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With HOPE fully funded, how can Georgia students maximize their state scholarship options?
With the HOPE Scholarship now funding college tuition at 100%, many people wonder how long that will last and what the distinctions are between HOPE and the Zell Miller Scholarship, which also fully funds tuition at state public colleges but has more demanding academic requirements. We’ve taken a look at both scholarships and have collected some insights and advice from students, parents, and college funding experts on how to earn, keep and maximize each award.
What’s Happening
Moises Guzman Jr. is a 17-year-old, freshly minted honors graduate from Coffee High School in Douglas, a town in south Georgia with a population just shy of 12,000. He plans to study engineering and business at South Georgia State College this fall, with tuition fully covered by the Zell Miller Scholarship.
“That scholarship really means a lot to me because I don’t know how much money I would be able to raise for college without it,” said Guzman, whose mother works at a nearby cargo trailer manufacturing plant. His father is recently retired from poultry processing. Both immigrated to Georgia decades ago from Mexico. Guzman works at Taco Bell and chips in to help with household expenses. He will be the first in his family to go to college.
The Zell Miller Scholarship, the most prestigious Georgia Lottery-funded college award, requires at least a 3.7 high school GPA and a minimum 1200 SAT, or 26 ACT, score. To keep the Zell Miller award, students must maintain a 3.3 GPA in college. Guzman earned a 4.0 GPA in high school, taking several Advanced Placement (AP) and Honors courses, and got a 26 on the ACT.
He’s among 22 students in Coffee County who earned the Zell Miller Scholarship this year.
Many more students qualified for the HOPE Scholarship, which has a lower academic bar — a 3.0 high school and college GPA. Over the past decade, the HOPE Scholarship has covered only 80% to 90% of tuition at most of Georgia’s public colleges and universities. This year the Legislature appropriated an extra $47 million to fully fund HOPE for fiscal year 2024. Both scholarships, awarded for attendance at schools within Georgia, will now cover 100% of public school tuition in the upcoming academic year.
Guzman said he didn’t know much about what it takes to get either scholarship until his junior year in high school. That’s when he learned that both HOPE and Zell require students to take at least four “rigor courses,” which include advanced math, advanced science, foreign language or AP, International Baccalaureate (IB) or Dual Enrollment (DE) classes at local colleges before they graduate.
Guzman talked to his high school counselor, who helped him develop a college plan, which included taking three dual enrollment classes at South Georgia State College — algebra, pre-calculus, and English— in his junior and senior years.
He also didn’t know about the difference between a regular high school GPA and the HOPE GPA, which is calculated using only grades from core courses including English, math, science, social studies and foreign languages. The HOPE GPA is what the Georgia Student Finance Commission uses to determine award eligibility. (So, art, PE, and driver’s ed classes don’t count).
Guzman also started working on the SAT his junior year, using free online resources such as Khan Academy and College Board, which offer test prep support and practice tests. He took the SAT twice and scored less than the 1200 needed to qualify for Zell. In his senior year, he took the ACT and scored a 26, the minimum score needed, on his first try. “I did struggle to get that test score,” he said.
Asked if he cares that HOPE Scholarship recipients now earn the same monetary award as Zell scholars, Guzman said, “Everyone here is really happy about it. This is a really small town and not everyone gets to go to college. If you do get one of those scholarships, it encourages you to go, and to be able to afford it. And for me, if I ever do lose Zell Miller, I’m glad I have a backup with HOPE that will still allow me to attend college.”
His sentiments are shared by many students and parents who’ve experienced or witnessed the struggle to maintain either the 3.0 or 3.3 college GPA needed to maintain the HOPE and Zell Miller Scholarships, respectively.
Daryl O’Hare of Roswell is a professional tutor with two daughters who earned Zell Miller scholarships. One just graduated from Georgia Tech, and the other is in her third year at Georgia State. She said the pressure that both of her daughters have experienced to maintain a 3.3 GPA to keep their Zell scholarships has been “intense and stressful.”
