2060 ABD Medicaid Application Processing | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

ABD Medicaid Application Processing

Effective Date:

December 2025

Chapter:

2050

Policy Number:

2060

Previous MT Number(s):

MT 73

Updated or Reviewed in MT:

MT-78

Requirements

The ABD Medicaid application process begins with the request for health coverage and ends with notification to the Assistance Unit (AU) of the eligibility status.

Basic Considerations

Order of Eligibility

Eligibility for ABD Medicaid Classes of Assistance (COA) is determined in the following order:

FBR COAs
LA-D/ Medicaid Cap COAs
Q-Track
ABD Medically Needy

QMB and SLMB may be approved while an eligibility determination for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families (TANF) or another Medical Assistance COA is pending. A member cannot be dually eligible for QI-1 and another COA with the exception of AMN Spenddown.

Application Requirements

An application for any ABD Medicaid COA may be processed from any of the following application documents:

Form 297 Application for TANF, SNAP, or Medical Assistance
Form 508 SNAP, TANF, Medical Assistance Renewal Form
Form 632 Presumptive Eligibility (PE) for Pregnancy
Form 632H Qualified Hospital Presumptive Eligibility Application
Form 632W Presumptive Eligibility (PE) Women’s Health Medicaid Application
Form 700 Application for Medicaid & Medicare Savings for Qualified Beneficiaries
Form 94 Medicaid Application
Form 94A Medicaid Streamlined Application
Federally Facilitated Marketplace (FFM) application (Obsolete as of 12/2024)
GA Access Application
Gateway Medical Assistance Online Application
Gateway Medical Assistance Renewal
Low Income Subsidy Application – SSA 1020B (LISA- application for Medicare Part D)
PeachCare for Kids® Application (Obsolete as of 09/2017)
Provider Portal Online Application
SSA Model Medicare Savings Plan (MSP) application
SUCCESS Application for Assistance (AFA) (Obsolete as of 09/2017)
Women’s Health Medicaid Review Form (Obsolete as of 12/2022)

A completed application consists of a signed (either written, not typed, or electronic such as via Gateway) application with information sufficient to contact the A/R or authorized representative (AREP). Refer to 2050-Application Processing Overview. The signature does not necessarily have to be that of the A/R. Any information that is missing, incomplete or otherwise unclear may be obtained from the A/R or AREP after the signed application is received and registered in the system by the agency.

A new signed application is required in the following situations:

When adding a program for an A/R who has been an ineligible spouse in an active AU and who is now requesting Medical Assistance for him or herself under a different COA from a recipient spouse.
An application was previously correctly denied due to failure to provide required verification. A/R wants to reapply in a subsequent month for ongoing benefits. Although the application date is protected, the A/R should sign another application unless there is good cause for not initially providing the verification.
An application was previously correctly denied due to not meeting a basic or financial eligibility criteria. A/R now meets these criteria and wants to reapply for ongoing benefits. Have the A/R complete and sign another application.

A new application is NOT required in the following situations:

If the system denies the application because the worker has not acted timely on the case
If the A/R is already a Medical Assistance recipient and is changing to another COA, a Continuing Medicaid Determination (CMD) is being completed or if an SSI recipient is entering a NH
If a current recipient is being added as a recipient to an existing AU, such as SSI added to Q-Track or Q-Track added to AMN
A non-applicant is added to an existing AU, even if the AU cascades to a lower COA or the spenddown amount is increased.

Homeless AUs are NOT required to provide a physical address but must provide sufficient information to establish Georgia residency. The applicant’s statement is acceptable unless conflicting information is known to the agency.

Procedures

Application Screening

Screen the application to determine the following:

current receipt of the benefits for which the A/R is applying
current receipt of other benefits available.

Interview Requirements

A face-to-face (FTF) interview is not a requirement for any Medicaid COA. At the caseworker’s discretion or the request of the A/R or AREP, a FTF interview may be scheduled; however, an application may not be denied for failure to appear for an interview.

A telephone interview is required for ABD LA-D COAs and Adult Medically Needy (AMN) COAs.

Caseworker will attempt to reach the A/R or AREP by conducting two unscheduled telephone attempts prior to scheduling an interview.

The A/R considered to be is the primary source of information for him or herself. The A/R may authorize an Authorized Representative (AREP) to apply, interview, and provide information on his or her behalf. An elected AREP may have verbal or written designation. If the designation is written, the applicant’s signature is required. If the designation is verbal, it must be documented. If the information is provided by an AREP is questionable or unclear, attempt to contact the A/R for clarification. This may be accomplished by telephone, mail, fax or in-person,

The A/R may withdraw, at any time, authorization of an AREP to act on his or her behalf. This request can be given verbally or in writing. If the request is given verbally, it must be documented. If the request is written, the applicant’s signature is required.

Information necessary to complete an eligibility determination may be obtained by any of the following methods:

FTF interview

A FTF interview may not be required of the applicant or AREP and an application may not be denied solely for failure to complete a FTF interview.

telephone call
mail
home visit
secure e-mail
Fax
Gateway

Orally or in writing, inform the A/R about the Medicaid program(s) for which he or she may be entitled. Provide relevant information pamphlets or other printed material.

