2160 Family Medicaid Overview | Medicaid

Family Medicaid provides Medicaid benefits for low-income families and individuals who are not receiving SSI and may or may not be receiving TANF. Benefits are provided through a variety of classes of assistance (COA’s), each with its own specific eligibility criteria.

Effective January 1, 2014, Family Medicaid will be comprised of two groups; the Modified Adjusted Gross Income (MAGI) COAs and the Non-MAGI COAs.

Family Medicaid Non-MAGI Assistance Units (AUs) include:

Family Medicaid MAGI AUs include:

Family Medicaid AUs must meet specific Basic Eligibility Criteria:

Each COA has different exceptions to the Basic Eligibility Criteria. Refer to Section 2200, Basic Eligibility Criteria and to each COA in this chapter.

A pregnant woman who is eligible for and receiving Medicaid under any Medicaid COA (except Q-track, P4HB or a suspended spend down) or SSI on the date the pregnancy terminates is eligible to continue to receive the 12-month extended postpartum period. The 12-month extended postpartum period count begins the month after the termination of pregnancy. Medicaid continues through the last day of the 12^th month.

Medicaid coverage under any Medicaid COA (except Q-track, P4HB or a suspended spend down) or SSI is continued for a pregnant woman who, after approval becomes financially ineligible solely because of new income or a change in income of any BG member. The pregnant woman remains eligible for Medicaid for the remainder of the pregnancy, including the 12-month extended postpartum period. Refer to 2720 Continuous Coverage For Pregnant Women.

Under certain conditions, Medicaid may cover services rendered to Medicaid-eligible Georgia residents who are out of state when medical services are provided. Procedures for qualifying for out-of-state coverage are found on the back of the Medicaid card.

Family Medicaid applications are accepted at the following sites:

Refer to 2050 Application Processing Overview.

The Medicaid application process begins with a request for assistance and ends with notification to the AU of the eligibility decision. Refer to 2050 Application Processing Overview for additional information.

A Continuing Medicaid Determination (CMD) is required before denying a Medicaid application or terminating Medicaid under the current COA. A CMD is the determination of Medicaid eligibility under all COA’s. Refer to 2050 Application Processing Overview and 2700 Case Management Overview for additional information.

At application and renewal, contact the A/R to inquire if any AU member is pregnant. If an AU member is pregnant, Gateway will send a follow-up contact with the pregnant woman during the month prior to the Estimated Delivery Date (EDD).