At Georgia Tech, the difference between 90% and 100% of a year’s tuition (at 15 credit hours per semester) is currently $1,026, or about $4,100 over four years. At Georgia State, the difference is $894 a year, or about $3,600 over four years. Room, board and fees can add an additional $10,000 to $20,000 per year, at both schools.
With a joint marital income of around $95,000 a year, O’Hare said the savings provided by the Zell Miller Scholarship in previous years has mattered to her family. Her eldest daughter chose to attend Georgia Tech over Northeastern University in Boston, which would have cost $45,000 more per year, all expenses considered.
“My kids knew that we were hyper-focused on making sure that they keep their scholarships,” said O’Hare. “So, you know, at Georgia Tech, there could be one professor who's just hard as nails. And if they gave you a C, you know, everything would be in jeopardy. So, I think that having the 3.0 for everybody at the 100% rate … I don't think that my daughters would say, ‘Oh, man, I worked so hard for that. And that's not fair.’ I think they would be like, ‘Wow, that would take some pressure off.’” (Both of her daughters later confirmed to State Affairs that they agreed).
Not everyone feels that way.
Joshua Keenum of Woodstock has a daughter who graduated from Georgia Tech with a public policy degree this year, maintaining her Zell Miller Scholarship all four years. His son is a rising high school senior who is dual-enrolled at Kennesaw State University with hopes of attending Georgia Tech or another top research university. A math and science standout, he has the stellar grades, test scores and a resume full of AP classes, including math and genetics, to earn a Zell Miller Scholarship.
Keenum, a manager at a chain of fitness clubs, would like to see his kids’ hard efforts rewarded with extra benefits.
“When you see the students who put in more effort and have higher GPAs, they should get greater compensation with these scholarships,” said Keenum. “Why do they need to work as hard if everything is going to be given to them at a lower GPA? Does that encourage more lackluster behavior? I don’t know, but I’m of that hustler mindset, where if I’m going to get a reward, I want to be good at what I do, and not just get by … A 3.0 just does not require the same effort.”
Leaders in the state House of Representatives argued along similar lines during the last legislative session, when they initially approved funding for HOPE at 95% of tuition cost instead of the full 100% that Gov. Brian Kemp had pushed for in his proposed budget. (After some haggling among House and Senate leaders in the closing days of the session, full funding for HOPE was restored, but only for fiscal year 2024).
Helese Sandler, director of college counseling at Savannah Educational Consultants, a private tutoring and academic coaching firm, said she has “a little bit of concern that some kids striving for a 3.7 might now think, ‘I don’t need it.’ But my experience of high achievers is that they’re going after not just in-state scholarships, but all kinds of scholarships and financial aid at public and private colleges across the country, some of which are very selective. I don’t think it’s going to demotivate them at all.”
The fact that the HOPE Scholarship is funding 100% of tuition in the upcoming academic year “means that now, with a 3.0, college is going to be more affordable,” she said. “Those extra few thousand dollars can make a huge difference to some families.”
That’s true for Jakera Lowman, 17, of Garden City, who’s heading off to Georgia Southern University in Statesboro this fall. Her mother, Leslie Lowman, who works as a custodian for Savannah-Chatham County Public Schools, said both the HOPE Scholarship and the federal Pell Grant are “what’s going to make college possible for my daughter,” who plans to live on campus and study nursing. With HOPE fully funded, Jakera will have $500 less in tuition to cover next year and about $2,000 less in student loans when she graduates.
About three times more students win HOPE than Zell Miller scholarships each year. In the 2022-2023 academic year so far, the state has awarded 38,002 students Zell Miller scholarships and 111,329 students HOPE scholarships.
Zell Miller scholars tend to gain admission to, and attend, the larger and more expensive colleges and universities in the state and thus win more tuition money. The average HOPE award was $4,359 per student this academic year, while the average Zell award was $8,110.
Why It Matters
Funding for the HOPE Scholarship and all HOPE tuition assistance programs can change from year to year according to the will of the governor and the General Assembly, noted Lynne Riley, who is president of the Georgia Student Finance Commission, and a former state treasurer and state representative. There is no statutory guarantee that HOPE tuition will remain fully funded.
