2853 Foster Care CMO Procedures

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Foster Care CMO Procedures

Effective Date:

January 2021

Chapter:

2800

Policy Number:

2853

Previous Policy Number(s):

MT 45

Updated or Reviewed in MT:

MT-63

Requirements

A child in placement qualifies for enrollment for medical assistance services provided to pay for eligible recipients to conserve state funds for children ineligible for medical assistance.

Basic Considerations

The Medical Assistance program provides funds to the state for the costs of providing medical services to Medicaid eligible recipients. DFCS should utilize these funds for services to children in placement in order to conserve state funds for those children who have been determined Medicaid ineligible.

Within 24 business hours of a child entering care, the Georgia Medicaid Management Information System (GAMMIS) shall be screened on the child to determine current Medicaid eligibility prior to any non-emergency medical services being obtained. This will avoid potential billing issues and use of county funds for otherwise Medicaid covered services.

Procedures

Screen each child entering foster care in the Georgia Medicaid Management Information System (GAMMIS) within one business day of child entering foster care.

Document all known information (i.e. demographic, removal, financial, etc.) on the required pages in Georgia SHINES within 24 hours of a child’s entry into foster care to generate the MA application.

The SSCM will sign, save and submit the Medicaid application in Georgia SHINES.

The SSCM will notify Amerigroup CMO, the Revenue Maximization (Rev Max) Medicaid unit, and the Georgia Department of Community Health (DCH) via the Amerigroup GA Families 360° DFCS Referral Form (E Form) within 24 hours of a child entering or exiting foster care.

Submission of the Amerigroup GA Families Referral Form does not constitute an application for Medical Assistance.

Notify Rev Max via the Notification of Change (NOC) in Georgia SHINES and include the child’s current legal status and placement information to allow Rev Max to transition the child to another Medicaid Class of Assistance when:

  1. A child in foster care turns 18.

  2. A child exits foster care.

Inform youth 18 and older exiting foster care to contact their assigned case manager to continue medical assistance and prevent case closure. Instruct youth to respond to Gateway application of former foster child status.

When a MA application is received by the Revenue Maximization Medicaid Unit, the unit will:

  • Remove the child from all pending or active benefit cases in the Gateway system and register a new Medicaid case, coding the Child in Placement page living arrangement as FC. This will generate the interface update to Dept. of Community Health.

  • The Medicaid Unit will assign the Gateway MA case to the appropriate regional Rev Max Unit for ongoing maintenance.

For children not active on Gateway, Revenue Maximization Medicaid Unit will:

  • Register a new Medicaid case coding the Child in Placement page living arrangement code as FC.

  • The MA application is processed for eligibility determination. Once completed, the case is assigned to the appropriate regional Rev Max unit for ongoing maintenance.

    Gateway will interface with DCH/GAMMIS within 24 to 48 hours removing the child from benefit cases and establishing foster care under age 18 Medicaid eligibility

  • The child will be enrolled in Amerigroup CMO

If a child does not meet Medicaid eligibility, the Gateway system will determine eligibility for enrollment in PeachCare for Kids® with the Gateway Child in Placement page completed with placement and living arrangement code.

For an SSI Child entering care, Rev Max Medicaid unit will follow above Gateway process coding the child’s living arrangement as FC. SSI recipients are exempt from CMO enrollment.

Child(ren) Leaving DFCS Custody

Once a child leaves DFCS custody, the following steps must be taken:

  • SSCM must notify the Rev Max RMS through a SHINES Notice of Change (NOC) of the change in custody

  • SSCM uploads the court order terminating DFCS custody into External Documentation

  • SSCM enters the new placement and address of the child in SHINES

  • RevMax completes a Continuing Medicaid Determination (CMD) for non- SSI children using the new information and changing the child’s living arrangement to AH in Gateway.

The child’s case is not closed but transferred out of Rev Max hard case ownership in Gateway to OFI.

If the child is aging out of care, the RevMax worker must CMD to Chafee Medicaid.