Basic Eligibility Criteria

Assistance Unit (AU) members must meet the following basic eligibility requirements:

Age – A child must be under the age of 19 to be eligible. There is no age requirement for adult AU members. Refer to Section 2255 - Age (Family Medicaid) .

Citizenship/Immigration/Identity status - Each AU member must be a U.S. citizen or meet immigration eligibility requirements. Refer to Section 2215 - Citizenship/Immigration/Identity .

Enumeration - The A/R must furnish, apply for, or agree to apply for a Social Security Number (SSN) for each AU member, unless Good Cause is established.

An adult who does not meet this requirement, without Good Cause, is penalized. The child(ren) in the AU that does not meet this requirement, without Good Cause, is excluded from the AU. Refer to Section 2220 - Enumeration .

Child Support Services (DCSS) - The AU must cooperate with DCSS in the attempt to obtain medical support from the absent parent (AP), unless Good Cause is established. A referral to, and cooperation with Child Support Services (DCSS) is; however, NOT a requirement for child-only Medicaid cases.

A child-only Medicaid case is defined as a Medicaid AU in which no adults are receiving Medicaid. An AU which contains a penalized adult is NOT considered a child-only case.

The AP of a child included in a Parent/Caretaker with child(ren) AU is not referred to DCSS if the AP provides health insurance for the child, unless the A/R wishes to pursue collection of child support monies.

An adult who does not cooperate with DCSS, without Good Cause, is penalized. Refer to Section 2250 - Cooperation with Division of Child Support Services .

Tax Filer and Non-Tax Filer Status - Individuals expected to be included on the next tax return filed are potentially eligible to receive MAGI Medicaid. Individuals that meet non-tax filer criteria are potentially eligible to receive MAGI Medicaid. Refer to Section 2245 - Living With A Specified Relative/Tax Filer/ Non-Tax Filer .

SSI recipients must be included in the budget group for MAGI COAs, but the income of the SSI recipients will not be counted in the budget. Refer to Section 2610 - MAGI Budget Groups / Assistance Units .

Residency - AU members must be residents of Georgia. Refer to Section 2225 - Residency .

Third Party Liability Requirements - The A/R is required to provide information regarding any Third Party Liability (TPL) available to any AU member. The A/R must assign his/her TPL rights to DCH, unless Good Cause exists.

An adult who does not meet this requirement, without Good Cause, is penalized. Refer to Section 2230 - Third Party Liability .

Although Application for Other Benefits is not an eligibility requirement for Medicaid, the A/R should be notified of potential benefits if applicable.