GEORGIA DIVISION OF FAMILY AND CHILDREN SERVICES

CHILD WELFARE POLICY MANUAL

Chapter:

(9) Eligibility

Policy
Title:
Policy
Number:

Applying for Medical Services at

Initial Entry and Exit
9.2

Effective
Date:

August 2014

Previous
Policy #:

1003.1
1003.2

CODES/ REFERENCES
N/A
REQUIREMENTS
The Division of Family and Children Services (DFCS) shall utilize the funds provided by the
Medicaid program to pay the costs associated with providing medical services to Medicaid
eligible recipients. These funds must be utilized in order to conserve state funds for those
children who have been determined Medicaid ineligible.
DFCS shall submit a childs Medicaid application to the DFCS Revenue Maximization Unit (Rev
Max) via Georgia SHINES, the Statewide Automated Child Welfare Information System, within
24 hours of a child entering DFCS custody.
DFCS shall screen each child entering foster care in the Georgia Medicaid Management
Information System (GAMMIS) within one business day of a child entering foster care.
DFCS shall notify Amerigroup, Rev Max, and the Georgia Department of Community Health
(DCH) within 24 hours of a child entering or exiting foster care using the Amerigroup GA
Families 360 DFCS Referral Form.
The Social Services Case Manager (SSCM) shall complete a PeachCare for Kids application for
any child entering care who does not meet Medicaid eligibility requirements.
DFCS shall inform and refer individuals who age out of foster care, or Chafee Medicaid to apply
for Former Foster Care Medicaid with the Right From the Start Medicaid (RSM) Outreach Project
or at any local DFCS office.
PROCEDURES
When a child enters DFCS custody, the SSCM will:
1. Gather as much medical history on the child as possible and enter it into Georgia
SHINES.
2. Ensure each child has been screened in GAMMIS within the required timeframe.
3. Check all available resources including SUCCESS to determine if there is any historical
or current information about the family.
4. Complete and submit the Medicaid Application for Foster Care in Georgia SHINES
including all information on the Person Detail Page, Citizenship and Identity Page,

Page 1 of 7

Custody Page, Income and Expenditures Documentation Checklist and Application and
Background page.
a. The Medicaid application is sent via Georgia SHINES to Rev Max where it is
assigned to a Revenue Maximization Specialist (RMS).
b. The Medicaid Application for Foster Care must be completed regardless of the
childs potential eligibility for Medicaid. Some of the information on these pages
will also be used to process the IV-E application;
5. Assign the designated RMS as a secondary worker to each case as soon as the Foster
Care Child (FCC) stage is created in Georgia SHINES.
6. Complete and submit the Amerigroup GA Families 360 DFCS Referral Form to notify
Amerigroup that a child has entered foster care within 24 hours of the date of removal.
a. Follow all directions at the top of the E-Form regarding submission to Amerigroup,
Rev Max, and the Georgia Department of Community Health (DCH).
b. Submit the E-Form for case actions including:
i Removal of a child
ii Changes in Placement
iii Child leaves DFCS custody
iv Updates
v Changes in DFCS Case Manager
c. Document all submissions of the E-Form in the narrative of the Contact Detail
page in Georgia SHINES within 72 hours of submission.
d. Use the E-Form to provide Amerigroup the name and contact information for the
provider selected to complete the Comprehensive Child and Family Assessment
(CCFA). Provide the CCFA provider with contact information for Amerigroup.
7. Document the Amerigroup contact in the Narrative of the Contact Detail in SHINES within
72 hours of the contact and include the Amerigroup staff members name, telephone
number and date and time of initial contact;
8. Verify that the Amerigroup Care Coordination Team (CCT) has scheduled each childs
initial Health Check and trauma assessment; (See policy 10.11 Foster Care: Medical,
Dental and Developmental Needs)
9. Complete a PeachCare for Kids application online at https://www.peachcare.org for any
child not eligible for Medicaid
10. Report any issues/concerns with Amerigroup to the DFCS System of Care Unit including
the Amerigroup staff member who was contacted, their telephone number, and the date
and time of the contact.
When a child enters DFCS custody, the RMS will:
1. Review the submitted Medicaid application for a child entering foster care.
2. Contact the SSCM or designated staff by telephone or email if there are any questions
with the application.
3. Request the SSCM, as the childs authorized representative, to sign the Health Insurance
Questionnaire (Form DMA-285), regarding third party resources available to the child.
4. Screen for the CRS number to prevent duplication of existing cases and/or merge
duplicate identification (ID) numbers.
5. Verify whether there is an existing case for Temporary Assistance for Needy Families
(TANF), Supplemental Nutrition Assistance Program (SNAP), and/or Medicaid that
includes each applicant child as a member.
6. Determine each childs eligibility for Medicaid, change living arrangement codes, and

