Georgia Division of Family and Children Services |
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Policy Title: |
Appendix G TOC: Medicaid Manual Transmittal Cover Letters |
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Effective Date: |
June 2025 |
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Chapter: |
Appendix G |
Policy Number: |
Appendix G TOC |
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Previous Policy Number(s): |
MT 73 |
Updated or Reviewed in MT: |
MT 74 |
Appendix G: Medicaid Manual Transmittal Cover Letters
Select the MT Number below to view the detailed cover letter.
MT Number | Date | Subject |
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06/01/2025 |
Updated: 2004 - Clearinghouse. 2065 - FM Application Processing. 2069 - Express Lane Eligibility. 2143 - QMB. 2144 - SLMB. 2145 - QI-1. 2166 - TMA. 2198 - WHM. 2195 Pathways. 2215 - Citizenship/Immigration/Identity. 2256 - Pathways QA. 2405 - Treatment of Income. 2407 - QIT. 2552 - Diversion of Income. 2750 - Ex Parte. Appendices A1 & A2 & B & F & G & H. Added TOC for A1 & A2 & B & G & H. Appendix F: Forms. |
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8/16/2024 |
Updated 2050 Application Processing Overview; 2051 Verification; 2230 Third Party Liability: 2415 Self-Employment; 2706 Medicaid Renewals; 2060 ABD Medicaid Application Processing; 2316 Homeplace ABD Medicaid; 2336 Trust Property Medicaid Qualifying; 2337 Trust Property-OBRA ’93; 2338 Trust Property; 2346 Special Needs Trust; 2407 Qualified Income Trust; 2708 ABD Medicaid Change; 2065 Family Medicaid Application Processing; 2166 Transitional Medical Assistance (TMA; 2194 PeachCare for Kids; 2610 MAGI Budget Groups/Assistance Units; 2655 Family Medicaid Deductions; 2712 Family Medicaid Changes Overview; 2715 Family Medicaid Changes In Income; 2716 Family Medicaid Miscellaneous Changes; 2840 IV-E Budgeting; Appendix F – Forms: 6Ai; 7; 285i; 298Q; 942i; 957; 962i; 981; 992; ABD CAR Reduction Request; Community Care Communicator. Added Spanish translations: 109SP; 216SP;217SP; 218SP; 219SP; 328SP; 411SP; 512SP; 937SP; 945SP; 946SP; 955SP; 988SP. Table of Contents (TOC)-Adding to PAMMS; Replacing ODIS hyperlinks with PAMMS hyperlinks; Removed Instructions column; standalone instructions are listed on a separate line. OSAH form 1 MA; 6A – LOC; 89; 118; 124; 125; 214; 306; 403; 526; 701; 942; 947; 948; 949; 956; 960; 966; 967; 970; 984; 985; 986; 987; 991; 998; 2337; 5460; GMWD Disabilities Fact Sheet; WHM PST. |
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7/10/2024 |
2060 ABD Application Processing; 2132 NOW/COMP; 2133 Katie Beckett/Deeming Waiver; 2139 ICWP; 2149 GMWD; 2150 AMN; 2067 Presumptive Eligibility Medical Assistance; 2399 Treatment of Resources Chart; 2706 Medicaid Renewals; Appendix A1 (ABD Financial Limits ; Appendix A2 (Family Medicaid Financial Limits) ; Appendix B Hearings; Appendix E Glossary: Appendix F Forms – all forms formatting has been updated. 106;107; 109; 129; 174; 184; 216; 217; 218; 219; 245; 328; 411; 512; 936; 937; 942; 943; 944; 945; 946; 954; 955; 958; 988. |
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11/01/2023 |
Updated 60-day SOP to 90 in 2054 and 2060. Updated RSDI Disability and SSI verbiage in 2060-2150-2205-and 2210. Updated immigration status verbiage for pregnant women and children under 19 in 2215. Updated DCH addresses in 2135-2230-2903-2905-2947. Updated Medicare-citizenship and conditional enrollment verbiage in 2143. Updated 60 day postpartum to 12th month extended postpartum. |
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7/01/2023 |
Added Pathways policy section 2195 and Qualifying Activity Reporting policy section 2256. Added revised English 297-94A-94A Attachments A-B-C-and new 94A Attachment D Pathways Contract. Updated A1 2023 ABD income limits andA2 2023 with Pathways income limits. |
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5/01/2023 |
Updated formatting and grammar. Updated Appendix H Children in Placement Car Guide and Reading Guide. Added2023 Family Medicaid income limits. Updated SMEU automation process in 2205. Removed 2718 PeachCare for Kids® Rebounds from MAN3480 TOC. Added English andSpanish revision for Forms 94-94A-297-297A-700-and 508-Notification of Eligibility-EMA-WHM Physician’s Statement-and added new Form 239M in Appendix F. |
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12/1/2022 |
