Presumptive Eligibility Process

Women who have received a diagnosis or suspect they have breast or cervical cancer must apply initially through the local Georgia Department of Public Health Department (DPH) or one of its partner affiliates such as Grady Hospital, Federally Qualified Health Centers (FQHC), and Rural Health Centers (RHC) who will complete the breast and/or cervical cancer screening procedures in accordance with CDC guidelines established under Title XV.

If the woman meets all the guidelines set forth by Title XV, DPH will take a Presumptive Eligibility application. This consists of completing an application, interviewing the woman, and determining eligibility in accordance with the basic eligibility criteria. Refer to Appendix A2 - Family Medicaid Financial Limits TOC for the income limits.

The PE period begins on the approved application date and ends when the woman is determined eligible or ineligible for regular Medical Assistance by DFCS; however, no later than the end of the second month of presumptive eligibility. The PE application date is the date that the application was entered into GAMMIS. Once the application is determined for full medical assistance and is approved, the date will revert to the first date of the month. If the application is denied, the case should be closed in GAMMIS the same date the determination is made in Gateway.

As part of the Presumptive Eligibility determination process, DPH personnel are required to complete the following forms which complete the application package:

DMA 632W - PE Women’s Health Medicaid Application

Certificate of Diagnosis

Form 94 - Medicaid Application

Form 216 - Declaration of Citizenship/Immigration Status

DMA-285 - Health Insurance Questionnaire for all applicants, if applicable

DMA-634W, Notice of Action