Page 2 of 7

remove each child from existing active/pending SUCCESS cases within one business
day of application.
7. For children active on SUCCESS, close the child/case for the ongoing month and register
a new Medicaid case coding the childs living arrangement.
8. For children not active on SUCCESS:
a.
Make the appropriate Medicaid Class of Assistance (COA) determination;
b.
Complete the Medicaid Application via SUCCESS and Georgia SHINES.
9. Complete the funding determination through Georgia SHINES when all required criteria
have been met; (See policy 9.3 Eligibility: Applying for Initial Funding)
10. Communicate the initial decision for Medicaid and IV-E via the Eligibility Summary page
in Georgia SHINES.
When a child enters DFCS custody, Amerigroup will:
1. Receive the Amerigroup GA Families 360 DFCS Referral Form from DFCS
2. Ensure the child is enrolled on their roster as a member.
3. Access each childs Virtual Health Record (If available) to begin care coordination
planning and developing each childs individualized care plan.
4. Assign each child to a CCT.
5. Assign each child a primary care physician (PCP) and primary care dentist (PCD).
6. Contact the primary care provider assigned to the child to obtain the most recent
information available and required historical data;
7. Provide ID cards to members via a secure portal on the Amerigroup website.
8. Coordinate medical assessments and development of an individualized care plan for
each child.
When a child exits DFCS custody, the SSCM will:
1. Notify Amerigroup, Rev Max, and DCH of the child exiting DFCS custody via the
Amerigroup GA Families 360 DFCS Referral Form within 24 hours.
a. Upon receipt of the Amerigroup GA Families 360 DFCS Referral Form, the CCT
prepares for the child to transition out of foster care.
b. Rev Max updates the residential and mailing address, determines if a family has
tried to add the child to TANF Medicaid, and updates the class of assistance.
i Rev Max will complete a Continuing Medicaid Determination (CMD) on
each child exiting Foster Care.
ii Rev Max will CMD a child exiting care to a child only Medicaid case in
Georgia One. This will allow the child to remain on Medicaid without any
coverage gaps once exiting care. The child may also remain with
Amerigroup via the GA Families program (not the GA Families 360
program) for continuity of care.
iii Rev Max will CMD a youth aging out of care to Chafee Medicaid.
iv Rev Max will CMD a youth aging out of Chafee to Former Foster Care
Medicaid.
NOTE: The childs Medicaid case should not be closed.
2. Update the childs placement in Georgia SHINES including an ending date and discharge
reason immediately but no later than three business days of the childs exit. If a child is in
a post Foster Care (PFC) stage and DFCS is paying a subsidy, enter the new placement
in the PFC stage.
3. Update the Legal Status page in Georgia SHINES.

