Georgia has the lowest ratio of caregivers to residents in the country, with only 7.1 caregivers available per 100,000 residents. The state ranks 3rd worst overall for senior care staffing, with just 1.4 nurses per occupied bed and 3.3 people aged 75 and older per home health aide. With the senior population growing by 15.7% between 2020 and 2024—the 10th highest growth rate nationally—demand for home health services is accelerating far faster than workforce capacity.

This guide covers everything agencies need to know about providing home health services in Georgia, from Department of Community Health (DCH) licensing requirements to Medicaid reimbursement through CCSP and SOURCE programs and strategies for building a sustainable caregiver workforce in one of the nation's most challenging markets.

Georgia Home Health Agency Licensing Requirements

Home health agencies in Georgia must be licensed by the Healthcare Facility Regulation Division (HFRD) of the Department of Community Health (DCH). The regulatory framework is established under O.C.G.A. § 31-7-150 and Georgia Administrative Code Chapter 111-8-31 for home health agencies.

License types. Georgia distinguishes between different types of home care providers. Home Health Agencies (HHAs) provide skilled services through licensed nurses and therapists, plus personal care through home health aides—these agencies can bill Medicare and Medicaid. Private Home Care Providers (PHCPs) offer non-medical in-home support such as bathing, dressing, meal preparation, housekeeping, companionship, and transportation. Each license type has specific requirements and regulatory frameworks.

New licensing platform (2025). As of 2025, Georgia has officially transitioned all applications from GAMMIS to GAHLES (Georgia Healthcare Licensing, Enforcement, and Surveys). All submissions must be made through the GAHLES online portal at gahles.dch.georgia.gov. The Home Health Agency Application Packet was updated on September 8, 2025.

Application requirements. Each person, private or public organization, political subdivision, or governmental agency desiring to operate a home health agency must apply for and obtain a license using forms furnished by DCH. Applications must be accompanied by the prescribed fee, paid through the DCH Payment Portal. Home health agencies required by state law to obtain a Certificate of Need must submit evidence that such requirements have been met when applying.

PHCP licensing process. For Private Home Care Providers, the licensing process involves two main steps: obtaining a provisional license through administrative review, then securing a regular license after an on-site survey. A provisional license is valid for one year and is non-renewable. To qualify for the on-site survey, agencies must serve at least two clients. At least two staff members are required at the time of application, including the Administrator. Even if your PHCP offers only non-medical services, an RN must be included in your organizational plan.

Expanded home health agency requirements. An applicant for an expanded home health agency must provide documentation of full accreditation by the Joint Commission (JCAHO), the Community Health Accreditation Program (CHAP), or another appropriate accrediting agency approved by DCH.

Surveys and inspections. Providers are inspected by DCH periodically; however, the department may exempt a provider from periodic inspections if it is certified or accredited by a recognized entity. Providers seeking exemption must submit documentation of their certification or accreditation, including a copy of the most recent survey report.

Penalties for non-compliance. Any person who operates a home health agency without first obtaining a license shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not to exceed $500 or imprisoned for a period not to exceed six months or both.

Home Health Aide Certification Requirements

Georgia does not require state-level licensure or certification for home health aides working in non-Medicare/Medicaid settings. However, to work for a Medicare or Medicaid certified home health agency, home health aides must meet federal training requirements.

Training program requirements. To work for a Medicare or Medicaid certified agency, a home health aide must successfully complete at least 75 hours of healthcare training through a qualified program. This includes 59 hours of classroom instruction and 16 hours of supervised clinical training, meeting federal requirements under CFR Title 42, Vol. 3, 484.

Competency evaluation. After training, HHAs must pass a competency examination to test their skills and knowledge. This is typically administered by the training program or by the hiring home health agency and includes both written and hands-on skills components covering caregiving techniques, patients' rights, and infection control.

Basic eligibility. Most Georgia agencies require candidates to be at least 18 years old and have a high school diploma or GED (preferred by most employers and required by many training programs). All candidates must pass a criminal background check. Unlike some states, Georgia agencies may hire candidates without a diploma if they can successfully complete the training program and competency evaluation.

Continuing education. Home health aides employed by Medicare and Medicaid home health agencies must complete 12 hours of in-service training annually, as required by federal regulations.

Georgia Nurse Aide Registry. Home health aides who wish to be listed on the Georgia Nurse Aide Registry (which provides additional credentialing) must complete an 85-hour nurse aide training program and pass the state certification examination. Being listed on the registry can expand employment opportunities, though it is not required for all HHA positions.

