MEDICAL ASSISTANCE PROGRAM*
Family Medicaid Classes of Assistance
- Deemed Newborn Medicaid (NB) is a non-MAGI class of assistance and provides Medicaid coverage to a child born to a mother who was eligible for and receiving Medicaid under any class of assistance in Georgia on the day the child was born. A child is eligible for NB Medicaid for up to 13 months beginning with the month of birth and continuing through the month in which the child reaches age 1 as long as the child continues to live in Georgia. A request for NB coverage is processed within 10 days.
- Parent/Caretaker with Child Under 19 (P/C) is a MAGI class of assistance that covers adults and children under 19 who meet the financial eligibility criteria based on Budget Group composition and taxable income. In addition, P/C is available for families who choose to receive only Medicaid rather than cash assistance (TANF), or choose to receive their child support rather than TANF, or do not wish to comply with the Personal Responsibilities or the Work Requirements of the TANF Family Service Plan. Applications for P/C are processed within 45 days.
- Transitional Medical Assistance (TMA) is a MAGI class of assistance that provides Medicaid for up to 12 months to families for whom Parent/Caretaker coverage is terminated due to new or increased earned income. TMA uses 205% of the Federal Poverty Level as the income limit for eligibility. This class of assistance is designed to help families transition into full independence.
- Four Months Extended Medicaid (4MEx) is a MAGI class of assistance that provides continued Medicaid eligibility when a Parent/Caretaker AU becomes ineligible for coverage due to the receipt of new or increased spousal support. The AU may receive four months of extended Medicaid coverage.
- Child Under 19 Medicaid (C19) is a MAGI class of assistance that covers children who are not eligible under the Parent/Caretaker COA. Eligibility covers children under age 1 who have income less than or equal to 205% of the Federal Poverty Level (FPL) and children from age 1 through 5 who have income less than or equal to 149% of FPL. It also covers children age 6 to 19 who have income less than or equal to 133% of the Federal Poverty Level. Applications for C19 are processed within 45 days of submission.
- Pregnant Women Medicaid (PgW) is a MAGI class of assistance that covers pregnant women who are not eligible for P/C coverage. Eligibility covers pregnant women who have taxable income that is less than or equal to 220% of Federal Poverty Level (FPL). PgW applications are processed within 10 days.
- PeachCare for Kids® (PCK) provides medical insurance for children who are financially ineligible for Medicaid. PCK is available to children from birth through the last day of the month of a child’s 19th birthday. To qualify, the countable income must be less than or equal to 247% of the FPL. PCK is administered by MAXIMUS. Applicants may apply at www.peachcare.org
- Medically Needy Medicaid (MN) is a non-MAGI class of assistance that provides Medicaid to children and pregnant women who do not qualify for Medicaid coverage in a higher class of assistance. This COA allows the BG members to “spenddown” excess income with their medical expenses as a means of becoming Medicaid eligible. It provides support for working families who have too much income to be eligible for other COAs, but also have high medical bills. This class of assistance will not be addressed in this training session.
- Women’s Health Medicaid (WHM) is based on the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Women’s Health Medicaid provides Medicaid coverage to women diagnosed and who are in need of treatment for breast or cervical cancer and/or precancerous conditions of the breast or cervix.
- Planning for Healthy Babies (P4HB) is a Medicaid program for women ages 18-44 who are not pregnant, do not receive any other type of Medicaid and have previously given birth to a baby born weighing less than 3lbs 5 ounces. P4HB became effective in January 1, 2011 and provides Family Planning Services, Inter-Pregnancy Care Services and Resource Mother Services to qualified recipients. Applicants may apply at www.p4hb.org.
- Federally Facilitated Marketplace (FFM) is the national gateway for providing healthcare coverage plans for individuals who are ineligible for Medicaid coverage. An automatic referral to the FFM is made when an individual seeking healthcare coverage is denied/closed in SUCCESS.
- Child Welfare Foster Care Medicaid (CWFC) provides Medicaid coverage for a child who is in placement for whom DFCS has partial or total responsibility and who also has been determined ineligible for IV-E Foster Care. This class of assistance will not be covered in this training session.
MEDICAL ASSISTANCE PROGRAM
Aged, Blind, or Disabled Medicaid Classes of Assistance
- Public Law Medicaid can continue Medicaid coverage for individuals who had previously been eligible for Medicaid due to receipt of SSI, but who became ineligible for this program, and consequently became ineligible for Medicaid, due to either an initial entitlement to Retirement, Survivors, Disability Insurance (RSDI) or an increase in RSDI.
