What is Medicaid?

Medicaid is a medical assistance program that helps many people who can't afford medical care for some or all of their medical bills.  If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy - and stay healthy.

How it Works

If you have applied and are approved for Medicaid, you will receive a Medicaid card in the mail.  Show your Medicaid card to your doctor, dentist, pharmacist, or at the hospital or clinic when you go for medical services.  Make sure they will accept Medicaid as payment for services.  After you have received your medical care, the Medicaid program will pay for the doctor, clinic, or other provider for your care.

Who is Eligible for Medicaid in Georgia?

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age; whether you are pregnant, disabled, blind, or aged; your income and assets; and whether you are a U.S. citizen or a lawfully admitted immigrant.

When you apply for Medicaid, the requirements listed above will be taken into account before a decision is made.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not. Eligibility for children is based on the child's status, not the parent's.

In general, you should apply for Medicaid if your income is low and you match one of the descriptions below:

• You think you are pregnant
• You are a child or teenager age 18 or under
• You are over the age of 65
• You are blind
• You are disabled
• You need nursing home care.

Other situations that may make you eligible: 

• If you are leaving welfare and need health coverage.
• If you are a family with children under 18 and have very low or no income and few resources.
• If your income is higher than the limits and you have medical bills you owe (and you are pregrant, under 18 or over 65, blind, or disabled.)

If you or someone in your family needs health care, you should apply for Medicaid even if you are not sure whether you qualify. Some income and resources do not count against you. For example, owning your home will not stop you from getting Medicaid. Every group has its own income limits, which increase on a regular basis. For example, in 2000, the monthly income level is $2,360 for a family of 3 and $2,842 for a family of 4. Apply and have a qualified caseworker evaluate your situation.

How To Apply For Medicaid

Anyone who applies for Medicaid can choose to apply in person (by going to the local Department of Family and Children Services, health department, or Social Security office), or by requesting forms to be mailed to you that you can fill out at home. There are several different ways to apply for Medicaid.

You can contact the Department of Family and Children Services (DFCS) in your county. The DFCS office will take your application or help you find other places to apply, such as schools, hospitals, or community centers near your home. The Right from the Start Medicaid (RSM) outreach project has workers available to take applications early in the morning, in the evenings, and on weekends. For more information, call 1-800-809-7276.

If you think you are pregnant, contact your county health department, primary health care center, or hospital. (Call the Georgia Division of Public Health at 404-657-2700 to find out where to apply in your county.) If you are pregnant and eligible, you can get a Medicaid certification form on the same day that you apply. You can get prenatal care for yourself and your baby immediately.

If you are aged (65 years old or older), blind, or disabled, apply for the SSI (Supplemental Security Income) program by contacting your local Social Security office. If you are approved for SSI, you will automatically receive Medicaid. You may also apply for Medicaid at the DFCS office, but you will not be able to apply for SSI there. (Call 1-800-772-1213 to find the closest Social Security office.)

What Documents are Needed to Apply for Medicaid?

When you apply for Medicaid, the application process will move along more quickly if you have information about yourself and your children handy. You may not need all of the items on this list, but these are the kinds of documents that will help:

• Your birth certificate or other proof of age (such as a census record, insurance policy, school transcript, etc.)
• Your social security number, if you have one
• Paycheck stubs, payroll records, recent W-2 forms
• Letters or forms that show your income from Social Security, SSI, VA, retirement, pensions, unemployment, workers compensation, child support, etc.
• Current health insurance policies, health insurance cards, or other health insurance information
• Life insurance policies
• Your 3 most recent bank statements or bank books
• Information about property you own (such as land, or stocks and bonds), or property you plan to buy or have transferred.

If you have any trouble finding this type of information, ask your caseworker for help.

What Happens After You Apply for Medicaid?

This section describes the process for DFCS. If you apply for SSI through the Social Security Administration (SSA), the process is somewhat different.

Once you complete an application for Medicaid, a Medicaid caseworker will interview you and review your application. The caseworker will make sure that all of the needed information has been provided.

If you have medical bills from the past 3 months that you were not able to pay, let your caseworker know about them when you apply. If you are eligible for Medicaid, it is possible that some of these bills may be paid by Medicaid, even if you were not enrolled in the program at that time.

You will find out whether or not you are eligible for Medicaid within 45 days after you apply. You will receive a letter in the mail telling you whether or not you are eligible. (If you are disabled and your disability has to be determined, the process may take up to 90 days.)

If you are eligible for Medicaid, you will receive a Medicaid card each month. Because the card will be mailed to you, it is very important to let your DFCS caseworker (or the Social Security Administration, if you receive SSI) know your new address whenever you move, so that your new card will get to the right address each month. 