Updated note in 2054. Updated Postpartum verbiage to 12- months in 2054 & 2160 & 2184 & 2720. Updated Ex Parte verbiage in 2750. Updated process of Former SSI-Disabled Child in 2116. Updated wording to EDWP in 2131. Updated QMB section 2143. Updated Excess Home Limit in 2316. Updated Medicare Buy-in email address in 2756. Added clarification for LTC IME in 2555. Updated EPSDT/Health check referral information in 2930. Updated Appendix F- Removed Forms 95 and 95S and added new revision Form 124 page 3. Added new Form 184 page 4. Removed Form 188 page 5. Added new revision Form 245 page 6. Removed Form 1008 and added new revisions Form 5460 HIPAA English and Spanish page 11. Updated DHS hyperlink from Form G-845-S and removed CCSP LOC page 12. Removed CCSP Communicator page 13. Added new revision Medicare Buy- In Problem Template and removed Ex Parte Qtrack and RSM Lists page 14. |
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10/01/2022 |
2050 2 Updated hyperlink page 2; added fax and secure email as acceptable inquiry format and secure email as acceptable verification format page 2. 2051 1-8 and 5 Updated grammar and formatting pages 1-8 and removed previous highlight from verbiage page 5. 2067 2-5 Updated grammar and formatting pages 2-5; updated process verbiage in Note found on page 2 and updated Note regarding pregnant women applications on page 4. 2069 1-5 Added new policy section 2069 Express Lane Eligibility (ELE). 2194 1-3 Added ELE PCK FPL page 1 and ELE PCK premium amounts page 2 and updated RSM address page 3. |
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8/01/2022 |
Replaced form 94 and 94SP; added Large Print 94 and 94S; replaced 94A and 94A SP; and added Large Print 94A and 94A SP; replaced form 297 and 297SP; added Large Print 297 and 297SP; replaced form 297A and 297A SP; added Large Print 297A and 297A SP; replaced form 508 and 508SP; added Large Print 508 and 508SP; replaced form 700 and 700SP; added Large Print 700 and 700SP. Added Large Print versions of Attachments A and B and C for the form 94A in both English and Spanish. Corrected 297M SP revision date from 3/12 to 1/14. |
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7/01/2022 |
2184 All Replaced 60-day PW transition verbiage with 180- day PW transition verbiage; 2220 45754 Updated section format and grammar; 2306 1 Updated hyperlink; 2308 45753 Updated section format and grammar; 2309 1 Updated hyperlink; 2310 1 Updated grammar; 2311 2-3&5 Updated format and added verbiage to clarify item under burial space items for endowment/perpetual care page 2; 2313 All Updated format; 2316 1-2&4 Updated format and added 2022 Excess Home Equity Limit page 2; 2318 45720 Updated format and reworded countable resource statement on page 4; 2319 2 Updated format; 2320 1&2-4 Updated hyperlink. Updated Interstate to Intestacy on pages 2-4; 2322 2 Updated format; 2323 1-2&4 Updated format; 2324 1 Added Footer; 2325 1 Updated hyperlink and added printed patient fund account statement as verification type; 2327 All Updated format and grammar |
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6/07/2021 |
Updated format- added new Medicaid Buy-in Form and added 2021 ABD & Family Medicaid Income limits. |
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1/31/2021 |
Updated format and provided policy clarifications for sections 2845-2890 regarding Children in Placement-also clarifications to sections 2186 and 2610. Updates made to 2198 regarding DCH email contact. |
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11/30/2020 |
Updated format and provided policy clarifications for sections 2801-2840 regarding Children in Placement-also corrected the Non-Discrimination link on forms 297- 297SP- 297A- 297A SP- 508 and 508SP. |
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8/10/2020 |
Updated forms 297- 297SP- 297A- 297A SP- 508 and 508SP. |
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6/30/2020 |
Updated format and provided policy clarifications for Family Medicaid Budgeting- Case Management and Referrals sections- added the 2019 threshold amounts for MAGI budgeting. |
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4/30/2020 |
2020 ABD and Family Medicaid Income Limits added-updated 2020 Excess Home Equity Limit and format for various policy sections. |
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2/28/2020 |