The HOPE Scholarship program was created in 1993 by then-Gov. Zell Miller, and the award covered 100% of tuition and the cost of books and fees to students who earned a B average in high school and maintained a 3.0 in college. The program proved very popular and helped drive increased enrollment at state colleges and universities.
The Zell Miller Scholarship was later created in response to an economic downturn. In 2011, in the wake of the ‘Great Recession,’ the Legislature reduced HOPE awards after lottery revenues failed to keep up with ever-increasing student demand. The Zell Miller Scholarship, with its more rigorous academic requirements, was introduced as a way to reward high-achieving students with full tuition while cutting the overall costs of the HOPE program.
“I was in the General Assembly when we had to make that call,” said Riley. “That was rough, but it was something where we had to react to the circumstances at the time.”
The Georgia economy is currently strong, and the Georgia Lottery, which funds both pre-kindergarten and higher education programs, boasts a surplus of $1.9 billion, with $1.1 billion in unrestricted reserves. But Riley said because of variable economic conditions, the commission’s primary message to high school students is to “aim high academically.”
“Once you achieve Zell, you can rest assured you’ve earned a 100% award of a current year’s tuition,” she said. “So you protect yourself against tuition increases, and you protect yourself against any reductions in the HOPE award amount in future years.”
Riley noted that students who qualify for Zell Miller scholarships “are highly attractive to our state colleges and universities and are very likely to receive additional scholarships and financial aid” from both public and private institutions.
That’s the case for Moises Guzman, who was selected as a Live Màs Scholar by Taco Bell and won an additional $13,000 in scholarship funds. He said those funds will prove vital if he’s successful in transferring to Valdosta State or a bigger university further away from home in a couple of years. For now, he’s planning to save on room and board by living at home.
And for students who enroll in private colleges and universities in Georgia, there is still an immediate financial benefit to being a Zell Miller scholar. The award amount for HOPE scholarships at private schools is $2,496 per semester, while the award for Zell Miller scholarships is $2,985 per semester, almost $1,000 more per year.
The key to winning either of the HOPE program scholarships is to start early, in 9th grade, to develop a college plan, said Sandler. Students should make sure they’re taking the right mix of classes to qualify for admission to their target schools, as well as scholarships and financial aid.
Jakera Lowman did just that, taking several AP and honors courses while earning certifications in child care and cosmetology at Woodville Tompkins Technical and Career High School. “She set her expectations high and then exceeded them,” said her mother, Leslie.
Jakera said her plan was to maintain at least a 3.0 GPA throughout high school. By her junior year, with a solid B-plus average, she began gunning for Zell. She ended up just short, with a 3.7 HOPE GPA, and an 1150 on the SAT, earning her a HOPE Scholarship and offers from several in- and out-of-state colleges, public and private.
“She took on a lot, and there were nights when she would have anxiety attacks, worrying about her grades in her advanced classes, which seemed to get harder and harder,” said Leslie Lowman. "But I was her cheerleader and I always reminded her that she was trying her best, and that was good enough."
“The amount of work in the advanced courses can be overwhelming, but college is expensive, and I’m really glad I got HOPE, and I won’t have to go too deep out of pocket to pay for it,” said Jakera.
Even if you shoot for Zell and miss out, maintaining a B or better grade average can also pay off in other ways, said Sandler.
Many colleges in Georgia and other states no longer require the SAT or ACT. But most colleges that offer score-optional admission do require a 3.2 or 3.3 high school GPA, she said.
So students who don’t test well should still keep their grades up in hopes of gaining admission to such schools as Georgia State, Georgia Southern, Kennesaw State and Oglethorpe universities. Many of these schools offer their own grants and scholarships that factor in both academic merit and financial need.
A 3.0 or higher college GPA at the University of Georgia can help students qualify for the Georgia Charter Scholarship, a $2,000 annual stipend. Georgia State offers several renewable scholarships worth $1,000 to $3,000 annually to students who maintain a 3.0.
