Medicaid In Ga Phone Number

Early Periodic Screening Diagnostic & Treatment

Early and Periodic Screening, Diagnostic, and Treatment benefit includes a comprehensive array of preventive, diagnostic, and treatment services for Medicaid eligible infants, children and adolescents under age 21, as specified in Section 1905 of the Social Security Act . The EPSDT benefit is also available to PeachCare for Kids® members up to 19 years of age. The EPSDT benefit is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. The goal of the EPSDT benefit is to assure that individual children get the health care they need when they need it.

The EPSDT benefit also covers medically necessary diagnostic services. When a screening examination indicates the need for further evaluation of a childs health, the child should be appropriately referred for diagnosis without delay. States are required to arrange for and cover under the EPSDT benefit any Medicaid covered service listed in Section 1905 of the Act if that treatment or service is determined to be medically necessary to correct or ameliorate defects and physical and mental illnesses or conditions for children through age 20 years of age.

Reviewing your Health Check Record

Billing Tips for Health Check

Health Check Referral Codes

Vision Screening

Georgia Medicaid Member Copays

Some Georgia Medicaid members pay a copay for services. There are no copays for preventive care, family planning services, emergency services, or dialysis services except as listed below:

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Increased State Costs Due To Loss Of Enhanced Federal Match

Although Georgia has up to 14 months to complete all renewals for enrollees, the enhanced federal match is only in place until the end of the quarter in which the PHE ends. For example, if the PHE ends in July, the additional federal funding would dry up after September 30placing an additional burden upon the state budget.

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Caresource24 Nurse Advice Line

Members can call CareSource24®, our Nurse Advice Line any time to talk with a caring, skilled nurse. This is a free call. You can call 24 hours a day, 7 days a week, 365 days a year. Our nurses can help you:

• Learn about a health problem
• Find out more about drugs or over-the-counter medications
• Find out about health tests or surgery
• Learn about healthy eating habits

To reach the CareSource24® Nurse Advice Line, call .

Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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Unprecedented Volume Of Eligibility Determinations

Processing Medicaid eligibility determinations happened on a regular basis prior to the pandemic. However, Georgia, like all states, will be facing a massive volume of redeterminations that need to be completed within a 14 month period, which increases the risk that eligible individuals will be erroneously determined ineligible or lose coverage for avoidable procedural reasons. For this reason, CMS has provided guidance that states initiate no more than one-ninth of their total caseload per month. According to a , Georgia plans to adopt a time-based approach to prioritize eligibility renewals. That means Georgia will prioritize actions based on the month of an enrollees initial application or last renewal or based on the time since the individual/households last redetermination of eligibility.

Complete And Submit An Application

Self-service application options:

Online: Log on to Georgia Gateway at to apply for benefits. Available 24/7.

Call the Customer Contact Center at to submit an application by telephone.

An application is considered filed when it has the name of the head of household, address, date and signature of the head of household or another household member and is received by DFCS.

Notice of Free Interpretation ServicesIf you have difficulty communicating with us because you do not speak English or have a disability, please notify a staff person. Free interpretation services, translated materials or other assistance is available upon request.

For additional support with requesting large print versions of DFCS applications, please visit .

DFCS Reasonable Modifications and Communication Assistance Request Form for Persons with Disabilities

Do you have a disability and need a reasonable modification or communication assistance to access DFCS services? to request a reasonable modification, communication assistance, extra help or to learn more about the rights of customers with disabilities.

Medicaid Benefit Renewal

All benefits recipients are required to undergo periodic review of continued program eligibility. A renewal form and any required accompanying verification can be submitted in Georgia Gateway or by using Form 508 the FOOD STAMP/MEDICAID/TANF Renewal Form.

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Pregnancy / Womens Health Medicaid

Presumptive Eligibility Medicaid for Pregnant Women and Womens Health Medicaid

Q. Where do I go to apply for Medicaid?A. There are several ways to apply for Medicaid and other medical assistance programs:

• You can find out if you qualify for Medicaid or other medical assistance and social service programs by speaking with a representative at your local DFCS office. Call the DFCS information line at 877-423-4746 to be directed to the appropriate office where someone can help you. For a list of DFCS locations and address, phone, fax numbers in your county click the following link: www.dfcs.dhr.georgia.gov, click on County Offices, next click on Complete List of All County offices.
• To apply for Medicaid, you can submit a completed signed application online at Georgia Gateway, or you may print a Medicaid application and submit the completed signed application at any local DFCS office, in person, by mail, telephone, fax or email. Click on the following links to complete and print your application.

Renew Your Medicaid Or Chip Coverage

As COVID-19 becomes less of a threat, states will restart yearly Medicaid and CHIP eligibility reviews. This means your state will use the information they have to decide if you or your family member still qualify for Medicaid or CHIP coverage. If your state needs more information from you to make a coverage decision, theyll send you a renewal letter in the mail. Go to Medicaid.gov/renewals, find a link to your state Medicaid office and confirm your contact information is up-to-date.

An official website of the United States governmentHeres how you know

Official websites use .gov

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Office Of The Ombudsman

The NavigateCareSource Office of the Ombudsman is an independent, neutral unit. If you have a problem that you feel CareSource has not addressed or resolved, the Office of Ombudsman is here to help. This involves:

• Making sure you get a fair answer to any issues.
• Helping you find covered care in the CareSource network.
• Finding doctors who can provide care not covered under your CareSource plan.