Explain the following information to the A/R and/or AREP:

services provided by DFCS and how to obtain those services
requirements of eligibility and the A/R’s responsibility to provide correct information to establish eligibility and benefit level.
HIPAA and confidentiality
basic and financial eligibility requirements
Clearinghouse requirements for any AU/BG member
potential Medical Assistance COAs
potential coverage for three months prior to the month of application
periodic renewals
timely reporting of changes and how and where changes are to be reported
assignment of Third Party Liability (TPL)
Medically Needy requirements, if applicable
patient liability or cost share, if applicable
The applicant’s right to the following:
- a fair hearing. Refer to Appendix B - TOC for details
- a decision within the standard of promptness (SOP)
- confidentiality
- non-discrimination in the processing of the application
- their rights and responsibilities in the Medical Assistance program, included in the single streamlined application or Form 297A - Rights and Responsibilities.

Mandatory Forms

Complete the mandatory forms below when processing an ABD Medicaid application.

Application for Assistance (AFA) (Obsolete as of 09/2017)
Form 297A, Rights and Responsibilities (only if Form 297 is used to apply)

Form 5460 - Notice of Privacy Practices (HIPAA)

Form 5460 - Notice of Privacy Practices and Form 297A - Rights and Responsibilities may be mailed to the applicant. The applicant is NOT required to sign and return either form, provided the case record is documented that these forms were sent.

Form 216 - Declaration of Citizenship (conditionally mandatory, see Note below)

This form is not required if 94 (rev. 5/10 or later), Form 94A, 297, 508 (Rev. 5/12 or later), 700 (Rev.11/09 or later), Gateway Medical Assistance application, or FFM application are used as they contain the required language to meet the needs of the declaration.

Form DMA 285 - Third Party Liability Health Insurance Questionnaire, when the person has other health insurance coverage. See Section 2230 - Third Party Liability for requirements.

A Form DMA 285 - Third Party Liability Questionnaire is not required when application is made for QMB, SLMB, or QI-1 via Form 700. Send a copy of Form 700 to DCH/TPL in lieu of Form DMA 285 if the client has medical insurance. Attach a copy of the insurance card, front and back, if available.

Complete any other forms as necessary depending on the COA and the A/R’s circumstances.

Other Required Actions

Determine if the A/R meets all points of eligibility.

Complete mandatory clearinghouse requirements.

Follow appropriate documentation standards for ABD Medicaid.

Explore Medicaid eligibility for the three prior months.

Obtain required verification.

For LA-D A/Rs whose income exceeds the Medicaid Cap, provide the following as a handout to the A/R or AREP:

Standard of Promptness (SOP)

Eligibility should be processed as soon as all verification is received, this should take no longer than the following time frames:

45 calendar days beginning with the application date for aged or blind applicants.
90 calendar days beginning with the application date for disabled applicants whose disability that has not already been established by Disability Adjudication Section (DAS) for the Social Security Administration (SSA) or the State Medical Eligibility Unit (SMEU)
10 working days beginning with the application date for all Q-Track applicants.

The standard of promptness is 90 calendar days when a disability decision is required before the eligibility determination can be completed. However, if a separate disability decision is not required, the 45-calendar day standard of promptness applies.

If the 45 or 90-day SOP date falls on a weekend or holiday, complete the application by the last workday prior to the weekend or holiday.

Application Processing Standards

Observe the following standards in processing ABD applications:

Register the application within 24 hours of the agency’s receipt of the application.
If the A/R or AREP is not interviewed on the same day an institutional COA application is filed, contact the A/R or AREP within a reasonable timeframe to conduct the required telephone interview.
If the A/R or AREP is not interviewed on the same day a non-institutional COA application is filed, and additional information is required, contact the A/R or AREP within a reasonable timeframe.
If verification or additional information is required, complete a verification checklist and mail or provide to the A/R or AREP. Establish a reasonable deadline for returning the requested verification.
If the A/R or AREP fails to meet the deadline for providing additional information, attempt to contact the A/R or AREP to assess the need for an extension of the deadline or the possibility of assisting in obtaining required verification.

Do not deny an application for failure to provide verification if the verification can be obtained by the caseworker.
Contact the nursing home or appropriate case manager by the 30^th calendar day from the application date if the LOC instrument has not been received. Document and follow-up as necessary.
Deny an application at the first point ineligibility is established. Do not leave a case pending in anticipation of the A/R becoming eligible at a date beyond the ongoing benefit month.
Deny the application within two days of SOP if the nursing home or case manager has failed to submit the LOC instrument to the authorized approval source.

If the LOC approval source has received the LOC instrument but has not yet completed it, do not deny the application.
Do not deny an application solely because the 10^th, 45^th, or 90^th day has been reached, and eligibility cannot yet be determined.
Deny an application before the SOP if the A/R or AREP fails to cooperate in the application process or fails to supply necessary information that he or she is capable of obtaining and DFCS has no direct means of obtaining.

