Who authorizes hours and writes the care plan in [state] Medicaid home care?
In most states, a case manager, care coordinator, or the managed care plan writes the plan and sets the hours, not the home care agency. The agency delivers what is authorized. Look in your state’s waiver manual for ’service authorization’ to see who signs and how changes are requested.
Who decides varies by program and by state.
Common patterns:
- A state agency or local aging agency assesses the person and sets the level of care.
- A care coordinator or case manager writes the plan with the client and doctor.
- A state contractor or the managed care plan approves (authorizes) the hours.
- The home care agency gets the authorization and delivers the service.
How to find your state’s answer:
- Read the waiver or State Plan provider manual. Search the words "service authorization," "prior authorization," and "plan of care."
- Find out who submits the form. In some programs, only the care coordinator can.
- Find out how to ask for more hours, and who to call.
- Check eligibility before each service. Your state portal usually shows if the client is in a managed care plan.
Example: In Georgia’s Elderly and Disabled Waiver, the care coordinator authorizes services and sends the Service Authorization Form. In NOW and COMP, DBHDD’s regional offices preauthorize. In ICWP, the agency sends its own request to Alliant Health Solutions.
Ask your state Medicaid agency which one applies to you.
Sources
- EDWP CCSP and SOURCE General Services manual, Q3 July 2026 · Georgia Medicaid (GAMMIS)
- Waivers - How To / Where (member and provider access) · Georgia Medicaid (GAMMIS)
- NOW and COMP waiver Medicaid fact sheet · Georgia DCH
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
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