How Long Will My Child Be Covered Under His/her Medicaid Plan How Do I Renew My Childs Coverage

Medicaid is based on month to month eligibility, but benefits are reevaluated on a yearly basis for aged, blind, and disabled Medicaid, and every six months for family Medicaid. The GA Division of Family and Children Services will confirm whether your child/children remain eligible for the program they have.

You will receive a review form in the mail with instructions be sure to return the review form by the date shown or your child/children may lose their benefits.

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Opportunities Exist To Ensure A Smooth Transition And Minimize Unnecessary Coverage Loss

Georgia state legislators, state agencies, managed care organizations, community-based organizations and others can work together to avoid a large increase in the number of people who are uninsured after the PHE ends. In particular, action should be taken in the planning and implementation that centers the needs of low-income Black and Latinx families who are overrepresented in Medicaid. Below are some examples of how state lawmakers and state agency leadership can take action.

State agencies, including Department of Community Health in conjunction with the Division of Family and Childrens Services and the states Medicaid managed-care organizations, should be transparent in the development and implementation of their operational plan for the end of the continuous coverage requirement and work with community-based organizations and other stakeholders before the PHE expires and throughout the process to ensure that plan meets the needs of those who will be most disproportionately impacted. State agencies also should publicly report and post key metrics over the course of the disenrollment period, including call center statistics and the share of disenrollments due to procedural reasons.

Unitedhealthcare Connected General Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

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Benefits Of Medicaid For Pregnant Women

First, you will be given a list of medical providers who accept Medicaid or given a website to look for a provider in your area.

Second, pregnant women are covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum.

Third, as long as you receive care from a Medicaid provider, your health care costs will be submitted through Medicaid and will be covered, in accordance with Medicaid regulations and guidelines.

Finally, Medicaid usually gives Pregnant women priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks.

If you need medical treatment before then, talk with your local office about PE Medicaid as explained above.

Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

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How Can Your Patients Can Enroll In Georgia Families

Maximus, the enrollment broker for GA Families, works with Medicaid members who are eligible to participate in the GF program. Members are encouraged to do the following to enroll:

Once a member has enrolled into a plan, they will have 90 calendar days to change their health plan or PCP. After the 90-day period, they will not be able to make any changes to their health plan affiliation without cause until the open enrollment period begins the following year.

To assist you and your patient in the enrollment process, there are a few thing you should know:

Maximus has also developed a brochure and CMO comparison sheet that you can download from their website for distribution to your patients in the office.

Providers can tell their patients which plans they are participating with, but they cannot advise their patients which plan to choose. The patients need to chose a plan based on their own decision making process.

Please be reminded that CMO Medicaid members have the option during their open enrollment period to change their CMO and PCP assignment. Open enrollment is continuous, based on the individual members enrollment date. Members will receive a letter from Georgia Families 30 days prior to their enrollment anniversary date. If the member does not make a choice during the 30-day window they will remain in their CMO.

Georgia Pathways Would Be Costly For The State And Complicated For Enrollees

Although Georgia Pathways is currently on hold due to the legal dispute over the work requirement and premiums, it could still be implemented at a later date. Lets take a look at what the state wants to do in terms of partial Medicaid expansion.

As part of the waiver proposal, Georgia asked CMS to provide the state with full Medicaid expansion funding , despite the fact that the state would only be implementing a partial expansion of Medicaid. A similar request from Utah was rejected by the Trump administration in 2019, and CMS followed the same process for Georgia: The federal government will not provide the 90% funding match for Georgias partial Medicaid expansion, but will instead pay the states normal federal matching rate of 67%. This means it will cost Georgia more to cover the expanded Medicaid population than it would if the state were to simply expand Medicaid fully, as called for in the ACA.

Under the Georgia Pathways program, enrollees must report their community engagement on a monthly basis. But if they comply with the community engagement requirement for at least six consecutive months, theyll be exempt from the reporting requirement and will only have to report changes, if applicable. Eligibility will continue to be redetermined annually.

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Ways To Apply For Chip:

• Fill out an application through the Health Insurance Marketplace®. If it looks like anyone in your household qualifies for Medicaid or CHIP, well send your information to your state agency. Theyll contact you about enrollment. When you submit your Marketplace application, youll also find out if you qualify for an individual insurance plan with savings based on your income instead. Create an account or log in to an existing account to get started.

FYI: Apply any time

You can apply for and enroll in Medicaid or CHIP any time of year. Theres no limited enrollment period for either Medicaid or CHIP. If you qualify, your coverage can start immediately.

Who Is Eligible For Medicaid In Georgia

As of April 2020, criteria for enrollment in Georgia Medicaid are set at the following levels for non-disabled adults :

• Children up to age 1 with family income up to 210% of federal poverty level
• Children ages 1-5 with family income up to 154% of FPL
• Children ages 6-18 with family income up to 138% of FPL
• Pregnant women with family income up to 225% of FPL
• Parents of minor children with family income up to 36% of FPL

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Customer Video: Upper Peninsula Health Plan

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Visiting The Medicaid Office

If you do not want to call the Medicaid office number and speak to a representative, you can go to the office. This is a helpful option if you would benefit from speaking to a program official in person. However, keep in mind that your Medicaid office may require you to schedule an appointment before you can meet with a representative. If this is true for your facility, call the office to schedule your meeting time.

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