Certified Nursing Assistant (CNA) Requirements

Many home health agencies in Georgia employ Certified Nursing Assistants, who have more extensive training and are listed on the Georgia Nurse Aide Registry managed by Alliant Health Solutions on behalf of DCH.

Training requirements. The Georgia Nurse Aide Program requires a minimum of 85 hours of training, which includes classroom instruction, laboratory practice, and clinical rotation. Training programs must be approved by DCH and are offered at technical colleges, vocational schools, and long-term care facilities across the state. If trained in a long-term care facility, candidates must become certified within 120 days of starting the program.

Competency examination. All candidates must pass the National Nurse Aide Assessment Program (NNAAP) Examination, administered by Credentia. You must pass both portions of the exam within one year from the completion date of your training program or within three attempts, whichever comes first. Failure to do so requires re-training at a Georgia State Approved Nurse Aide Training Program.

Registry and certification. After passing the examination, Credentia reports results to the Georgia Nurse Aide Registry, and active status should appear within 10 business days. The registry verifies that CNAs are in good standing and have no findings of abuse, neglect, or misappropriation of property.

Renewal requirements. CNA certification must be renewed every two years through the Georgia Nurse Aide Registry. There is no fee, no grace period, and renewals are not automatic. Federal regulations require that CNAs must have worked as a CNA for pay under the supervision of a licensed nurse for a minimum of eight hours within a continuous period of 24 consecutive months from the most recent certification date.

Reinstatement. If certification expires and you don't meet the 8-hour work requirement, you must retake and pass both the written and skills exams (if expired less than three years) or complete a Georgia-approved training program and pass both exams (if expired three years or more).

Reciprocity. If you are currently listed as active and in good standing on another state's Nurse Aide Registry, you may obtain a Reciprocity Application via the Georgia portal at mmis.georgia.gov.

Contact the Georgia Nurse Aide Program at (678) 527-3010 or toll-free (800) 414-4358, Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time. For exam registration, visit credentia.com/test-takers/ga.

Medicaid Reimbursement in Georgia

Understanding Georgia's Medicaid program is essential for agencies serving lower-income populations. Georgia Medicaid delivers home and community-based services primarily through waiver programs designed to help seniors and people with disabilities remain in their homes rather than institutional settings.

CCSP (Community Care Services Program). This is Georgia's primary elderly and disabled waiver program, providing home and community-based services as an alternative to nursing home care. CCSP serves Georgia residents who are elderly (aged 65+) or physically disabled and under age 65. Services include personal care assistance, adult day care, respite care, home delivered meals, personal emergency response systems, and assistance with Activities of Daily Living.

CCSP eligibility. In 2025, an applicant, regardless of marital status, can have a monthly income up to $2,901. Applicants must be determined to need nursing facility level of care through the state's assessment process. CCSP allows non-applicant spouses a Monthly Maintenance Needs Allowance and Community Spouse Resource Allowance. It typically takes 2-4 months from start to finish for a client to be enrolled in CCSP.

SOURCE (Service Options Using Resources in Community Environment). SOURCE is a statewide Primary Care Enhanced Case Management Service under the Elderly and Disabled Waiver that links primary medical care with long-term health services. SOURCE serves aged, blind, and disabled Georgians who are SSI/Medicaid eligible and require Intermediate Nursing Home level of care. SOURCE requires an assessment to determine eligibility, including evidence of memory deficit and/or physical disability along with a chronic medical condition.

Key differences between CCSP and SOURCE. CCSP provides the same home and community-based services as SOURCE, but does not limit eligibility to SSI Medicaid recipients, allowing applicants to have higher monthly income. Both programs offer case management, adult day care, alternative living services, personal care, home delivered meals, and respite care for family caregivers.

Waitlist information. CCSP is not an entitlement program—meeting eligibility requirements does not guarantee immediate receipt of benefits. There are limited participant enrollment slots, and when full, a waitlist forms. The Elderly and Disabled Medicaid Waiver (under which SOURCE is authorized) is approved for approximately 49,398 beneficiaries per year statewide.

Reimbursement rates. DCH reimburses home health agencies a specific rate per visit for covered services. For detailed procedure codes and reimbursement rates, providers should refer to the Provider Portal and the Home Health Services Chapter 1000 of the Provider Manual. The SFY 2025 budget included rate increases for Medicaid providers of home and community-based services, with significant funding dedicated to expanding HCBS for Georgians with intellectual and developmental disabilities.

How to apply. To apply for these programs, individuals should contact their local Area Agency on Aging or call Georgia Cares at 866-552-4464.

