Basic Considerations

Family Medicaid Non-MAGI Assistance Units (AUs) include:

Newborn

Family Medically Needy

Pregnant Medically Needy

Refugee

Foster Care

Adoption

CHAFEE

Women’s Health Medicaid

Family Medicaid MAGI AUs include:

Parent/Caretaker with Child(ren)

TMA/4MEx

Pregnant Women

Children Under 19 Years of Age

Georgia Pathways to Coverage™ (Pathways)

Planning for Healthy Babies® (P4HB)

Former Foster Care Medicaid

Family Medicaid AUs must meet specific Basic Eligibility Criteria:

age

citizenship/immigration status

cooperation with DCSS

enumeration

identity

residency

third party liability

specified relative relationship/tax filer/non-filer status

Each COA has different exceptions to the Basic Eligibility Criteria. Refer to Chapter 2200 - Basic Eligibility Criteria and to each COA in this chapter.

A pregnant woman who is eligible for and receiving Medicaid under any Medicaid COA (except Q-track, P4HB or a Family Medicaid Medically Needy in suspense) or SSI on the date the pregnancy terminates is eligible to continue to receive the 12-month extended postpartum period. The 12-month extended postpartum period count begins the month after the termination of pregnancy. Medicaid continues through the last day of the 12 th month.

Medicaid coverage under any Medicaid COA (except Q-track, P4HB or Family Medicaid Medically Needy in suspense) or SSI is continued for a pregnant woman who, after approval becomes financially ineligible solely because of new income or a change in income of any BG member. The pregnant woman remains eligible for Medicaid for the remainder of the pregnancy, including the 12-month extended postpartum period. Refer to Section 2720 - Continuous Coverage for Pregnant Women .

If a pregnant woman meets spend down for at least one month during their pregnancy or in the pregnancy termination month, the pregnant woman is eligible for the 12-month extended postpartum period. Eligibility for any Family Medicaid COA can begin with the month of application and can include up to three months prior to the month of application. All points of eligibility for that COA must be met in each of the three prior months. Refer to Section 2053 - Retroactive Medicaid .

Pathways does not allow for retroactive coverage.

Three months retroactive Medicaid does not pertain to January 2014 applications for MAGI COAs.

Under certain conditions, Medicaid may cover services rendered to Medicaid-eligible Georgia residents who are out of state when medical services are provided. Procedures for qualifying for out-of-state coverage are found on the back of the Medicaid card.