The Georgia Futures website, where Georgia students apply for college and financial aid, has links to dozens of public- and privately-funded scholarships that high school and college students with a B average can earn.
What’s Next
When the General Assembly convenes in January, it will consider Kemp’s proposed amended fiscal year 2024 and 2025 budgets, which will likely include continued full funding of the HOPE Scholarship. Economists predict another healthy state budget surplus when the 2023 fiscal year ends on June 30, and the Georgia Lottery surplus remains robust. But a decline in state tax revenue collections over the past three months could have some legislators girding for another vigorous debate in the Statehouse over the level of HOPE funding for the next academic year.
Have thoughts on how lottery proceeds or other state education funds should be spent or managed? Contact Jill Jordan Sieder on Twitter @JOURNALISTAJILL or at [email protected].
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Header image: Coffee High School graduate Moises Guzman Jr. and his parents Rocio Navarrete Gonzalez and Moises Guzman Sr., celebrate his $10,000 Live Màs scholarship at the Taco Bell restaurant in Douglas, Georgia, where he works. (Credit: Tacala Companies)
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Georgia considering occupational licensing reform
The Gist
ATLANTA — As Georgia grapples with a severe workforce shortage, a Senate committee is looking at changing laws and policies that keep skilled professionals, including doctors and nurses, waiting a year or more to get to work.
What’s Happening
The Senate Study Committee on Occupational Licensing heard this week from several experts with insights into the bureaucratic barriers plaguing skilled workers.
Many occupational licenses in Georgia are issued by one of 43 licensing boards housed in the Professional Licensing Boards Division of the secretary of state’s office. They cover 197 license types, including cosmetologists, nurses, social workers, foresters, architects and plumbers. Other professions are regulated by independent state boards, including doctors, engineers and realtors.
About 30% of U.S. workers need a license to work, said Marc Hyden, director of state government affairs for R Street Institute, a public policy think tank based in Washington, D.C.
Hyden praised recent laws passed in Georgia that have expedited the process for veterans and military spouses with professional skills to obtain licenses when they move into the state. But he said more reforms are needed.
The licensing division is understaffed and underfunded, Hyden said, and receives only $8.5 million of the $24 million it generates from licensing fees. This lack of resources prevents some boards from providing timely and efficient service, he said, creating a backlog of prospective skilled workers.
About 27% of professional license applications administered by the Professional Licensing Board Division take a year or more to process, according to the secretary of state. The rest can take up to six months. Some boards are relying on paper applications, mail service and manual processes to handle applications.
Why It Matters
Hyden noted that other states manage to issue licenses within 30 days, in part because their boards are better staffed and meet more often — monthly, instead of quarterly, as with some Georgia boards.
Georgia is enjoying record economic growth. Over the last four years, the state has attracted over 1,700 economic development projects, $65 billion in investment and 165,000 jobs, according to the Georgia Chamber of Commerce.
But the state’s workforce can’t supply enough workers to meet the growing number of job opportunities. There is only one job seeker for every three job postings, the Chamber said.
Among jobs in highest demand in Georgia are registered nurses, pharmacists, accountants, construction contractors and truck drivers – all of which require state licenses. Many workers now in these fields are nearing retirement.
According to the Georgia Health Care Workforce Commission, 20% of health care workers are over age 55 and looking to retire in the next 10 years. About 4% of the health care workforce leaves annually and is not being replaced by new graduates.
Most of the state is medically underserved, with 65 of Georgia’s 159 counties without a pediatrician, 82 counties without an obstetrician and 90 without a psychiatrist.
To draw more people into skilled professions, “we need to think creatively … and improve licensing,” said Daniela Perry, vice president of the Chamber.
What’s Next
One area ripe for reform is how the state handles licensing of professionals who come to Georgia from other states and countries.
Since 2019, 22 U.S. states have adopted universal license recognition laws that establish a streamlined process to recognize professional licenses issued by another state. If the applicant holds a license in good standing and has no pending disciplinary actions or a disqualifying criminal record in one state, they can practice in another.
