2101 ABD Medicaid Classes of Assistance Overview

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

ABD Medicaid Classes of Assistance Overview

Effective Date:

November 2023

Chapter:

2100

Policy Number:

2101

Previous Policy Number(s):

MT 58

Updated or Reviewed in MT:

MT-71

Requirements

An individual must meet the requirements specified under a particular class of assistance (COA) in order to be determined eligible for ABD Medicaid.

Basic Considerations

ABD Medicaid COAs are divided into the following two types:

  • FBR (Federal Benefit Rate) – COAs that use the SSI FBR to determine income eligibility.

  • Non FBR – COAs that use an income limit other than the FBR to determine income eligibility.

The FBR COAs consist of the following:

  • SSI Medicaid

  • Pickle (PL 94-566)

  • Disabled Adult Child (PL 99-643)

  • Disabled Widow(er) Age 50-64

  • Widow(er) 60-64 (PL 100-203)

  • Widow(er) 1983 (PL 99-272) (No longer approve these COAs)

  • Protected Medicaid 1972 (PL 92-603) (No longer approve these COAs)

  • Former SSI Disabled Child

The Non-FBR COAs consist of the following:

  • Elderly and Disabled Waiver Program (EDWP) formerly known as Community Care Services Program (CCSP)

  • New Options Waiver (NOW)

  • Comprehensive Supports Waiver Program (COMP)

  • TEFRA/Katie Beckett

  • Hospice

  • Hospital

  • Independent Care Waiver Program (ICWP)

  • Nursing Home (NH)

  • ABD Medically Needy (AMN)

  • Qualified Disabled Working Individuals (QDWI)

  • Q Track:

    • Qualified Medicare Beneficiary (QMB)

    • Specified Low-Income Medicare Beneficiary (SLMB)

    • Qualifying Individual 1 (QI-1)

      QMB eligibility for persons receiving SSI is discussed in 2143 Qualified Medicare Beneficiaries.

Refer to Chapter 2050, Application Processing, for a discussion of other Medicaid coverage, including the following:

Refer to Chapter 2900, Referrals, for other sources of medical assistance.

Procedures

Follow the steps below to determine ABD Medicaid eligibility under a specific COA.

Step 1

Accept the individual’s ABD Medicaid application and register the application on the system.
Step 2

Screen each A/R to determine potential SSI eligibility, Family Medicaid, PeachCare for Kids® and/or TANF eligibility.

  • Refer to Chapter 2500, ABD Financial Responsibility and Budgeting, to determine which SSI trial budget to complete (Individual, Couple or Spouse to Spouse Deeming).

  • Use the FBR as the income limit when completing the SSI trial budget.
Step 3

Refer the A/R to the appropriate worker if the A/R appears to be eligible for Family Medicaid and/or TANF and wishes to file an application for either.

The A/R’s application for assistance is protected indefinitely.

Refer the A/R to SSA to file an SSI application if his/her Federal Countable Income (FCI) is less than the appropriate Federal Benefit Rate (FBR) unless one of the following situations exist:

  • The A/R requests coverage for any of the 3 months prior to the SSI or ABD Medicaid Application Month.

  • The A/R is ineligible due to the deemed income or resources of his/her spouse or parents.

  • The A/R dies prior to applying for SSI.

  • The A/R is ineligible for Family Medicaid/SSI due to excess resources.

  • The A/R has Medicare or other insurance that is expected to pay (or pays) more than 50% of medical expenses, and the A/R is in a public or private hospital or nursing home.
Step 4

Obtain information necessary to process application. Request verification, if necessary.
Step 5

Determine the COA most advantageous to the A/R.

Explain the advantages of each COA if the A/R is potentially eligible under more than one COA and allow the A/R to choose the COA.
Step 6

Determine basic eligibility. Refer to Chapter 2200, Basic Eligibility Criteria.
Step 7

Determine financial eligibility. Refer to PROCEDURES under the specific section on each COA.
Step 8

If the A/R is eligible under the COA currently being used to determine eligibility, approve ABD Medicaid on the system.

If the A/R is ineligible under the COA currently being used to determine eligibility, complete a CMD. Refer to 2052 Continuing Medicaid Determination.