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GA Medicaid Overview

Medicaid is a Federal program that is administered by the states. In Georgia, the Department of Community Health is the lead planning agency for all health issues in the state, and provides Medicare services through its Division of Medical Assistance.

Medicaid is a financial assistance program. For those who are eligible, Medicaid can pay for an extensive list of health related services. (See: Medicaid Covered Services.)

Eligibility

To qualify for Medicaid, an individual must meet certain eligibility criteria. In Georgia, there are over twenty different coverage categories of Medicaid, known as classes of assistance, and each one has its own set of eligibility criteria. The classes of assistance are determined by a person's living arrangement, types and amounts of income, marital status, and prior Medicaid coverage, among other factors. For every class, an individual must meet the following criteria:

·      Be age 65 or older, or be totally disabled, or be blind

·      Be a U.S. citizen or a lawfully admitted alien who was lawfully admitted prior to August 22, 1996.

·      Be a resident of Georgia (there is no time limit to establish residency, only the intention to permanently live in Georgia)

·      Agree to assign all health insurance benefits to the Georgia Department of Community Health

·      Apply for and accept any other benefits which may help to pay for medical expenses

·      Meet financial eligibility guidelines for both income and assets. The financial criteria are different for every class of assistance.

Below is a brief description of the classes of assistance in Georgia.

Medical Treatment Facility (MTF) - This includes nursing homes, hospice care, hospital stays of 30 days or more, and Community Care Services.

Supplemental Security Income (SSI) - If an individual is eligible for SSI, he or she qualifies for Medicaid automatically. Any person who may be potentially eligible for SSI will be referred to Social Security before a Medicaid application will be taken.

Qualified Medicare Beneficiaries (QMB) - This coverage pays an individual's Medicare premium, Medicare coinsurance and deductibles. It does not pay for any prescription drugs.

Public laws - Through the years, Congress has passed six public laws which provide for Medicaid coverage for people who have been terminated from SSI. Each public law has different financial criteria.

Adult Medically Needy - This is the one Medicaid program that has no income maximum. An individual can qualify for Medicaid if his or her medical bills exceed a certain dollar amount. The specific dollar amount for each individual is based on his or her monthly income (this is known as the spenddown). Medically needy is limited to three months at a time, and only pays for bills incurred after the spenddown is met.

The rest of the Medicaid classes of assistance are for children, pregnant women, and some families with no income. See: Right from the Start (Medicaid for pregnant women and children under 19); and Women's Health Medicaid Program ( Medicaid for women with breast or cervical cancer).

Additional Information

Understanding Medicaid - A Handbook about Medicaid Services in Georgia is a publication that summarizes the various services and provides additional information about them. It is available in PDF format (requires Acrobat Reader) online at:
http://www.communityhealth.state.ga.us/departments/dch/v4/top/shared/medicaid/publications/medfinal2.pdf

Medicaid Program Manuals are available from the Georgia Health Partnership web portal in PDF format (requiring Acrobat Reader) at:
https://www.ghp.georgia.gov/

To find the manuals at this website, first select the "Provider Information" tab, then locate the "Medicaid Provider Manuals Section" and choose "View Full List", and finally select the manual you wish to read.

See Also:

PeachCare for Kids: Health Insurance for children not eligible for Medicaid

Back to:

Medicaid Financial Eligibility

Home and Community Based Services (HCBS) Waivers and Demonstration Projects

GA Benefit Information System Overview

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