This year Georgia passed HB 155, which allows licensing boards to grant licenses to some out-of-state professionals if the license they hold is “substantially similar” in qualifications and scope to what Georgia requires.
The Georgia law is more restrictive than those in other states, which only call for “similar” qualifications and don’t require residency, said Austen Bannan, an employment expert with Americans for Prosperity. Other states allow years of professional experience to stand in for some training requirements. Georgia doesn’t, mandating seasoned skilled tradespeople pursue hundreds or thousands of hours of additional training.
“The idea is not to force people to relearn their skill set,” Bannan said.
Georgia is also missing out on the skills of many foreign-trained professionals due to its stringent licensing requirements, said Darlene Lynch, who chairs the Business & Immigration for Georgia Partnership, which works to enhance economic development by tapping into the skills of immigrants.
Georgia’s foreign-born population has grown by 90% over the last 20 years, and 10% of Georgians — more than a million people — are now foreign born, she said, adding that half are naturalized citizens, and a third have college or graduate degrees.
Though 1 in 5 doctors in Georgia is foreign-born, Lynch said, “Too often we’re watching doctors driving Ubers, dentists working behind a CVS counter, a welder working at a poultry plant — they’re not going back to the field where they have the most experience.”
She urged the committee to adopt the licensing practices of other states, which recognize the medical credentials of foreign-born physicians and other health care professionals, and develop expedited pathways for other skilled immigrants to become licensed.
“We have a pool of talent that other states don’t have to draw upon,” Lynch said.
Sen. Larry Walker III, R-Perry, chair of the occupational licensing committee, said many of the issues raised at the meeting this week have come up at the GA WORKS Commission, an effort led by Secretary of State Brad Raffensperger this year to slash bureaucratic barriers in occupational licensing. That includes a total revamp of the application process, which is projected to be fully digitized by spring 2024.
“We’ve got to get into the modern world with this licensing issue if we’re going to continue to grow our economy,” Walker said.
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Header photo: Some foreign-trained doctors and other health professionals wait for years for approval to practice in Georgia, due to the state’s demanding occupational licensure requirements. (Credit: baona)
Jimmy Carter’s 99th birthday bash swings into high gear Saturday
Key takeaways: Birthday celebrations for Jimmy Carter, Georgia’s most famous native son and the nation’s oldest-living president, will take place Saturday to avoid the threat of a looming partial federal government shutdown. James Earl Carter Jr. turns 99 on Sunday, the day the federal government is set to shutdown if federal lawmakers don’t reach an …
Senate study committee hears suggestions to improve Georgia foster care
The Gist
ATLANTA — College-bound Halle Mickel gave state lawmakers on Tuesday a compelling glimpse into Georgia’s foster care system.
The 19-year-old who has seven siblings in five different homes told the Senate Foster Care and Adoption Study Committee how her family’s life has been “turned upside down” ever since they were separated last April. She sees her siblings once a week. Sometimes, those visits are canceled because child welfare workers aren’t prepared, she said.
“The pain it caused not only my mom but me felt horrible,” she said. “Watching them cry as they have to leave my mom and go home to a stranger. Seeing my siblings not getting the proper hygiene care they need and so much more. Like many others, my family has been torn to pieces by the child welfare system due to struggling with poverty and being in need of immediate help. Parents aren’t always at fault when DFCS is involved.”
Mickel’s story was included among more than four hours of testimony from advocates and experts in the foster care, child welfare and family court fields. Tuesday’s session focused primarily on finding solutions for Georgia’s taxed foster care system.
What’s Happening
Georgia has about 11,000 children in foster care, committee chair Sen. Kay Kirkpatrick told State Affairs in a post-hearing interview Tuesday. Many are in the system due to abuse, neglect, family drug addiction, violence and other hardships.
Georgia’s foster care system is stretched so thin that children in foster care in Georgia spend about two years in the system — nearly three months longer than the national average of 21.7 months, according to The Council of State Governments Southern Office.
