2066 Placement Outside The Home | Medicaid
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Georgia Division of Family and Children Services |
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Policy Title: |
Placement Outside The Home |
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Effective Date: |
December 2019 |
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Chapter: |
2050 |
Policy Number: |
2066 |
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Previous Policy Number(s): |
MT 51 |
Updated or Reviewed in MT: |
MT-57 |
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Requirements
An individual living in a placement outside the home may, under certain circumstances, be eligible for Family or ABD Medicaid.
Basic Considerations
Who May be Eligible
An individual is potentially eligible for Medicaid if any one of the following situations exist:
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an individual admitted to a medical institution to receive medical care
An individual incarcerated or placed in a detention facility who is admitted to a medical treatment facility is considered a resident of the detention facility and is therefore ineligible for Medicaid. -
an individual in a private community facility such as a homeless shelter or a shelter for victims of domestic violence
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a child in a private child care institution that provides 24-hour non-secure custodial care, such as a children’s home
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a child in a family licensed home supervised by the Department of Juvenile Justice (DJJ)
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an child in a private licensed group home
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a child in a family foster home approved by one of the following agencies:
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DFCS
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Child Services and Family Counseling
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The United Methodist Children’s Home
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The Georgia Baptist Children’s Home (Palmetto Campus)
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DJJ (as contract home or attention home)
Social Services verifies that a placement has been made in an approved facility.
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an individual in a licensed emergency shelter
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a child placed in any other public or private agency, which DFCS approves for placement.
Public Institution
For Medicaid eligibility purposes, the following placement facilities are not considered public institutions:
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public educational or vocational training institution
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publicly operated general hospital
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publicly operated nursing home
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publicly operated community residence or group home that serves no more than 16 individuals
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public child care institution that accommodates no more than 25 children and the child is approved to receive Title IV-E foster care payments
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an intermediate care facility for the mentally disabled (nursing home unit), even if located on the premises of a public institution
| Normally Medicaid is not approved for individuals residing in public institutions, such as Georgia Regional Hospital. However, some of these institutions have Medicaid participating nursing homes associated with them. If a level of care instrument is received from one of these facilities, proceed with the Medicaid eligibility determination. |
Who is Ineligible
An individual is ineligible for Medicaid if any of the following situations exist:
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the individual is incarcerated in a jail, prison or other facility operated primarily for detention
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a child is placed in a detention facility, such as a Youth Development Campus (YDC)
A child placed temporarily in a Regional Youth Detention Center (RYDC) or YDC while awaiting transfer to a private facility may be eligible for Medicaid. -
the individual is placed in a public institution
If the placement in the public institution is temporary while awaiting a private placement more appropriate to the needs of the individual, the individual is potentially eligible for Medicaid. (See NOTE above.) -
the individual is legally committed to an institution, whether public or private
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the individual is placed in an institution operated for the treatment of tuberculosis
Individual Placed Out-of-State
An individual placed by a state agency in an out-of-state institution or licensed foster care facility is considered a legal resident of the state making the placement.
The state of origin is responsible for the medical expenses of the child.
| If the individual is a IV-E eligible child and IV-E payments are made, the child can be approved for Medicaid in the state where the child is placed. Refer to Chapter 2800 for IV-E Foster Care/Adoption Assistance policy. |
The placement facility may locate a local doctor, dentist or other medical provider who will enroll as a Medicaid provider in the state of origin.
| If no providers are willing to enroll for the other state’s Medicaid, notify the state office Medicaid Policy Unit. |
Private Placement of a Child
A child placed by a parent or other responsible adult in a private placement facility or LA-D may be eligible for Family or ABD Medicaid.
For Family Medicaid, the child placed in a private childcare (residential) institution is considered as an AU of one (1) and no longer in the home of the family. A child placed in a psychiatric hospital by a parent or other caretaker relative would be considered absent from the home for treatment or training and would not be considered as an AU of one (1).
Refer to Chapter 2600, Family Medicaid AUs and BGs.
| For FM, budget any money received by the facility for the child. If the parents provide money, it is considered child support and the $50 child support deduction is allowed. If another responsible adult provides money, it is considered a contribution. |
For ABD Medicaid, see Section 2225, Residency for determining state of residence.
Use the following chart of situations to determine if an individual is potentially eligible for Medicaid based on current living arrangement outside the home:
| Situation | Medicaid Eligibility | ||
|---|---|---|---|
If the individual is placed in: |
Then s/he is Medicaid |
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a public institution
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ineligible eligible |
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a public childcare institution that accommodates no more than 25 children and the child is receiving Title IV-E foster care payments |
eligible |
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a publicly operated community residence or group living home that serves no more than 16 individuals (example: residential drug treatment center operated by the Mental Health Division of DHS) |
eligible |
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a public educational or vocational training institution |
eligible |
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a publicly operated general hospital |
eligible |
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a publicly operated nursing home or hospice provider |
eligible |
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a Regional Youth Detention Center operated by DJJ |
eligible |
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a prison, jail or other incarceration facility operated primarily for detention |
ineligible |
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a Youth Development Campus
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ineligible eligible |
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a public or private placement of legal commitment through court proceedings |
ineligible |
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an institution operated for the treatment of mental diseases or tuberculosis |
ineligible |
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a medical institution to receive medical care, such as a hospital |
eligible |
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a private community facility such as a battered women’s or homeless shelter |
eligible |
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an intermediate care facility for the mentally retarded (nursing home unit) even if located on the premises of a public institution |
eligible |
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a private licensed group home or personal care home licensed as a CCSP provider |
eligible |
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a private child care institution that provides 24-hour non-secure custodial care, such as a children’s home
|
eligible |
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an attention home operated by the DJJ |
eligible |
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a contract home operated by the DJJ |
eligible |
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a family foster home approved by DFCS or DJJ, Families First, Inc., United Methodist Children’s Home, Georgia Baptist Children’s Home (Palmetto) can use any other public or private agency which DFCS may approve for placement |
eligible |
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a licensed private emergency shelter |
eligible |
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an institution or foster care home in the state of Georgia placed by another state’s agency
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ineligible eligible |
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Outdoor therapeutic program/outdoor therapeutic residential wilderness program. |
eligible |