2137 Hospital | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Hospital

Effective Date:

February 2020

Chapter:

2100

Policy Number:

2137

Previous Policy Number(s):

MT 10

Updated or Reviewed in MT:

MT-58

Requirements

The Hospital Class of Assistance (COA) provides Medicaid for individuals who are hospitalized for at least 30 consecutive days. The period of confinement may include a combination of days in either a Medicaid participating or non-Medicaid participating institution.

Basic Considerations

To be eligible under Hospital COA, the A/R must meet the following conditions:

The A/R requests Medicaid due to a stay in a Medicaid participating hospital.
The A/R meets the Length of Stay (LOS) and Level of Care (LOC) basic eligibility criteria.
The A/R meets all other basic and financial eligibility criteria.

Procedures

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

Step 1

Accept the A/R’s Medicaid application.

Step 2

Obtain information required to complete the eligibility determination.

Step 3

Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). Refer to Chapter 2200, Basic Eligibility Criteria.

Step 4

Determine financial eligibility.

Refer to Chapter 2500, ABD Financial Responsibility and Budgeting for procedures on whose resources to consider and the resource limit to use in determining resource eligibility.
Complete a Medicaid CAP budget to determine income eligibility. Refer to Section 2510 Medicaid Cap Budgeting.

There is no patient liability or cost share under this COA.

Step 5

Approve Medicaid under the Hospital COA if the A/R meets all the above eligibility criteria.

Do not approve Medicaid under the Hospital COA for any month in which the A/R was not hospitalized for at least one day of the month.