Medicare Home Health Coverage

Medicare remains a significant payer for home health services in Georgia, particularly given the state's growing senior population. Agencies must understand Medicare requirements to serve this population effectively.

Eligibility requirements. To qualify for Medicare home health coverage, beneficiaries must be homebound (meaning leaving home requires considerable effort due to illness or injury), need skilled nursing care on an intermittent basis or require physical therapy, speech-language pathology services, or continued occupational therapy, have a physician certify the need for home health care and establish a plan of care, and receive services from a Medicare-certified home health agency.

Medicare certification. Agencies seeking to serve Medicare beneficiaries must obtain Medicare certification through CMS in addition to their Georgia state license. This process involves additional surveys and compliance requirements beyond state licensing.

2025 rate updates. On November 1, 2024, CMS issued its Calendar Year 2025 Home Health Prospective Payment System Final Rule (CMS-1803-F). CMS estimates that Medicare payments to home health agencies in 2025 will increase in aggregate by 0.5%, or $85 million, compared to 2024. The 30-day standard payment rate was set at $2,057.35, up from $2,038.15 in 2024. The finalized 2.7% market basket update is offset by a productivity adjustment of 0.5% and a permanent prospective PDGM adjustment of -1.975%.

Labor Laws and Wage Requirements

Georgia's labor law landscape creates unique considerations for home health agencies regarding wages and worker protections.

State minimum wage. Georgia's state minimum wage is $5.15 per hour—one of the lowest in the nation. However, this only applies to employers not covered by the Fair Labor Standards Act (FLSA). In practice, the federal minimum wage of $7.25 per hour applies to most home health agencies, as they are typically covered by the FLSA.

Federal law prevails. When both Georgia law and federal law cover an employee, the law that provides greater protection controls. For most home health workers, this means the federal minimum wage and overtime rules apply.

Overtime requirements. Under the FLSA, non-exempt home care workers are generally entitled to overtime pay (1.5x regular rate) for hours worked over 40 in a workweek. The domestic service exemption applies narrowly—typically only to those hired directly by home care patients or their families, not to employees of third-party home health agencies.

Tipped employees. Per the FLSA, employers in Georgia must pay tipped employees a minimum wage of $2.13 per hour, with a tip credit of $5.12 per hour. However, this rarely applies to home health workers, who do not typically receive tips.

Proposed legislation. Several bills have been introduced in the Georgia legislature proposing minimum wage increases. GA SB273 proposes increasing the state minimum wage to $22.00 per hour effective January 2026 with annual cost-of-living adjustments. GA HB394 proposes a $15.00 per hour minimum wage for covered employees. As of this writing, neither has been enacted.

Meal and rest breaks. Georgia does not require employers to provide specific meal or rest breaks to adult employees. However, employers that offer breaks must adhere to FLSA guidelines.

Georgia's Workforce Challenges

Georgia faces among the most severe home health workforce challenges in the nation. Understanding these dynamics is essential for agencies developing recruitment and retention strategies.

Workforce shortage scope. Georgia has the lowest ratio of caregivers to residents in the country, with only 7.1 caregivers available per 100,000 residents. The state ranks 3rd worst for senior care staffing, with only 1.4 nurses per occupied bed (50th in the nation) and 3.3 people aged 75+ per home health aide (49th in the nation). Georgia has only 79 home health workers per 1,000 adults aged 65 and older, placing it 44th nationally.

Current and projected job openings. Georgia currently has nearly 40,000 job openings in healthcare. In 24 months, over 60,000 openings are expected. By 2030, the state will need 100,000 healthcare workers. In Georgia alone, 142,900 jobs in home health care will be available in the next six years. Currently, roughly 75,000 people work as paid caregivers across the state, and demand is projected to rise by 37%.

Demographic drivers. Georgia's senior population of approximately 1.78 million represents 15.9% of the state population. The 65+ population grew by 15.7% between 2020 and 2024—the 10th highest growth rate nationally. By 2030, seniors are projected to comprise 18-20% of Georgia's population. Almost 20% of Georgians are over age 60, and about 10% of the state's seniors live alone.

Wage competitiveness. According to recent data, the average home health aide salary in Georgia ranges from approximately $12.77 to $18.00 per hour depending on the source, region, and employer. Indeed reports an average of $12.77 per hour based on salary reports, while Salary.com reports higher averages around $18 per hour in metro Atlanta. Georgia's wages are generally below the national median of $16.82 per hour for home health aides.

