2750 DCH Reports-Ex Parte Lists | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

DCH Reports-Ex Parte Lists

Effective Date:

December 2025

Chapter:

2700

Policy Number:

2750

Previous MT Number(s):

MT 74

Updated or Reviewed in MT:

MT 78

Requirements

Monthly reports are generated by the Department of Community Health (DCH) or DCH’s contract entity and are transmitted by Gainwell Technologies to Gateway. Eligibility determinations are completed by the Department of Family and Children Services (DFCS).

Basic Considerations

As part of the Continuing Medicaid Determination (CMD) process for selected A/Rs whose SSI benefits are terminated or denied, DCH makes temporary determinations of continued eligibility under a new Ex Parte Medicaid Class of Assistance. Four reports listing these individuals are generated and are accessible via Gateway.

The reports are as follows:

MAEXP_001_MLY_MONTHLY_SSI_EXPARTE_DETERMINATION_LIST

Monthly report generated on the 2^nd business day of the month. Report lists individuals received in the Inbound Ex Parte file for the month.

MAEXP_003_MLY_MONTHLY_DISPOSITIONED_EXPARTE_REPORT

Monthly report generated on the 2^nd business day of the month. Report includes all clients that were processed and authorized as part of the Ex Parte automation and will include all clients approved or denied by Caseworker the prior month.

MAEXP_004_DLY_DAILY_PENDING_EXPARTE_REPORT

Daily report that is run Monday-Friday. Report includes all clients that were received in Inbound Ex Parte file from GAMMIS that have not been disposed. This includes clients that a verification checklist has been sent requesting more information. The report may show same client multiple times if received during different months. The client received date will be different.

MAEXP_002_MLY_MONTHLY_SSI_EXPARTE_EXCEPTION_REPORT

Monthly report generated on the 2^nd business day of the month. Report includes all individuals received on the Inbound Ex Parte file from GAMMIS, but Gateway was unable to automate the application registration for the client. This report is reviewed by designated staff.

Procedures

Effective 09/01/2020, enhancements to Gateway and GAMMIS were made to automate the Ex Parte eligibility determination process. If Gateway is unable to automate the registration of an Ex parte A/R received on the monthly file, then the A/R will be placed on an Exceptions report and reviewed by designated staff.

Automated Process

As part of the automated process, Gateway receives a monthly file from GAMMIS. This file includes all new SSI Ex Parte determinations made by DCH for the prior month resulting in eligibility for Aged, Blind, and Disabled (ABD) COAs or MAGI Family Medicaid COA. This includes terminations from SSI. Gateway then automates the application registration, using then-current registration and association rules.

Determining Eligibility

Caseworker should use all available information, including interfaces (SDX, BENDEX, SOLQ, Truv, DOL, Vital Records, FD$H, $TARS, Ex Parte), related case information to determine eligibility for an appropriate COA. The appropriate COA may be the COA specified by the Ex Parte report or one that provides a higher level of coverage.

If necessary, the caseworker should contact the client to obtain missing or clarify unclear information. If there is not enough information to make a determination or the information cannot be obtained by telephone call, send the following items to the client, giving an appropriate due date for return:

NOTES:

Do not assume Citizenship/Immigration status; it must be verified.
In the absence of evidence to the contrary, assume all other eligibility criteria have been met and that SSA has determined there has been no transfer of assets. IF SSI was terminated due to resources, obtain additional information about current resources.
Assume SSA has forwarded TPL information to DCH
For Ex Parte ABD COAs, do not assume Medicare eligibility; it must be verified.
Prior receipt of SSI is prima facie evidence of disability for 12 months from the SSI termination date unless SSI was terminated for failure to meet disability criteria.
For Public Law COAs, determine COLA and entitlement to or increases in RSDI based on SDX/BENDEX, using the best estimate possible.
For Waiver COAs Aid Category 449 or category code “Waivered Services”, use Ex Parte Interface which provides PA begin and PA end dates needed. Additional LOC and Communicator are not required. Process as EDWP, NOW/COMP or ICWP based on PA information on report.
When the Ex Parte interface indicates GAPP, determine eligibility for Medicare as an Ex Parte individual as usual. If the resulting COA is PeachCare for Kids® or Medical Assistance is denied or closed for any month(s) in the authorization period, caseworkers will NOT be able to authorize because PeachCare of Kids® enrollees are not eligible for received GAPP services. A referral will be made to the Katie Beckett Unit.
- If the individual is eligible for Katie Beckett, then eligibility will be authorized.
- If the individual is NOT eligible for Katie Beckett, the PeachCare for Kids® approval or Medicaid denial/closure will then be authorized.
Refer children who meet the following criteria to for Katie Beckett consideration:
- 19 years old and younger AND
- Who do not qualify for another Medical Assistance COA AND
- Who appear to meet Katie Beckett eligibility

Do not refer to Katie Beckett if Social Security Administration (SSA) interfacing indicates the child was denied Supplemental Security Income (SSI) or terminated from SSI due to being “not disabled.”

A complete redetermination of eligibility must be completed on all cases when a change is reported, or within 12 months after the SSI termination, whichever comes first. Contact with the individual may be required to complete this process.

Other Considerations

SOP

Approve or deny the case within 10 days of receipt of the file.

Reviewing Eligibility

A complete redetermination of eligibility must be completed on all cases when a change is reported or within 12 months after the SSI termination, whichever comes first. Contact with the individual may be required to complete this process.

Continued SSI Eligibility

For individuals that are currently receiving SSI, no action is required.

Documentation

All actions taken on an Ex Parte case must be documented in a case note. Follow all current documentation standards

Notification

Upon completion of case and task disposition, Gateway will notify GAMMIS of A/R’s approval or denial through daily interface files sent from Gateway to GAMMIS.

For Spenddown Cases: The system generated notice, which includes Medicaid eligibility information, replaces Form 962. Complete a Form 962 only if eligibility cannot be entered in the system, such as a three-month prior application that is greater than thirteen months old.

Eligible in GAMMIS, But Not on Ex Parte List

At times an individual may become known to DFCS who is showing in an Ex Parte category on GAMMIS but has never appeared on an Ex Parte list. Treat these individuals as Ex Parte individuals by either registering an application or by updating an existing case.

If the A/R is eligible for full Medicaid, approve in Gateway as soon as possible.

If the A/R is not eligible for full Medicaid, such as AMN or Q-Track, approve on Gateway beginning with the first month following the end date reflected from DCH.