Often there aren’t enough families to take in children so many end up in hotels or offices as a result, Candice Broce, head of Georgia Family and Children Services, recently told the committee.
Broce was back before the committee Tuesday with good news. The foster care system reached a milestone on Sept. 8, when no foster children were reported staying in hotels or offices, she said. Since then, the agency has only used hoteling in a few emergency cases, she noted.
Still, Tuesday’s testimonies showed Georgia is spending more money troubleshooting and intervening rather than preventing children from having to go into the foster care system.
About $538 million in state and federal money is spent on Georgia’s foster care system. The bulk of that — $498.5 million — goes to intervention and late intervention programs, according to Voices for Georgia’s Children, a nonprofit child policy and advocacy group.
“In Georgia, we allocate around 20% of Title IV funding towards prevention while the majority of resources are funneled into the foster care and adoption industry,” said Sarah Winograd of Together With Families, an advocacy group for families in the child welfare system.
“While the majority of the resources are funneled into the foster care and adoption industry,” Winograd told the committee. “It’s an industry. Consider the numbers: a staggering $32,000 per year to keep one child separated from their family and in foster care.”
It costs her organization “a mere $500 to $1,500 per child in assistance and resources at Together with Families to prevent foster care and help families improve their own lives,”she said.
Why It Matters
The committee heard suggestions to help Georgia focus more on prevention rather than intervention. Among the suggestions:
- Issue state identification cards to foster children. Often kids are removed from their homes during chaotic situations leaving birth certificates and other import documents unavailable to them. Children would be issued a state ID within 90 days of entering the foster care system, displaying information such as the child’s Medicaid number. It would enable older children in the system to get jobs and perform other vital daily tasks. The cost would run about $5 a child. “That should be something that’s not too difficult to achieve,” Kirkpatrick said.
- Use the Safe Babies approach in Georgia courts. Between 2011 and 2018, Georgia saw a 44% increase in infants and toddlers entering foster care, more than any other Southern state. As a result, it needs a more collaborative, family-based approach to dealing with the youngest children in foster care, such as the Safe Babies approach used in Iowa. Iowa’s infant courts are adorned with quilts, diapers, toys and books, to help alleviate the trauma experienced by toddlers and infants in the court system. In a recent visit, Georgia officials saw how one Iowa judge, his court staff and attorneys dealt with a mother who became distraught during the hearing. The judge stopped the hearing, allowing attorneys and other staff to embrace the woman. The DFCS case manager and defense attorney told the woman they were there to help her figure out ways to keep her baby. “That’s super important. It’s been successful in other states,” Kirkpatrick said.
- Use opioid settlement money to finance foster care needs. Kirkpatrick called it a good idea but “it might not be that easy to accomplish. It’s not really under the legislature’s control.”
What’s Next?
Kirkpatrick, a Republican and retired orthopedic surgeon who practiced in metro Atlanta for over 30 years, called Tuesday’s hearing extremely productive.
“I thought it was another great meeting,” she said. “We work pretty hard to get input from all the different groups. We won’t make our decisions about which things to tackle until we finish [all of] our meetings. We have one more where we’ll be getting some testimony.”
The senate committee’s next meeting is in Columbus on Oct. 26. It will focus on adoption.
“After that, we’ll get together and figure out what our legislative priorities are going to be,” Kirkpatrick said.
Want to know how many foster children have been placed in foster homes outside of your county? Go to seetheneed.org to find out. See The Need was created by Alpharetta-based FaithBridge Foster Care to raise awareness about foster care in America.
Have questions, comments or tips? Contact Tammy Joyner on X @lvjoyner or at [email protected].
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Header image: The Senate Study Committee on Foster Care and Adoption held their second meeting at the Capitol to hear testimony from citizens, nonprofits and state agency representatives. (Credit: Georgia Senate)
Lawmakers explore ways to keep seniors from heading to nursing homes too soon
The Gist
The House Human Relations & Aging Committee explored several legislative and regulatory solutions to address the long-term care needs of Georgia’s rapidly expanding elderly population last week. A big focus was on how to best use Medicaid funds to provide more care for seniors who don’t yet need to be in a nursing home, and are trying to stay in their homes, assisted living facilities or personal care homes.