Rural healthcare challenges. Georgia's rural counties have seen closures of smaller hospitals and community-based clinics, creating healthcare deserts. When institutional care disappears, home-based care needs increase—but recruiting caregivers willing to serve remote areas becomes more difficult. Caregivers in rural Georgia may drive 30 minutes or more between clients.

Strategies for Georgia Agencies

Given Georgia's specific market dynamics—massive demand, severe workforce shortages, and regional variation—agencies must adopt targeted strategies to succeed.

Competitive compensation. With Georgia operating under the federal minimum wage and no state mandate for higher pay, agencies that can offer above-market wages will have an advantage. In metro Atlanta, where competition is fierce, agencies may need to pay $14-17 per hour or more to attract candidates. Analyze your local market and set wages accordingly. Even small premiums above competitors can make a meaningful difference.

Navigate regional differences. Metro Atlanta is fundamentally different from Savannah, Augusta, or rural south Georgia. Atlanta's booming economy creates intense competition with warehouse, retail, and hospitality jobs. Suburban counties like Gwinnett, Forsyth, and Henry may offer better recruiting conditions with large populations and more affordable housing. Calibrate your strategies to local realities.

Partner with technical colleges. The Technical College System of Georgia operates 22 colleges across the state with healthcare training programs. Partner with these institutions to reach students, offer clinical rotation opportunities, or provide scholarships in exchange for employment commitments. Build relationships with instructors and career services staff.

Leverage Georgia's diverse communities. Georgia's demographic diversity—particularly in metro Atlanta with large African American, Hispanic, Asian, and immigrant communities—creates recruiting opportunities for agencies with culturally competent outreach. Build relationships with community organizations, churches, and cultural centers. Hire recruiters who reflect the communities you serve.

Optimize for geographic efficiency. Georgia spans over 59,000 square miles. Build geographic service clusters that minimize drive time between clients. Compensate fairly for travel time and mileage—caregivers losing money on gas won't stay long. Smart territory management is essential.

Monitor regulatory changes. Georgia's regulatory landscape requires ongoing attention. Stay current with DCH announcements, GAHLES portal requirements, and any updates to licensing standards. The transition from GAMMIS to GAHLES in 2025 demonstrates how quickly processes can change.

Focus on retention. Given the extreme difficulty of recruiting in Georgia—where the state has the lowest caregiver ratio in the nation—retaining current staff is paramount. Invest in structured onboarding, consistent scheduling, career development pathways from HHA to CNA to higher credentials, and recognition programs. Every caregiver who stays saves the cost and effort of replacement.

Key Resources and Contacts

Agencies operating in Georgia should maintain relationships with these key regulatory and support organizations:

Georgia Department of Community Health (DCH)
Healthcare Facility Regulation Division
Website: dch.georgia.gov
GAHLES Portal: gahles.dch.georgia.gov
Email: [email protected]
Phone: (404) 657-5700

Georgia Nurse Aide Program
Managed by Alliant Health Solutions
Website: mmis.georgia.gov
Phone: (678) 527-3010 or (800) 414-4358
Hours: Monday-Friday, 8:00 a.m.-4:30 p.m. ET

Credentia (CNA Exam Registration)
Website: credentia.com/test-takers/ga

Georgia Medicaid
Website: medicaid.georgia.gov
Provider Portal: mmis.georgia.gov

Georgia Cares (Waiver Program Information)
Phone: 866-552-4464

Division of Aging Services
Website: aging.georgia.gov
Area Agencies on Aging directory available on website

Georgia Health Care Association
Industry advocacy and resources
Website: ghca.info

The Bottom Line

Georgia presents both substantial opportunities and significant challenges for home health agencies. The state's 1.78 million seniors—growing at one of the fastest rates in the nation—ensure sustained demand for services. The regulatory environment through DCH provides clear pathways for agency licensing and operation, with the new GAHLES platform modernizing the application process.

However, the workforce crisis is severe. Georgia has the lowest caregiver-to-population ratio in the entire country, and the gap between supply and demand is widening. With 142,900 home health jobs projected to be available in the next six years and only 75,000 current caregivers statewide, agencies must be strategic and creative in their approach to staffing.

Success in Georgia requires understanding DCH licensing requirements and the GAHLES portal system, navigating CCSP and SOURCE Medicaid programs effectively, developing aggressive but sustainable recruitment strategies tailored to regional markets, and building retention programs that keep valuable caregivers engaged for the long term.

The demand for home health services in Georgia will continue accelerating as the population ages. Agencies that invest in competitive compensation, build strong training pipelines, and create supportive workplace cultures will be best positioned to meet this growing need while building sustainable businesses in the Peach State.