/referral ecosystem.
That's not necessarily bad.
Maybe the agency absolutely dominates that market.
But the buyer needs to understand it.
I'd probably classify it like this:
Green: multiple counties, multiple referral sources, strong caregiver density, diversified CCSP/SOURCE census.
Yellow: significant concentration in one AAA region or referral channel, but long history and strong retention.
Red: majority of census dependent upon one relationship, one case manager, one narrow geographic area or a referral source that may not survive ownership transition.
This is exactly the kind of thing that doesn't show up on an EBITDA calculation.
But it absolutely shows up during due diligence.
Waiting Lists Can Also Tell You Something
Georgia's historical CCSP policy explicitly contemplated waiting lists when available benefit funding could not immediately accommodate additional eligible participants.
That's important from an investment standpoint.
A waiting list can sound negative.
Sometimes it is.
But it can also indicate something else:
unmet demand.
If a region has a large aging population, nursing-home-eligible residents and constrained HCBS capacity, there may be significant underlying demand for community-based care.
The diligence question becomes:
Is the constraint demand—or access to funding, authorization, caregivers, or providers?
Those are completely different problems.
If there aren't enough clients, I worry.
If there are plenty of clients but not enough caregivers, that's an operational problem.
If there are clients and caregivers but authorizations are constrained, that's a reimbursement/access issue.
You need to know which one you're buying.
Georgia's 12 AAA Regions Matter
For anybody underwriting Georgia, I would literally put a map in the data room.
Georgia's Area Agencies on Aging include regional organizations covering Atlanta, Coastal Georgia, CSRA, Heart of Georgia, Georgia Mountains, Middle Georgia, Northeast Georgia, Northwest Georgia, River Valley, Southern Georgia, Southwest Georgia and Three Rivers service areas.
Source: Georgia Division of Aging Services
Then plot:
Revenue by county.
Clients by county.
Caregivers by county.
CCSP clients.
SOURCE clients.
Referral sources.
Revenue by AAA region.
Now a buyer can actually see the business.
That is dramatically more useful than saying:
"We are a Georgia Medicaid provider."
Don't Confuse EDWP With Georgia's Other Waivers
Georgia has several Medicaid HCBS programs.
EDWP is only one.
Georgia also operates the:
Independent Care Waiver Program (ICWP)
for certain adults with severe physical disabilities or traumatic brain injury;
and the:
NOW and COMP waivers
for individuals with intellectual and developmental disabilities.
CMS lists Georgia's EDWP, ICWP, NOW and COMP as separate approved 1915(c) waiver programs.
Sources: CMS and Georgia Medicaid
This matters enormously in M&A.
A company saying:
"We're a Medicaid waiver provider."
doesn't tell me enough.
Which waiver?
Which services?
Which population?
Which counties?
Which case-management relationships?
Which authorizations?
That's the actual business.
Licensing vs. Medicaid Enrollment
This is another distinction buyers need to make.
A home care company can have the regulatory authority to operate but still lack the Medicaid infrastructure that produces valuable waiver revenue.
Think about three separate assets:
1. The license
Can you legally provide the service?
2. Medicaid enrollment
Can you bill Medicaid for that service/program?
3. The operating network
Do you actually have patients, caregivers, authorizations and referral relationships?
Those aren't the same asset.
And they shouldn't be valued the same way.
A clean license with zero patients is one thing.
A Medicaid-enrolled provider with little utilization is another.
A mature CCSP/SOURCE provider with hundreds of active members across several Georgia regions is an entirely different company.
EVV Is Part of the Infrastructure
Georgia requires Electronic Visit Verification for Medicaid-funded Personal Support Services across several waiver programs, including CCSP and SOURCE.
EVV records information including the individual receiving the service, caregiver, type of service, location, date and beginning and ending times.
Source: Georgia Department of Community Health
For buyers, that gives you another diligence dataset.
Don't just request payroll.
Request:
EVV utilization by month.
Then reconcile:
authorized hours → EVV hours → billed hours → paid claims → payroll hours.