It's a good idea to carry your Medicaid card with you at all times, in your purse or wallet, so you will have it with you when you need to show it to a doctor or pharmacist to receive services.

Since your personal situation may change for example, if you get a different job or if your family size changes - the Medicaid program will review your situation from time to time to make sure that you are still eligible.

If your situation changes, you must call your DFCS caseworker or the Social Security Administration (SSA) office as soon as you know about any changes.

How Does Medicaid Work?

Once you are eligible for Medicaid, there are two different ways that you can receive medical services. You may participate in Georgia Better Health Care (GBHC) or receive services from any provider who accepts Medicaid payments. Each of these is described below.

Georgia Better Health Care (GBHC):

Most people who are eligible for Medicaid will be enrolled in the Georgia Better Health Care (GBHC) program. You may choose your GBHC doctor. If you do not choose one, GBHC will match you and your children with a doctor in your community. (You and your children may have different GBHC doctors.) Your GBHC doctor will provide your health care, keep your medical records up-to-date, send you to a specialist when necessary, and refer you to the hospital when needed.

If you are enrolled in GBHC, you will receive a lime green card that lists the name, address, and phone numbers for your GBHC provider. If you want to change your GBHC provider, call GBHC member services at 1-800-246-2757 (or 404-982-3535 in metro Atlanta) and talk to a representative.

Not everyone may participate in GBHC. Nursing home patients, some pregnant women, and recipients who will be eligible for Medicaid for only a short time may not participate. Medicaid recipients who receive both Medicaid and Medicare may choose to participate in GBHC.

Other Medical Care Providers Who Accept Medicaid

If you do not belong to GBHC, you will not be assigned to a doctor or organization for your health care.

When you need a check-up or any medical care that is covered by the program, you can present your blue or yellow Medicaid card to any doctor, dentist, pharmacist, or clinic that accepts Medicaid. After you have received your medical care, the Medicaid program will pay the doctor or clinic directly.

About Co-Payments

What Does Medicaid Cover (Pay For)?

It's always a good idea to ask your doctor or pharmacist whether the specific service or item you need is covered by Medicaid. There are some limits to these services, and some may require you or your doctor to get permission first. (This is called prior approval.) Generally, though, Medicaid covers the following services:

• Doctors' and nurses' office visits (when you visit a doctor or nurse for check-ups, lab tests, exams, or treatment)
• Prescription drugs
• Inpatient hospital services (room and board, drugs, lab tests, and other services when you have to stay in the hospital)
• Outpatient hospital services (services you receive in a hospital, even though you do not stay in the hospital overnight)
• Nursing facilities (nursing homes)
• Emergency ambulance services
• Preventive dental care,fillings, and oral surgery for children
• Emergency dental care for adults
• Non-emergency transportation (to get to and from medical appointments)
• Medical equipment and supplies prescribed by a doctor for use in your home (such as wheelchairs, crutches, or walkers)
• Exams, immunizations (shots), and treatments for children (see box, below)
• Family planning services (such as exams, drugs, treatment, and counseling)
• Home health services ordered by a doctor and received in your home (such as part-time nursing, physical therapy, or home health aides)
• Hospice care services provided by a Medicaid hospice provider
• Vision care for children (limited services for adults)
• Hearing services for children 

Some other services covered by Medicaid include:

• Case management
• Diagnostic, screening, and preventive services
• Laboratory services
• Medicare cost sharing
• Mental health clinic services
• Mental Retardation (MR) Waiver services
• Community Care services
• Independent Care Waiver services
• Nurse midwife and nurse practitioner services
• Nurse visits in the home after delivery of the baby

• Orthotics and prosthetics (artificial limbs and replacement devices)
• Podiatry services

• Psychological services (for people under the age of 21)
• Therapy services (physical, occupational, and speech)
• Rural Health Clinic and Federally Qualified Health Center services
• Childbirth education classes
• Birthing center services
• Dialysis and services for end-stage renal kidney) disease
• Durable medical equipment.

What's Not Covered?

Some services are not covered by Medicaid. These include: private duty nursing, services given by a relative or member of your household, cosmetic surgery, disposables (such as adult diapers, cotton, or bandages), experimental items, and chiropractic services -- among others. If you're not sure, ask your provider!

How to Apply:   

If you are applying for Medicaid without SSI, contact your local Department of Family and Children Services (DFCS) office.  Check our Special Needs Database for the nearest Family and Children Services office.

To apply for Medicaid via SSI, contact your local Social Security office.  You can call 1-800-772-1213 to find the closest office.