Interview Requirements

A face-to-face (FTF) interview is not required for any Family Medical Assistance COA. At the caseworker’s discretion or the request of the applicant or AREP, a FTF interview may be scheduled, however an application may not be denied for failure to appear for an interview.

The A/R is considered to be the primary source of information for him or herself. The A/R may authorize an Authorized Representative (AREP) to apply and provide information on his or her behalf. An elected AREP may have verbal or written designation. If the designation is written, the applicant’s signature is required. If the designation is verbal, it must be documented. If information provided by an AREP is questionable or unclear, attempt to contact the A/R for clarification. This can be accomplished by telephone, mail, fax or in-person.

The A/R may withdraw, at any time, authorization of an AREP to act on his or her behalf. This request can be given verbally or in writing. If the request is given verbally, it must be documented. If the request is written, the applicant’s signature is required.

Information necessary to complete an eligibility determination may be obtained by any of the following methods:

FTF interview A FTF interview may not be required of the applicant or AREP and an application may not be denied solely for failure to complete a FTF interview.

telephone call

mail

home visit

fax

secure email

Gateway

Orally or in writing, inform the A/R about the Medical Assistance program(s) for which she or he may be entitled. Provide relevant information pamphlets or other printed material. Explain the following information to the A/R or AREP:

services provided by DFCS and how to obtain those services

refer the A/R to other appropriate services such as family planning

requirements of eligibility and the A/R’s responsibility to provide correct information to establish eligibility and benefit level

HIPAA and confidentiality

basic and financial eligibility requirements

Clearinghouse requirements for any AU/BG member

potential Medical Assistance COAs

potential coverage for three months prior to the month of application

periodic renewals

timely reporting of changes and how and where changes are to be reported

assignment of Third-Party Liability (TPL)

Medically Needy requirements, if applicable

the role of the Division of Child Support Services (DCSS), assignment of medical support rights to the State, and Good Cause for non-compliance

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Referrals to anyone in the AU under the age of 21. Information regarding EPSDT and contact information is included on the GA Gateway approval notice. Refer to Section 2930 - Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) .

Woman Infant and Children (WIC) Referrals to anyone in the AU that is pregnant; breastfeeding; postpartum women; or has a child under the age of 5 years, Section 2985 - Women, Infant and Children (WIC) Services .

the applicant’s right to the following: a fair hearing (Refer to Appendix B - TOC for details), a decision within standard of promptness (SOP), confidentiality, non-discrimination in the processing of the application, their rights and responsibilities in the Medical Assistance program, included in the single streamlined application or Form 297A - Rights and Responsibilities .

In addition, explain the following to an AU that includes a pregnant woman:

the right to apply and how to apply for TANF 45 days prior to the expected date of delivery

continuous financial eligibility for the pregnant woman

presumptive eligibility (PE) Medicaid process and how to apply at a public health facility or other qualified provider if the Medicaid eligibility determination for the pregnant woman cannot be made the same day that the application is filed. Accept the Medicaid application even if the applicant applies for PE Medicaid.