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M edicaid is a government funded health insurance program that pays medical bills. It is an eligibility program, which means your child or your family must meet certain requirements in order to qualify for services.

 

 

star Who is Eligible for Medicaid?

Many groups of people are covered by Medicaid. Even within these groups, certain requirements must be met. These may include your age, whether you are pregnant, disabled,  your income and resources (like bank accounts) and whether you are a U.S. citizen or a lawfully admitted immigrant. Your child may be able to get coverage, even if you are not. Different Medicaid programs have different eligibility requirements.

Basic Requirements to Qualify for Medicaid

Medicaid Terms You Should Know

Citizenship and Residency Rules

Community Options: A Guide to Georgia Medicaid Programs and Medicaid Waivers

Understanding Medicaid in Georgia and the Opportunity to Improve It

 

starHow do you Apply? 

COMPASS is a way for people in Georgia to get answers to questions about health and human services and to apply for those services online.

Applications are also available through Department of Families and Children's Service. (DFCS)

Medicaid Application (English)

Medicaid Application (Spanish)


starWhat is EPSDT and How does it Impact my Child?

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the part of  the Federal Medicaid Act that defines Georgia’s responsibility for all Medicaid eligible children. EPSDT requires states to provide any “necessary health care, diagnostic services, treatment and other measures . . . to correct or ameliorate defects and physical and mental illnesses and conditions as covered by the Medicaid Act.”  This means that services (such as therapies, skilled nursing care, behavioral supports, vision and dentistry) must be provided for children under age 21. These services should be based on the child’s individual needs, as determined  by their doctor or other healthcare professional and not limited by pre-determined limits or caps. Read More...

Does Medicaid pay for Diapers?

 

starDenials and Appeals

If your Medicaid-eligible child is denied services or if services are reduced in frequency, duration or intensity, you (the parent) must receive a notice in the mail within 30 days of the request. Georgia legislation (SB 507) requires that the denial letter include a description of 1) the exact treatment/services being denied, described in words and codes; 2) any additional information needed from the child’s medical provider that could change the decision; 3) the specific reason, including the facts relevant to the individual case that was used to determine that the service is not medically necessary. If your claim is denied, you have a right to an appeal and the denial letter should inform you of the procedure to follow. The state must make a final determination of your appeal within 90 days of the date you submit the request. If your child is enrolled in a CMO, this time frame may be extended by any time it takes you to appeal the CMO's decision to the state. Send a request for an appeal to: Department of Community Health, Medicaid Office of Legal Services, 2 Peachtree Street, NW 40th Floor, Atlanta, GA 30303 or FAX: 404-657-9711. (It is recommended that you send your request by certified mail, return receipt requested.)

More Information on Appeals

star Medicaid Programs

Georgia Families

SOURCE: Service Options Using Resources in a Community Environment

GAPP: Georgia Pediatric Program

HIPP: Health Insurance Premium Payment Program

GA CHIPRA Premium Assistance Program

 

starKatie Beckett/Deeming Waiver

This Medicaid Program allows states to ignore family income for certain children with disabilities. It provides benefits to eligible children 18 years of age or less. These children must meet specific criteria to be covered. Qualification is not based on medical diagnosis; it is based on the institutional level of care the child requires.

The Katie Beckett Story

Katie Beckett/Deeming Waiver Snapshot

How to Apply, Instructions and  Forms

Watch P2P's Two part series on the Deeming Waiver Part 1 and Part 2

 

 

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starIn Their Own Words . . .

Hello,my name is Kori Lateef Capers. I currently live with my mother in Atlanta. I am 35 years old and soon to be 36. I enjoy life and I have many gifts. I enjoy music and worshiping God. I also sing. Kori started receiving SSI when he was about 14 years of age. He graduated from Douglass High School in 1997. After graduation, he started going to Central Training Center, which is a part of the Fulton County System. They automatically applied for the waiver at that time for him . . . Read More . . .