2069 Express Lane Eligibility | Medicaid

Children (newborn through the month a child turns 19) who are active and receiving benefits on a SNAP or TANF case can have Medicaid or PCK eligibility determined according to ELE criteria as set forth in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. The Division of Family and Children Services (DFCS) agency will utilize information collected when an application/renewal/change (including ELE opt in statement) is completed by SNAP or TANF eligibility workers for services to determine eligibility. This data includes, but is not limited to all demographic data, proof of income, and household size.

If a SNAP or TANF application/renewal/change is received for a child younger than 19 years old, information provided by the family on that application/renewal/change or otherwise collected for the SNAP or TANF eligibility determination is used by the DFCS agency to determine most factors of Medicaid/PCK eligibility. During eligibility determinations, the DFCS agency will advise SNAP or TANF applicants/recipients that the information provided for the SNAP or TANF application/renewal/change will be shared with the DFCS agency for determining the children’s Medicaid/PCK eligibility, unless the individual chooses to opt-out on the initial application/renewal/change document or verbally during the SNAP or TANF interview. A separate Medicaid or PCK application is not required.

DFCS must obtain consent from the child’s parent, guardian, or custodial relative agreeing to the ELE determination for the children’s potential Medical Assistance eligibility. The consent can be obtained verbally, electronically, or written (consent received from application).

DFCS should ensure that the child is not already enrolled in Medicaid (including SSI), PCK, or Medicare prior to an ELE determination. If a child(ren) under 19 Medical Assistance application is received and there is no active SNAP or TANF case, then an ELE determination cannot be completed.

The DFCS agency will use the SNAP or TANF income findings, calculated based on the specific program’s eligibility policies (income exclusions, disregards, household composition, deeming, etc.) to determine income eligibility for Medicaid/PCK. DFCS will use other information collected by the SNAP or TANF program on the application/renewal or through its verification processes to determine most other factors of Medicaid/PCK eligibility (e.g., verification of citizenship, State residency). Any SNAP or TANF eligible children that meet the specific program’s citizenship requirements, must also meet Medicaid/PCK citizenship requirements. A Reasonable Opportunity Period (ROP) for citizenship is allowed for ELE determinations. Refer to Section 2215-Citizenship/Immigration/Identity.

For Medicaid/PCK ELE determinations, DFCS should compare household income to the highest Medicaid income applicable to a child (0-19) which will be equal to 235% FPL. If household income is over 235% FPL but at or below 247% FPL, the child should be evaluated for ELE-PCK.

If a child is found eligible for PCK from the ELE determination, DFCS must provide notice that the child may qualify for Medicaid and/or lower premiums if evaluated using the regular eligibility determination and provide an avenue on how to request a full eligibility determination. A separate application is not required. Refer to 2194 PeachCare for Kids® for ELE PCK premium amounts.

If the child’s Medicaid or PCK eligibility cannot be determined based on the processes used for ELE (e.g., the child is over income for PCK using the “Express Lane” agency’s income finding), a full eligibility determination must be conducted using the regular Medicaid/PCK processes. The income findings from the “Express Lane agency” should not be used, and additional information or verification should be requested from the family as necessary.

If a full determination is conducted based on a request or denial for any potential ELE applicant, the application is no longer considered ELE.

For ELE applications, retroactive months requested should follow the regular eligibility determination process.

It is the expectation that the ELE determination will be completed at the same time as the SNAP or TANF application/renewal but no longer than 45 days from the date ELE was requested.

If there is an already active SNAP or TANF case with a child younger than 19 years old and the client would like to opt in the ELE process to have Medicaid or PCK eligibility determined according to ELE criteria, the client can complete the opt-in statement and drop off at their local DFCS office or upload online at www.gateway.ga.gov at any time.

If the client has an approved ELE determination and would like to opt out of the ELE process and have a full Medical Assistance determination made, the client can call the DFCS call center at 1-877-423-4746 or complete the opt-out statement and drop off at their local DFCS office or upload online at www.gateway.ga.gov at any time.