2050 Application Processing Overview | Medicaid

An inquiry regarding public assistance programs can be made at any time, either in person, by mail, by telephone, fax, secure email, or at another designated agency. Information regarding public assistance programs must be provided to any individual without requiring that an application be filed.

An application must be provided to anyone upon request.

An application may be requested in person, by mail, telephone, facsimile, secure e-mail, or at any designated agency.

The A/R may apply for Medical Assistance at numerous locations throughout the state. These include the local county DFCS office, Social Security Administration, health departments, and some hospitals and nursing homes. The A/R may apply online at www.gateway.ga.gov/. Applications are also available at local RSM Assistance Group offices. The A/R can use the Georgia Department of Community Health website (dch.georgia.gov/) to locate an application.

Anyone may apply for Medical Assistance benefits, including the following individuals:

The applicant/recipient (A/R) is the primary source of information for him/herself. The A/R may authorize an AREP to apply and provide information on his/her behalf, however the A/R is considered the best source of information and must be contacted to confirm that the information received is correct. This may be accomplished either by telephone, by mail, or in person, unless contact is precluded by physical or mental limitations of the A/R.

The A/R may withdraw, at any time, authorization for an AREP to act on his/her behalf. This request should be made in writing and signed by the A/R.

A complete application consists of a signed (either written or electronic such as on a Gateway application) application submitted with a name and information adequate to contact the applicant or AREP. A typed name on the signature line of a paper application is not acceptable. It is NOT necessary for the applicant to complete all questions, as missing or incomplete information may be obtained by telephone, by mail, fax, secure email, or in person. See Section 2060 - ABD Medicaid Application Processing and Section 2065 - Family Medicaid Application Processing for more program specific instructions.

An application received from the Federally Facilitated Marketplace (FFM) which has been assessed as potentially eligible for Medical Assistance should be processed based on the information provided in the application. Do not request additional or duplicate information that has already been obtained by the FFM.

Assist the AU as needed to complete the application form.

The application form may be completed by the applicant, an AREP, or an agency representative. An application must be accepted without prior screening or interview.

An individual has the right to file an application on the day of initial request for benefits. The agency will not refuse anyone the right to same day filing. The agency must inform the individual of the right to file an application on the same day s/he or his/her AREP contacts the agency in person, by telephone, mail, facsimile or secure email, expressing interest in obtaining assistance.

If an individual requests an application by mail, the right to same day filing is met if the application is mailed to the individual on the same day s/he makes the request to the agency.

“Right to Same Day Filing” affects the following:

The date of application is the date the application form is received by the county office, whether in person, or by mail. When received via internet or facsimile, the date of application is the date the form was transmitted.

An application must be registered within 24 hours of receipt by the agency.

Eligibility for Medical Assistance must be determined under all COAs before an application is denied. Refer to Section 2052 - Continuing Medicaid Determination (CMD).

Eligibility for Medicaid coverage for the three months prior to the month of application must be considered for every Medical Assistance application filed.

Completion of the application process is defined as notification to the applicant of the approval or denial of Medical Assistance benefits.

An individual may withdraw an application for Medical Assistance at any time during the application process. A withdrawn application must be registered and denied. The applicant must be notified of the disposition of the withdrawn application.

Refer to Section 2011 - Health Information Portability and Accountability Act for information regarding privacy of health information.

If an individual receives Medical Assistance, and it is determined that documents are inconsistent with pre-existing information, are counterfeit or altered, the Division of Family and Children Services shall investigate for potential fraud and abuse and refer to Georgia Department of Community Health, Office of Inspector General; in Metro Atlanta (404)463-7590, and statewide at (1-800-533-0686); by email oiganonymous@dch.ga.gov; by mail at Department of Community Health, OIG PI Section, 2 Martin Luther King Jr Drive SE, 19^th Floor, East Tower, Atlanta, GA 30334; or visit dch.georgia.gov/report-medicaidpeachcare-kids-fraud. Refer to (Section 2060 - ABD Medicaid Application Processing and Section 2065 - Family Medicaid Application Processing).