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Cost Share Payment Policy Update

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Cost share is a portion of your care cost determined by Medicaid. If Medicaid has notified you of a cost share amount, we are required by law to collect it in order to continue providing services. Previously, cost share could be deducted from caregiver stipends. However, due to recent updates from the Georgia Department of Community Health (DCH), this is no longer allowed under the Elderly and Disabled Waiver Program (EDWP). Cost share must now be paid directly by the client or caregiver.
Your cost share is calculated by Medicaid based on your income and financial eligibility. Flournoy Health Systems and Primecare Home Care Services do not determine the amount.
No, your cost share amount has not changed as a result of this transition. Only the method of payment has been updated to comply with updated state policy. A small number of individuals may see a change to their cost share around the same time due to unrelated Medicaid updates. If you have questions about your specific amount, please reach out to your Medicaid case worker or contact us. We are here to help.

Cost share is collected monthly and due by the 3rd of each month for the previous month’s services, unless a specific payment schedule has been discussed with the finance team. Before making your first payment, you’ll need to complete and sign an authorization form. Once it’s reviewed and signed, payments can be made by:

  • Debit or Credit Card
  • ACH (Bank Draft)

Yes. While payments are due monthly, we will continue honoring previous collection schedules. There are different payment options based on your program type:

    • For Structured Family Caregiving Clients: 
      • $1–$250: Full amount collected on the 3rd of the month
      • $251–$500: Split into 2 equal payments (first 2 Fridays of the month)
      • $501 and above: Divided into 4 weekly payments (each Friday of the month)
    • For Traditional Clients:
      • $1–$250: Full amount collected on the 3rd of the month
      • $251 and above:
        1. Split into 2 equal payments, collected on the 15th and 30th of the month
        2. Option 2: Full amount collected on the 15th
        3. Option 3: Full amount collected on the 30th

Per DCH policy, failure to pay your cost share for two consecutive months or three out of the past six months may result in removal from the EDWP program by your case manager.

If payment is not received within 30 calendar days, Primecare may be required to discharge the client from services on the 46th day.

Please reach out to your Medicaid caseworker. They may be able to reassess your financial situation. Unfortunately, Primecare cannot adjust or waive cost share amounts.
Yes. As long as services are delivered as scheduled (e.g., 7 days/week), the caregiver will continue receiving the full stipend.
Any outstanding balance for services already rendered will still be collected the following month, even if services are temporarily paused or discharged.
Please reach out to your Administrative Health Coach. They will help connect you with someone from our Finance Department who can support you with billing and payment.

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