That's one of the fastest ways to understand whether a Medicaid personal-care company's numbers actually make sense.
Georgia's Current Operational Environment
There is also a very current diligence issue.
In July 2026, Georgia DCH reported that a significant number of EDWP prior authorizations had been incorrectly entered into GAMMIS during issues involving the Georgia Horizons system.
DCH said most authorizations had subsequently been processed and that it was continuing corrective work and training with EDWP case-management agencies.
Source: Georgia Department of Community Health, July 27, 2026
That doesn't mean Georgia Medicaid is fundamentally broken.
But if I'm buying an agency in 2026, I'm asking:
Were claims delayed?
Were authorizations delayed?
Did AR spike?
Did revenue temporarily decline?
Are there services performed but not yet paid?
Don't normalize a temporary systems issue into the company's valuation without understanding it.
The Valuation Opportunity
This is ultimately why Georgia interests me.
A buyer may look at two agencies and see:
$5 million revenue.
$750,000 SDE.
15% margin.
Same state.
Same payer.
Same multiple.
I don't.
Agency #1 might have:
one dominant county cluster,
one major referral relationship,
limited SOURCE exposure,
high caregiver concentration,
and little presence outside its core market.
Agency #2 might have:
multiple AAA regions,
SOURCE and CCSP exposure,
strong SFC census,
multiple case-management relationships,
dense caregiver coverage,
and years of operating history across several counties.
Those businesses should not automatically be treated as interchangeable just because their EBITDA is identical.
The second company may have built something much harder to replicate:
distribution.
And in Medicaid home care, distribution can be more valuable than people realize.
What I Would Ask a Georgia Seller Before Going to Market
Before Jake at Acquire Care took a Georgia agency to buyers, I would want a spreadsheet showing:
Every active county.
Revenue by county.
Clients by county.
CCSP vs. SOURCE revenue.
Structured Family Care revenue.
Personal Support revenue.
Adult Day revenue, if applicable.
Referral source by client.
Case-management source.
AAA region.
Authorized hours versus delivered hours.
Caregiver count by geography.
EVV utilization.
Claims aging.
Historical reimbursement increases.
Then we can tell the actual story.
Maybe the seller doesn't just own a $4 million home care company.
Maybe they own a three-region Georgia Medicaid platform with infrastructure that would take another operator years to recreate.
That's a different pitch.
The Bigger Lesson From Georgia
The Georgia market reinforces something I see constantly in healthcare M&A:
Revenue doesn't tell you where the moat is.
Sometimes the moat is the license.
Sometimes it's a Medicaid contract.
Sometimes it's caregiver density.
Sometimes it's referral relationships.
Sometimes it's geography.
And sometimes—as can happen in Georgia—it's a combination of all five.
CCSP and SOURCE make Georgia particularly interesting because the programs are statewide, while the infrastructure surrounding access and delivery can be highly regional.
So when someone says:
"This agency does $4 million of Georgia Medicaid."
My next question isn't:
"What's the EBITDA?"
It's:
"Show me the counties."
Because that's where the real diligence starts.
Sources
Georgia Department of Community Health / Georgia Medicaid — Waiver Programs & Long-Term Services and Supports
Explains EDWP, CCSP, SOURCE, ICWP, NOW and COMP.
Georgia Department of Human Services — Division of Aging Services
Lists Georgia's Area Agencies on Aging and the counties served by each regional AAA.
Centers for Medicare & Medicaid Services — Georgia Elderly and Disabled Waiver
Federal 1915(c) waiver approval and current waiver information.
Georgia Medicaid / GAMMIS — EDWP CCSP & SOURCE Provider Manuals and Reimbursement Schedule
Current provider manuals and published reimbursement information for EDWP services.
Georgia Department of Community Health — Georgia Horizons Update, July 27, 2026
Current information regarding EDWP prior-authorization processing issues.
Acquire Care represents healthcare business owners on the sell side. We help owners understand what buyers are actually valuing before the business ever goes to market.
Because a license isn't a business.
A Medicaid number isn't a business.
And one interested buyer doesn't establish a market.
One buyer is no buyer.
