Medicaid is a government funded health insurance program that pays medical bills. It is an eligibility program, which means your child or your family must meet certain requirements in order to qualify for services.
Many groups of people are covered by Medicaid. Even within these groups, certain requirements must be met. These may include your age, whether you are pregnant, disabled, your income and resources (like bank accounts) and whether you are a U.S. citizen or a lawfully admitted immigrant. Your child may be able to get coverage, even if you are not eligible. Different Medicaid programs have different eligibility requirements.
Georgia Gateway is the central way for people in Georgia to get answers to questions about health and human services and to apply for those services online. Applications are also available at Department of Families and Children’s Service. (DFCS) locations throughout the state.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the part of the Federal Medicaid Act that defines Georgia’s responsibility for all Medicaid eligible children. EPSDT requires states to provide any “necessary health care, diagnostic services, treatment and other measures . . . to correct or ameliorate defects and physical and mental illnesses and conditions as covered by the Medicaid Act.” This means that services (such as therapies, skilled nursing care, behavioral supports, vision and dentistry) must be provided for children under age 21. These services should be based on the child’s individual needs, as determined by their doctor or other healthcare professional and not limited by pre-determined limits or caps. Read More…
If your Medicaid-eligible child is denied services or if services are reduced in frequency, duration or intensity, you (the parent) must receive a notice in the mail within 30 days of the request. Georgia legislation (SB 507) requires that the denial letter include a description of 1) the exact treatment/services being denied, described in words and codes; 2) any additional information needed from the child’s medical provider that could change the decision; 3) the specific reason, including the facts relevant to the individual case that was used to determine that the service is not medically necessary. If your claim is denied, you have a right to an appeal and the denial letter should inform you of the procedure to follow. The state must make a final determination of your appeal within 90 days of the date you submit the request. If your child is enrolled in a CMO, this time frame may be extended by any time it takes you to appeal the CMO’s decision to the state. Send a request for an appeal to: Department of Community Health, Medicaid Office of Legal Services, 2 Peachtree Street, NW 40th Floor, Atlanta, GA 30303 or FAX: 404-657-9711. (It is recommended that you send your request by certified mail, return receipt requested.)
For more information and assistance, contact the Atlanta Legal Aid Society or Georgia Legal Services Program office nearest you.
This Medicaid Program allows states to waive family income for certain children with disabilities. It provides benefits to eligible children 18 years of age or less. These children must meet specific criteria to be covered. Qualification is not based on medical diagnosis; it is based on the institutional level of care the child requires.
Hello. My name is Kori Lateef Capers. I currently live with my mother in Atlanta. I am 35 years old and soon to be 36. I enjoy life and I have many gifts. I enjoy music and worshiping God. I also sing. Kori started receiving SSI when he was about 14 years of age. He graduated from Douglass High School in 1997. After graduation, he started going to Central Training Center, which is a part of the Fulton County System. They automatically applied for the waiver at that time for him . . . Read More . . .