Page 3 of 7

4. Inform the youth they may apply for Former Foster Care Medicaid with the RSM
Outreach Project or at any local DFCS office and document the discussion in the case
narrative in Georgia SHINES.
PRACTICE GUIDANCE
Eligibility Determinations
All funding, reimbursability and Medicaid eligibility determinations for foster or adoption
assistance children are the responsibility of Revenue Maximization Specialists (RMS) based on
information submitted by a DFCS SSCM via Georgia SHINES. Coordination between SSCMs
and the RMS is critical to the funding determination and Medicaid coverage for children in outof-home placement.
If a child in DFCS custody is covered by health insurance other than Medicaid, the name of the
insurance company, policy number, group number and named of insured are important in
processing the application for Medicaid. At the time that a claim is filed, such coverage will be
primary with Medicaid being the secondary insurance provider.
Children who are in an out-of-home placement may be eligible for Medicaid coverage under
several Classes of Assistance (COA). These include the following:
1. IV-E Foster Care (FC) or IV-E Adoption Assistance;
2. SSI;
3. Child Welfare Foster Care, RSM, or State Adoption Assistance;
4. Medically Needy;
5. Emergency Medical Assistance (EMA).
The RMS processes the Medicaid determination in SUCCESS. The Medicaid Class of
Assistance (COA) aligns with the funding determination. See policy 2100 Medicaid: Classes of
Assistance for the eligibility requirements of each type of Medicaid.
Medicaid
The Medicaid program is a joint federal/state program that is authorized under the Social
Security Act. Funds are available to states for providing medical services to eligible recipients
and for reimbursing activities that support the administration of the Medicaid program. DFCS
accesses Medicaid funds through the Department of Community Health (DCH) and the Division
of Medical Assistance (DMA) for case management and services for children in out-of-home
care. Children who are IV-E eligible and/or SSI eligible are eligible for Medicaid. However,
children whose foster care is paid by state funds may not be eligible for Medicaid. Consequently,
the Medicaid COA for which these children qualify must be determined. Each COA has
resource limits and certain deductibles. Most children in foster care are eligible for Medicaid.
IV-E Foster Care Medicaid (IV-E FC)
Title IV-E eligibility is determined for each child who enters care via court order or voluntary
placement agreement (VPA) regardless of the length of stay in care. In order for a child to be
IV-E eligible, certain criteria must be met including certain judicial determinations (See policy 9.4
Eligibility: Removal from the Home and policy 9.6 Eligibility: Aid to Families with Dependent
Children (AFDC) relatedness Criteria).

Page 4 of 7

Supplemental Security Income (SSI):

SSI is a federal payment program for disabled individuals administered by the Social Security
Administration. If a child in DFCS custody receives SSI, the Social Security Administration
processes the childs monthly Medicaid card.
Child Welfare Foster Care (CWFC) or IV-B Medicaid:
CWFC Medicaid provides medical coverage to children who have been determined ineligible for
IV-E FC. The child must be placed in an approved foster home or licensed child placing agency
(CPA) or child caring institution (CCI). Eligibility continues through the month in which the
CWFC child reaches age 21 (assuming the CWFC per diem payment continues to be made and
all other requirements are met after the child turns 18).
The child must meet
citizenship/alienage requirements. Only children in DFCS custody may receive this type of
Medicaid. (Youth committed to the Department of Juvenile Justice (DJJ) may be eligible for
Right from the Start Medicaid (RSM). Youth ages 19-21 may continue to receive CWFC if there
is a signed voluntary agreement to remain in care (Consent to Receive Extended Youth
Services) and the youth is in a placement receiving a per diem for his/her care at least one day
per month.
Right from the Start Medicaid (RSM)
RSM provides medical coverage to children in foster care who have been determined ineligible
for IV-E Foster Care. The resource and income limits are considerably higher for RSM;
therefore, more children qualify. RSM provides Medicaid to eligible children through the month
in which the child turns 19 years of age. Youth, who are adjudicated delinquent and are placed
in an out-of-home facility, may be eligible for RSM and/or IV-E foster care payments. The
application process involves the submission of a RSM request from the DJJ Juvenile
Probation/Parole Specialist (JPPS) to the Rev Max DJJ Eligibility worker.
Medically Needy (MN) Medicaid
MN Medicaid has no income limits. The child must meet citizenship/alienage requirements.
Eligibility continues through the month in which the child reaches age 18.
Emergency Medical Assistance (EMA)
If the child does not meet the citizenship/alienage requirements, EMA may be an option when
there is an emergency medical need. The immediacy of treatment must be verified by a
doctor and subsequently, the claim approved by the Department of Medical Assistance (DMA).
Routine, non-emergency health care may require using state funds. Eligibility for this Medicaid
is determined on a monthly basis.
Former Foster Care Medicaid
This Medicaid became effective 01/01/ 2014 in accordance with the Affordable Care Act (ACA).
The ACA allows Medicaid coverage to be extended to individuals who age out of foster care, or
out of Chafee, to the last day of the month they reach 26 years of age. Applicants may not be
determined ineligible based on a diagnosis or pre-existing condition. The eligibility month is the
month following the youths 18th birthday or the month following the closure of Chafee Medicaid.
PeachCare for Kids
PeachCare for Kids (PCK) provides comprehensive health care for children who do not qualify
for Medicaid and do not have any other form of insurance. The child must meet
Page 5 of 7

