2700 Case Management Overview

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Case Management Overview

Effective Date:

May 2023

Chapter:

2700

Policy Number:

2700

Previous Policy Number(s):

MT 60

Updated or Reviewed in MT:

MT-69

Requirements

Case Management is the process by which the DFCS eligibility worker (EW) monitors the ongoing eligibility received by the ABD and Family Medicaid recipient. Case Management begins immediately following the approval of a Medicaid application and continues as long as the Assistance Unit (AU) remains eligible for Medicaid.

Basic Considerations

Case Management consists of the following components:

  • Notifications

  • Renewals

  • Changes

  • Alerts

  • Continuing Medicaid Determinations (CMDs)

  • Case Management Lists

  • Computer Matches

  • Hearings

Notification

An AU must receive proper notification of actions taken on his/her Medicaid case. Refer to 2701 Notification.

Renewal

A periodic renewal of eligibility is conducted to ensure that the recipient continues to be eligible for Medicaid under the correct Class of Assistance (COA). AUs are required to cooperate with the periodic renewal of eligibility. Refer to 2706 Medicaid Renewals.

Changes

AUs are required to report all changes, which may affect their eligibility. A change in resources, income or other circumstances reported by the recipient must be acted upon in a timely manner. Refer to 2708 ABD Medicaid Changes and 2712 Family Medicaid Changes Overview.

Alerts

The Gateway system generates Alerts, messages to the caseworker to take specific action on a case. Appropriate action should be taken on the Alert in a timely manner.

CMD

If an AU or an individual in an AU is determined ineligible at application or while receiving Medicaid, a Continuing Medicaid Determination (CMD) must be completed. The CMD process is used to explore eligibility for all other COAs before denying or terminating Medicaid. Refer to 2052 Continuing Medicaid Determination.

Case Management Lists

Periodic reports produced by DCH inform the EW of required case actions and aid in monitoring continued Medicaid eligibility for certain recipients. Refer to 2750 DCH Reports-Ex Parte Lists and 2752 DCH Presumptive Reports.

Computer Matches

Computer matches are generated by matching DFCS information with the information of other agencies, such as Georgia Department of Labor, the Social Security Administration and the Internal Revenue Service. These matches assist with verification of the recipient’s income and resources and act as an aid in detecting unreported income and resources.

Refer to 2001 Computer Matches Overview for additional information.

Hearings

The applicant or recipient (A/R) has the right to request a hearing on any decision made by DFCS or DCH affecting his/her Medicaid eligibility and/or patient liability/cost share. The EW has certain responsibilities in processing the request for a hearing. Refer to Appendix B, Hearings.