Updated PNA amount- policy format for select sections and provided clarification regarding self-employment income for MAGI recipients and IRS BEERs Procedural changes regarding the Medicaid Program. |
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12/31/2019 |
Updated policy format for Manual 3480 for select sections-updated MAGI budgeting policy and provided clarifications issues by DCH regarding SOP for disabled applications and retroactive coverage for Medicaid. |
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7/31/2019 |
Updated TPL- PNA amount and State Supplement amount. |
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5/31/2019 |
2019 ABD and Family Medicaid Income Limits- Updated new TPL requirements- steps on how disability is determined for KB children and clarified existing TMA ineligibility for new household members. |
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2/18/2019 |
Updated policy regarding DOC signatures for adults-updated Medicaid references to Medical Assistance when appropriate- added policy regarding GA STABLE Accounts. Updated PCK and P4HB sections to align with MAGI Policy and updated the 2017 and 2018 tax threshold amounts along with the 2018 and 2019 Excess Home Equity limit amounts. |
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7/03/2018 |
Corrected ABD Limits for 2017 and 2018- updated forms for 94A and 94A SP- WHM Physician Statement of Treatment form- and instructions for form 962. Appendix C corrections to align with current procedures. |
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5/02/2018 |
2018 ABD and Family Medicaid Income Limits- Updated requirements in KB regarding Psychological evaluations-how GMCF sends initial vs final denial/approval letters and updated note regarding LOC end date. Updated KB forms. Removed resources from list of determining an IME and updated DCH query contact person regarding Medical Expense. |
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5/01/2017 |
2017 ABD and Family Medicaid Income Limits- updated citizenship verification requirements- update to QI1 budgeting- and added PDF fillable 245 and instructions-adding of transgendered women to list of eligibility conditions for Women’s Health Medicaid. |
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5/01/2016 |
2016 ABD and Family Medicaid Income Limits- updated tax filing income thresholds- updated Exceptional Transportation contact information |
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5/01/2015 |
2015 ABD and Family Medicaid Income Limits- updated definition of SSI intervening months- addition of Documentation Standards |
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5/01/2014 |
2014 ABD and Family Medicaid Income Limits- updated renewal procedures including Administrative Renewals. |
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1/01/2014 |
New MAGI policy and forms that are required as part of Affordable Care Act- added new section for Former Foster Care Medicaid- 2014 ABD and Family Medicaid Income Limits Updated |
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6/01/2013 |
Updated Appendix A-1 and A-2 with 2013 Income Limits |
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10/01/2012 |
COMPASS Medicaid renewal and the All Program Renewal form 508 to be used as Medicaid applications and incorporation of the most current Voter Registration policy and procedures. Procedures for documenting the new SVES match for citizenship/identity and allowing a Reasonable Opportunity Period for qualified immigrants to provide verification of their immigration status. Updated procedures for handling hearing withdrawals and for handling MEQC and PERM case record requests. |
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5/01/2012 |
New ABD and FM income limits- new referral section for CBAY waiver- all KB LOC now done by GMCF- GRITS match acceptable for identity- updated documentationr equirements for deemed newborns. |
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8/01/2011 |
New HP contact information- updated forms for KB packet- updated appendix on Long Term Care Unit-updated policy on verifying unearned income at renewal. |
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5/01/2011 |
New income limits for ABD and Family Medicaid- New section of Planning for Healthy Babies (P4HB) Updated foster care CMO de-linking procedures. |
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2/01/2011 |