citizenship/alienage requirements. PeachCare for Kids (PCK) is available to children from birth
through the last day of the month of a childs 19th birthday. PeachCare for Kids will waive the
monthly premium for children in DFCS custody.
GAMMIS
GAMMIS consolidates all required functions for Medicaid, PeachCare for Kids TM (PCK) and the
public employee health benefits into a single computer system. The state agency which has
oversight of these functions is the Department of Community Health (DCH). When screening in
GAMMIS, assistance from the appropriate Office of Financial Independence (OFI) supervisor or
case manager will be required.
Georgia Families 360
On March 03, 2014, DFCS transitioned from a standard fee-for-service Medicaid program to a
statewide Medicaid Care Management Organization (CMO) through Amerigroup Georgia
Managed Care Company. The transition impacted children in DFCS custody and children
receiving AA as they became members of a new program called Georgia Families 360 which is
separate from Georgia Families, the general Medicaid program administered by the Georgia
Department of Community Health (DCH). Georgia Families 360 is designed to provide
coordinated care across multiple services and focus on the physical, dental, and behavioral
needs of member children. The program is designed to ensure each member has a medical and
dental home, access to preventive care screenings, and timely assessments. It also seeks to
ensure medical providers adhere to clinical practice guidelines and evidence-based medicine.
Amerigroup Care Coordination Teams (CCT) and Care Managers
Each Georgia Families 360 member is assigned to a regional Care Coordination Team with
a specified Care Manager. The CCT members are Masters level staff, the majority of whom
hold a professional license to practice in their respective field. The CCT completes a Health
Risk Screening (HRS) on youth in care to identify medical and/or behavioral needs. The CCT
is responsible for coordinating the health components of the Comprehensive Child and
Family Assessment (CCFA), including the initial physical assessment, dental screening, and
trauma assessment. Care Managers are the primary partner for identifying and making
referrals for needed services. They ensure each youth has an individualized care plan that
addresses both physical and behavioral health needs. They work with community agencies
to ensure appropriate services are provided.
Amerigroup Notification Form (E-Form)
DFCS communicates with Amerigroup, Rev Max, and DCH utilizing an electronic notification
form (E-Form). It is the primary means for communicating information about a member in
Amerigroup. The E-Form must be completed and sent to Amerigroup, Rev Max, and DCH within
24 hours of a youth entering foster care. It should be completed thoroughly to include
demographic information, medical information, placement information, the identified CCFA
provider and other referrals (e.g., Babies Cant Wait). The E-Form is also used to report updates
such as placement changes, a youth exiting care, etc. If there is information not available at the
time of the initial referral to Amerigroup, submit an E-Form (update) as soon as the information
is obtained. Accurate and timely communication with Amerigroup and Rev Max is vital to the
Medicaid eligibility determination and the assignment of an Amerigroup Care Coordination
Teams and service providers. Important decisions regarding the assignment of primary care
providers and referrals are made based upon the information submitted on the E-Form.
Page 6 of 7

FORMS AND TOOLS

Amerigroup GA Families 360 DFCS Referral Form
PeachCare for Kids, https://www.peachcare.org
Policy 2100 Medicaid: Classes of Assistance
Policy 2194 Medicaid: PeachCare for Kids

Back to Table of Contents

Page 7 of 7