What’s Happening
Lawmakers, leaders of state health and welfare agencies and a variety of long-term senior care facilities and associations spent four hours discussing how to provide better care for the growing population of low- and middle-income Georgia seniors who have a range of medical, housing and social service needs.
Some need modest support that can be provided in their homes by relatives or other paid caregivers, while others, including people with dementia, need ready access to medical services and constant oversight, but not the more intensive, expensive and skilled care that’s provided in nursing homes.
Much of the discussion centered around HB 582, a bill introduced in the last legislative session by House Public Health Committee Chair Rep. Sharon Cooper, R-Marietta. It would allow assisted living communities, personal care homes and other providers of home- and community-based services to enroll as Medicaid providers and receive Medicaid funds, which is currently prohibited by state law.
Access to Medicaid funds would help Georgians who need these services, but can’t afford them, “to age in place without moving to a skilled nursing facility,” according to the bill.
Nursing homes are currently funded by state-managed Medicaid dollars, comprised of about two-thirds federal funds and one-third state funds. And some personal care homes that have up to 24 beds serving elderly people who are frail are also allowed to receive Medicaid funding in Georgia through waivers granted by the federal Centers for Medicare and Medicaid Services.
Meanwhile, some larger assisted living providers want much wider access to Medicaid funds to meet the ever-increasing demand for affordable housing and supportive care that aging residents need.
Among them is Wesley Woods Senior Living, which provides apartment homes and care to about 1,800 older adults in Georgia, ranging from seniors with extremely low incomes to the affluent. CEO Terry Barcroft told the aging committee that she has 172 beds categorized as assisted living or personal care homes, where staff provide daily living support services to residents.
Many of their units are occupied by seniors on fixed incomes who depend on subsidized housing assistance, she said, and can’t afford to pay for supportive services. Wesley Woods provides more than $1 million in charitable care to make sure such people can stay in their homes,” said Barcroft.
But there are many more seniors in Georgia who need assisted living care but who don’t qualify for Medicaid waivers. The passage of HB 582 would create more accessible options within long-term care programs for thousands of people “who don’t need 24-hour skilled nursing but do need 24-hour watchful, protective oversight,” Barcroft said.
Why It Matters
The state’s senior population is rapidly growing. Georgians aged 60 or older currently represent more than 15% of the total state population of 11 million, said Debra Stokes, executive director of the Georgia Council on Aging. Numbering 1.7 million in 2020, the senior population will expand by more than 500,000 people by 2030, when they’ll outnumber the under-20 population. By 2040, older Georgians will number 2.8 million, with the greatest rate of growth among those 80 and older.
Meanwhile, the number of Georgians age 65 or older living with Alzheimer’s disease and dementia is also expected to climb to 190,000 people in 2025 from 150,000 in 2020, a 27% increase, said Nancy Pitra, government relations director for the Alzheimer’s Association of Georgia. At the same time Georgia’s Medicaid costs to care for seniors with Alzheimer’s, $1.2 billion in 2020, are expected to increase 26% by 2025, she said.
People with moderate to severe dementia need constant oversight, Pitra noted, and allowing them to access Medicaid-funded services in assisted living facilities would mean living and receiving care in more affordable, less isolated, home-like environments.
This swelling of the aging population will elevate the demand for affordable housing that is already tough to come by in Georgia. It will also exacerbate the existing shortage of skilled nurses, nursing assistants, memory care providers and other caregivers that serve seniors.
Finding new ways to finance the cost of long-term care for seniors is crucial, said MaryLea Boatwright Quinn, assistant deputy commissioner of the Division of Aging Services in the Department of Human Services. She leads the agency’s home- and community-based services program for vulnerable adults, which has a budget of $114 million, and allocates state and federal funds to aging-related agencies in Georgia.
Home- and community-based services positively impact seniors’ health and reduce health care costs by reducing hospitalizations and getting people to be more compliant with disease management, said Quinn, a licensed medical social worker.