Prior months are not part of ROP- updated Q-Track resource limits- Appendix C updated with new GAMMIS contacts and procedures- new forms for reporting completion of Q-Track and RSM Exparte lists. |
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11/01/2010 |
Updated hearing procedures- removed Georgia Partnership for Caring section as program no longer exists- updated how incomplete KB packets are handled-updated SGA amount. |
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8/01/2010 |
Updated Reasonable Opportunity Period- Elimination of DataBroker- updated QDWI limit- new section on Children’s Medical Services |
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5/01/2010 |
Reasonable Opportunity for verifying citizenship/identity-new section on Medicare Savings program applications-updated procedures for PeachCare rebounds- new Q-track limits |
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2/1/2010 |
Updated burial terminology- revised BCCP section and changed name to Women’s Health Medicaid- updated long term care expenses that can be used as IME- added new combined 985/Burial Exclusion form |
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11/01/2009 |
Updated voter registration procedures- new section on GAMMP program- updated contact info for sending IME request- updated reviews section. |
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8/01/2009 |
New voter registration procedures- child no longer needs to live with mother to be Newborn eligible- updated procedures for Special Needs Trusts- updated procedures for handling closed Chafee records |
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5/01/2009 |
New FM income limits; procedures for Iraqi/Afghani special immigrants; Case Record organization; new Q- track limits; new sections on Personal Care Contracts and Money follows the person. Updated procedures for determining Burial Contract values; MRWP/CHSS section changed to NOW/COMP. Citizenship/ID no longer required for Newborn recipients. New procedures for handling Chafee reviews. |
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2/01/2009 |
New ABD income limits- updated burial space items-update to show that Databroker requirements no longer necessary for RSM PGW and RSM Child cases. Added new PCK Rebound procedures. Enhanced Subsidized and Subsidized Guardianship added for children in placement. New procedures added for abandoned children. Several new forms added including OCSS non-cooperation letter. |
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11/01/2008 |
Updated citizenship/identity section; appendix M; new section added for LTC partnership policies; new procedures for dealing with nursing home bans. Added new section for Chafee Option Medicaid and for Champions for Children Program. Added revised versions of several forms. |
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8/01/2008 |
Updated citizenship/identity section- added new OCSS budgeting procedures- updated burial funds- TPL- and Medicare Buy-In. New Medicaid Quality Check form and guidelines- new section on Georgia Medicaid for Workers with Disabilities |
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5/01/2008 |
Updated income limits- Contracts- BCCP- TPR- Transfer of Assets- SSI Recipients and Exparte. New information on the Georgia Hearing Aid Distribution Program. |
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2/01/2008 |
Updates to HIPAA section- TPR- application processing-Burial Contracts- Burial Funds- Estate Recovery- IV-E Budgeting- update of forms |
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11/01/2007 |
Updates to TPR section- citizenship/identity-clarifications on Burial funds- life estates- trusts- new appendix for Georgia Databroker System- update of forms |
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7/01/2007 |
Clarifications on Trusts- Annuities and Transfer of Assets- return of deemed eligibility for Newborns- new Declaration of Citizenship- clarifications for Children in Placement CMD Procedures |
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4/01/2007 |
DRA updates- new Q-track and Family Medicaid Income limits- new intake and CMD procedures for children in placement |
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2/01/2007 |
Changes to transfer penalties as a result of DRA- new citizenship and identity affidavits- new forms for Undue Hardship |
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1/01/2007 |