Disposition of the Application

Determine if the A/R meets all points of eligibility.

Process applications in chronological order, when possible, with the exception of Q-Track applications, based on the following:

date of application
whether all information is available to determine eligibility.

See Standard of Promptness (SOP) for SOP guidelines.

If eligible, approve the application ongoing and for any retroactive months, if appropriate.

Notification

Provide adequate notification to the A/R of the eligibility determination. A copy may also be sent to a AREP at the request of the A/R. Adequate notification includes the reason(s) for any action taken.

The notice must include the following:

the basis for the approval, denial, or termination
the period of eligibility
the reason for the action
the A/R’s right to request a fair hearing (Refer to Appendix B - Hearings TOC)
the telephone number of the DFCS Call Center
the telephone number of legal services
the amount of medical expenses required to meet the ABD Medically Needy spenddown, if the A/R meets all eligibility requirements other than income.
For LA-D cases in which a penalty is imposed: the duration of the penalty, the Form 411 - Undue Hardship Waiver Form Application and information that the A/R has 14 days in which to submit the form with supporting information to the caseworker.

See Section 2342 - Transfer of Assets and Appendix F:Forms - TOC for the form.

Period of Eligibility

Approve Medicaid and continue eligibility as long as the A/R continues to meet the requirements of the COA under which they are approved. A CMD must be completed prior to denial or termination of any Medicaid COA. Refer to Section 2052 - Continuing Medicaid Determination.

A COA that has been approved using EMA criteria does not require a CMD when terminated.

Property Search Requirements

Conduct a property search on required ABD Medicaid applicants for the following reasons:

to verify the value and status of all real property in which the A/R or deemor declare ownership interest.
to detect any undisclosed property in which the A/R or deemor may have ownership interest.
to detect and verify any transfer of real property affected by the A/R.

A property search must be completed if a questionable situation regarding ownership of property is discovered during the eligibility determination process.

If necessary, conduct a property search by checking the current tax digest and transfers for the past 60 months in the grantee/grantor book for the county in which the A/R resides or did reside prior to entering LA-D.

Chart 2060.1 – ABD Medicaid Property Search Requirements

If:	then a search of the TAX DIGEST is:	and a search of the GRANTEE/GRANTOR record is:
the COA is AMN	Not required, unless questionable	Not required, unless questionable
the COA is LA-D	Required	Required
the COA is a Public Law or SSI	Required	Not required, unless questionable
the COA is Q-Track only	Not required, unless questionable	Not required, unless questionable
the A/R has not lived in Georgia during the 24 months prior to the month of application	Not required	Not required, unless questionable

If:

then a search of the TAX DIGEST is:

and a search of the GRANTEE/GRANTOR record is:

the COA is AMN

Not required, unless questionable

the COA is LA-D

Required

the COA is a Public Law or SSI

Required

Not required, unless questionable

the COA is Q-Track only

Not required, unless questionable

the A/R has not lived in Georgia during the 24 months prior to the month of application

Not required

Not required, unless questionable

Out of County Property Search

Request assistance in completing a property search from the DFCS office in another county where the client may have resided for a substantial period of time before moving to the current county of residence using Form 991 - MAO Property Search Record. Review the exceptions to property search requirements to determine the necessity for a property search.

Special Considerations

Special Considerations for SSI Applicants

The Social Security Administration (SSA) accepts and processes applications for Supplemental Security Income (SSI) at local SSA offices. Any individual applying for ABD Medicaid at DFCS who appears to be financially eligible for SSI should be referred to the local SSA office to file an application. DFCS will also accept the ABD application for a Medicaid determination and begin the SMEU process. An exception to this may be QMB in some situations.

SSI applicants have the right to have any month for which they have been determined ineligible for an SSI payment for a reason other than failure to meet the disability criteria examined for eligibility under ABD Medicaid. Refer to Section 2053 - Retroactive Medicaid.

DFCS is responsible for determining Medicaid eligibility on SSI applicants in the following circumstances:

the three months prior to the month of SSI application for SSI approvals and denials
months associated with an SSI application for which the applicant is ineligible for an SSI payment for a reason other than failure to meet disability
if an individual is alleging a disability regardless of SSI application status.

An SSI applicant who wants a determination of ABD Medicaid eligibility for months associated with a denied SSI application for reasons other than disability or prior months should contact DFCS to apply for that period of time. The prior months are protected indefinitely until such time as an eligibility determination has been made.

Refer to Section 2053 - Retroactive Medicaid, for processing procedures for retroactive months associated with an SSI application.

Chart 2060.2 - ABD MEDICAL ASSISTANCE FORM REQUIREMENTS

Form 216 - Declaration of Citizenship/Immigration status is not required if the A/R has declared their citizenship or immigration status on the eligibility application (94, 94A, 297, 508, 700 or via Gateway Customer Portal application) and signed application under penalty of perjury. Also, declaration of citizenship/immigration status/identity is not required if the A/R is determined under EMA procedures. Refer to Section 2215 - Citizenship/Immigration/Identity.