- Institutionalized/Home-Based Program covers aged, blind or disabled persons who are in an institution or home-based program for 30 continuous days. This program uses an income limit that is 3 times the Supplemental Security Income (SSI) limit. It includes individuals in a hospital or nursing home as well as other individuals.
- Hospital Medicaid covers aged, blind or disabled persons who are in a hospital for 30 days or in a nursing home. This program uses an income limit that is 3 times the SSI income limit.
- Hospice Care Medicaid provides Medicaid to terminally ill persons who wish to receive services at home or in a Medicaid participating nursing home from a hospice care provider. This type of Medicaid uses the same income and resource limits as listed above.
- Katie Beckett Medicaid provides Medicaid to blind or long-term disabled children at risk of entering an institution. This Medicaid coverage allows the child to be cared for at home rather than having to enter a nursing home. To determine eligibility for Medicaid under Katie Beckett, consideration of the parents’ income and resources is “waived”. Only the child’s monthly income and resources are considered.
- Waiver Classes of Assistance provides additional services above what regular Medicaid pays. Each program defines what expenses are covered.
- Community Care Services Program Medicaid (CCSP) provides coverage to persons who wish to receive treatment under the Community Care Services Program at home rather than enter a nursing home.
- New Option Waiver (NOW) and Comprehensive Supports Waiver Program (COMP) are designed to provide in-home and community-based services to Medicaid eligible mentally retarded and developmentally disabled individuals who do not receive Medicaid benefits under a cash assistance program.
- Independent Care Waiver Program (ICWP) provides Medicaid for individuals who meet criteria for Nursing Home placement, but remain at home. These individuals are severely physically disabled or have traumatic brain injuries. These individuals need more care than can be provided by CCSP.
- Q-track Classes of Assistance provide limited benefits to Medicare eligible individuals. Qualified Medicare Beneficiaries (QMB) acts as a medical coverage supplement to persons on Medicare. The income limit is 100% of the Federal Poverty Level (FPL) and the resource limit is twice the SSI limit. QMB pays the Medicare premium, deductible, and co-payment for Medicare recipients.
- Specified Low-Income Medicare Beneficiary (SLMB) is a class of Medicaid assistance that pays the monthly premium for Medicare Supplemental Medical Insurance (Part B) for individuals who meet certain financial criteria, but whose income or resources make them ineligible for Medicaid.
- Qualifying Individuals 1 (QI-1) is a class of assistance that pays the monthly premium for Medicare Supplemental Medical Insurance (Part B) for individuals who meet financial criteria based on a percentage of the FPL. The eligibility criteria are identical to SLMB except that the coverage is time-limited depending on available State funds and the income limit is higher than the SLMB limit.
- ABD Medically Needy Medicaid (AMN) provides Medicaid for the aged, blind or disabled who cannot qualify for Medicaid any other way. This program allows the individual or family to “spend down” excess income with their medical expenses as a means of becoming Medicaid eligible
Basic Eligibility Requirements**
- Must be a U.S. citizen or have a parent who has been a permanent resident for 5 years or more
- Must be a resident of Georgia
- Must meet income eligibility requirements by family size
- Must have a Social Security number or verification that number has been applied for
- You think you are pregnant• You are age 65 or older• You have a disability• You are a child or teenager• You are legally blind• You need nursing home care
Eligibility is based on gross income with some qualifying deductions (e.g. child care expenses)
Salaried/Wage Earners – Taxable income, earned and unearned.
Self-employment – income after all allowable IRS business deductions claimed on the self-employed individual tax return.
What is needed to apply…
- Birth certificate (Georgia-born residents do not have to have a copy to apply)
The Social Apostolate of Savannah may be able to help obtain out-of-state birth certificates for people who are in financial hardship. They are located at 502 East Liberty Street, Savannah, (912) 233-1877
- Form of Government-issued Photo ID: e.g. Driver’s License, Passport (US or foreign) State issued identification card, Consular Identification Card
- Social Security number or proof that a card has been applied for.
- Income documents (for one month- i.e. one month’s worth of paystubs or Form 809 for cash-only income from one employer or Form 126 – 3 months for cash-only self-employed income
Non-U.S. citizens may apply for Medicaid or PeachCare for their U.S.-born children and do not have to prove citizenship, legal residency status or present a social security number. Applying for services does not trigger any action with USCIS Immigration Service.
Georgia Gateway – Common Point of Access for Social Services
Georgia Gateway is a self-service website.
* Medicaid Overview. Division of Family and Children’s Services, OFI Training & Services Section. September 2014
**Source: https://dch.georgia.gov/medicaid-faqs. Retrieved October 20, 2014.