Updates to Burial Policy- treatment of vehicles in ABD-new ABD COLA limits-miscellaneous Family Medicaid Changes |
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10/01/2006 |
Updates to Citizenship policy- updates to policy on contracts |
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8/01/2006 |
Citizenship changes resulting from Deficit Reduction Act |
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7/01/2006 |
Updates new PNA allowance- Pooled Trust policy in ABD-new CAR procedures for Family Medicaid-procedures for processing Medicaid for child of a minor child foster parent |
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4/01/2006 |
Updates Q Track and Family Medicaid Income Limits-Estate Recovery- Allowable Mileage Rates for Medically Needy |
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2/01/2006 |
Updates Citizenship/Alienage Verification requirements. |
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1/01/2006 |
Life Estates and Contracts- Verification of Income and Resources for certain Family Medicaid COAs. For Children In Placement- relative care placement and how to treat out of state emergency services. |
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10/01/2005 |
Relative Care Placement- Loans when the Applicant/Recipient is a Borrower-Clarification on Bonds- Updates to Forms- Clarification on Annuities and other Miscellaneous Updates and Clarifications |
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7/01/2005 |
Medicare Prescription Drug Plan Low Income Subsidy Applications-Affect of the Drug Plan on Other Policies-Updates to Third Party Liability Procedures- IV-E Income Limit Increases- Clarification of Home Place Property Transfer- Miscellaneous Updates and Clarifications to Policy and Procedures |
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4/01/2005 |
2005 FPL Income Limits- Clarifications on TEFRA/Katie Beckett-Changes in Treatment of Promissory Notes/Contracts- GBHC de-linking for Children in Placement |
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1/01/2005 |
2005 Income Limit Updates |
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12/02/2004 |
Miscellaneous Policy Updates |
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9/01/2004 |
Qualified Income Trusts- Changes to Policy as a result of the elimination of the Institutionalized Medically Needy Program and clarification on miscellaneous policy |
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7/01/2004 |
State fiscal year 2005 Changes – Elimination of Institutional Medically Needy as of September 2004-Reduction of Pregnant Woman Medicaid Income Limit to 200% of the FPL effective July 2004- Miscellaneous Policy Clarifications and Updates |
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4/01/2004 |
2004 FPL Income Limits- Family Medicaid SOP Aligned with ABD Medicaid SOP- Family Medicaid Budgeting Clarification- Exceptional Transportation- Miscellaneous |
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1/01/2004 |
2004 COLA- Nursing Home Sanctions- Miscellaneous Updates |
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10/01/2003 |
Medicaid Case Record Organization- Instructions on ABD Supervisory Review- Revised Procedures for Adoption Assistance Medicaid Redeterminations- Miscellaneous Policy Clarifications and Updates |
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7/01/2003 |
Changes in Medicaid Procedures due to Georgia Health Partnership- Addition of Section on HIPAA- Change in Private Pay Rate for Nursing Homes and other Miscellaneous Clarifications |
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4/01/2003 |
2003 FPL Increases- Clarifications to Adoption Assistance Medicaid Procedures- Removal of the Face- to-Face Interview Requirement- Miscellaneous |
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1/01/2003 |
2003 COLA- Institutionalized Hospice- Documentation Standards |
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11/01/2002 |
Addition of Appendices B- C- E- Foster Care Revenue Maximization Procedures- and Miscellaneous Medicaid Updates and Changes |
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7/01/2002 |
Elimination of the Work Transition Medicaid Class of Assistance and Miscellaneous Changes |
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3/18/2002 |
2002 Income Limits |
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New Economic Support Services Policy Manual |