“We’re trying to help people … stay in their home of choice and avoid institutionalization as long as possible,” she said.
What’s Next
One of the newer models relying on Medicaid, and Medicare, to provide long-term, community-based care for seniors is PACE, or Programs of All-Inclusive Care for the Elderly, which provides, often at an adult day health center, comprehensive medical and wraparound services to medically frail elderly people through an interdisciplinary team of caregivers.
Most patients enrolled in PACE programs live at home. Costs for their care are capped at a flat per diem rate, instead of being paid per service, and providers are required to deliver all the medical, social, transportation, food, physical therapy, memory care and other services that seniors in the program require.
The FY 2024 state appropriations bill mandated that the Department of Community Health conduct a needs assessment on the establishment of one or more PACE programs.
Brian Dowd, deputy commissioner of the department, told lawmakers that his team has been studying some of the PACE programs operating in 32 states for several months, and determined that the model could be viable in several Georgia counties they looked at, including Fulton, Dekalb, Cobb, Bibb, Chatham, Richmond, Gwinnett and Muscogee.
Because “they’re essentially on the hook for everything” that patients need, Dowd said, providers are also incentivized to use case management and other efficiencies to keep costs down.
Adopting PACE wouldn’t rely on a Medicaid waiver, which typically lasts five years, he said. It would more likely involve amending the state Medicaid plan. Dowd said the Department of Community Health is examining the need for legislation to authorize PACE programs in Georgia, and also developing cost projections for the program.
Kathleen Benton, CEO of Savannah Hospice, told lawmakers that she had spent two years researching PACE programs, and hopes the state will fund a pilot program.
She estimated the per person cost of a PACE program in Georgia would be $4,700 per month. “That’s much different than the $6,100 spent on nursing homes right now,” she said, adding that with PACE, patients and providers are more satisfied, attrition for both groups is low, and the supportive family members of patients aren’t overwhelmed with trying to provide or coordinate all of their care.
“We’re in a perfect storm in Georgia,” she said. “Beyond the aging population, we have a labor shortage,” and no good solutions on the horizon to solve it, Benton said. “We must look for inherent caregivers in the home. We have to support them and provide them respite.”
Rep. John LaHood, R-Valdosta, who manages several assisted living and senior care centers in Georgia, told State Affairs he sees pros and cons in the PACE model.
“In one way it makes it more predictable for the state to put a price tag on one person and say, ‘Alright, they’ve been taken care of at this price, no matter what they need,’ ” he said. “I think my concern would be that a PACE provider might be incentivized to be so efficient, to mitigate the risks of overspending, that they might avoid necessary care and getting that person engaged with the necessary providers. We would need some accountability, some kind of backstop for that.”
While all lawmakers and others who spoke at the committee meeting agreed that providing more independent living situations, medical care and social supports for seniors is important to pursue, not everyone was sure that using Medicaid funding to do it would work.
Some were not clear if repealing the state prohibition on funding assisted living and large personal care homes with Medicaid monies is permitted by the federal Medicaid agency. Others pointed out that 45 states are already using Medicaid funds for assisted living and a variety of home- and community-based services, with no regulatory backlash.
Catie Ramp, CEO of the Georgia Senior Living Association, a nonprofit trade association representing private pay senior living facilities, said her association is concerned about the potential negative consequences of allowing more Medicaid spending in the senior living market.
She said Medicaid’s low reimbursement rates might lead providers to “minimize quality of care and care options” in order to avoid passing on costs to residents. Otherwise, their labor costs will rise significantly, she said.
Barcroft said that labor shortages since the pandemic have led Wesley Woods to raise its base pay to $15 an hour, costs which “can only be passed on to residents and their families,” she said, adding that she hoped the state would continue to promote medical career pathways “to help students understand what CNAs [certified nursing assistants] and med techs do,” and draw more people into the field.
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Header photo: A nurse assists a resident at Fellowship Home at Brookside, an assisted living center in Valdosta. (Credit: The Fellowship Family)