REQUIREMENTS

The Division of Family and Children Services (DFCS) shall:

1. Utilize funds provided by the medical assistance program to pay for medical services for eligible recipients to conserve state funds for children ineligible for medical assistance.
2. Screen each child entering foster care in the Georgia Medicaid Management Information System (GAMMIS) within one business day of a child entering foster care.
3. Document all known information (i.e. demographic, removal, financial, etc.) on the required pages in Georgia SHINES within 24 hours of a child’s entry into foster care to initiate the Medicaid Application.
4. Sign, save and submit the Medicaid Application in Georgia SHINES.
5. Notify Amerigroup, the Revenue Maximization (RevMax) Unit, and the Georgia Department of Community Health (DCH) via the Amerigroup GA Families 360° DFCS Referral Form within 24 hours of a child entering or exiting foster care. NOTE: Completion of the Amerigroup GA Families 360° DFCS Referral Form does not constitute an application for Medicaid (see Practice Guidance: Amerigroup GA Families 360° DFCS Referral Form).
6. Notify RevMax via the Notification of Change (NOC) in Georgia SHINES and include the child’s current legal status and placement information to allow RevMax to transition the youth to another Medicaid Class of Assistance when:
   
    
   1. A child in foster care turns 18.
   2. A child exits foster care.
7. Inform youth 18 and older exiting foster care they may apply for medical assistance at any local DFCS office, if their medical assistance case closes. Instruct youth to notify the county office where they apply of their former foster care status.

PROCEDURES

The Social Services Case Manager (SSCM) will:

1. Gather as much medical history on the child as possible and document in Georgia SHINES, upon the child’s entry into foster care.
2. Conduct the following screenings:
   
    
   1. Each child in GAMMIS within 24 hours of entering care to determine if the child already has a Medicaid card.
   2. All available resources to determine if there is any historical or current information about the family.
3. Document all known information in the following pages in Georgia SHINES within 24 hours of a child’s entry into foster care to initiate an application for medical assistance:
   
    
   1. Person Detail
   2. Citizenship and Identity
   3. Custody
   4. Legal Status
   5. Placement List
   6. Income and Expenditures Documentation Checklist
   7. Application and Background NOTE: Completion of the required pages in Georgia SHINES will allow data to be transmitted from Georgia SHINES to Georgia Gateway and pre-populate to the Medicaid application. The Medicaid Application must be completed regardless of the child’s potential eligibility as some of the information on these pages will be used to process the IV-E application.
4. Sign, save and submit the Medicaid Application in Georgia SHINES. NOTE: A RevMax Specialist (RMS) will be assigned as a secondary worker as soon as the Medicaid Application is saved and submitted in SHINES.
5. Notify Amerigroup that a child has entered foster care within 24 hours of the date of removal via the Amerigroup GA Families 360° DFCS Referral Form. Follow all directions at the top of the form regarding submission to Amerigroup, RevMax, and the Georgia Department of Community Health (DCH).
6. Submit the Amerigroup GA Families 360° DFCS Referral Form for the following case actions:
   
    
   1. Removal of a child.
   2. Changes in placement.
   3. Child exits DFCS custody.
   4. Updates to existing information.
   5. Changes in DFCS SSCM.
   6. Notification of the Comprehensive Child and Family Assessment provider’s name and contact information.
7. Document the following in the narrative of the Contact Detail in Georgia SHINES within 72 hours:
   
    
   1. All submissions of the Amerigroup GA Families 360° DFCS Referral Form.
   2. The Amerigroup contact, including the staff member’s name, telephone number and date and time of initial contact.
8. Verify that the Amerigroup Care Coordination Team (CCT) has scheduled each child’s initial Health Check and trauma assessment, if applicable (see policy 10.11 Foster Care: Medical, Dental and Developmental Needs).
9. Report any issues/concerns with Amerigroup to the Wellness Programming Assessment and Consultation (WPAC) Unit via email at healthmatters@dhs.ga.gov. Include the following:
   
    
   1. The term “Amerigroup Issue” and the county name in the subject line.
   2. The Amerigroup staff member who was contacted, their telephone number, and the date and time of the contact.
   3. A summary of the issue/concern.
10. Notify Amerigroup, RevMax, and DCH of a child exiting DFCS custody via the Amerigroup GA Families 360° DFCS Referral Form within 24 hours of the exit.
11. Notify RevMax via an NOC in Georgia SHINES of any child exiting care and/or turning 18, within three business days. Update the following in Georgia SHINES:
    
     
    1. Legal Status page.
    2. Child’s placement, including an ending date and discharge reason if the child is exiting foster care. NOTE: 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.
12. Inform youth 18 and older exiting foster care of the following and document the discussion in the narrative of the Contact Detail in Georgia SHINES:
    
     
    1. Notices to renew their Medicaid will be sent to their last known address in Gateway and they must renew their Medicaid annually by verifying Georgia residency.
    2. Youth may apply for medical assistance at any local DFCS office, if their medical assistance case closes, and must notify the county office where they apply of their former foster care status.

The RMS will:

1. Review the submitted Medicaid Application.
2. Contact the SSCM by telephone or email if there are any questions with the application.
3. Request the SSCM sign, as the child’s authorized representative, the Health Insurance Questionnaire (Form DMA-285), regarding third party resources available to the child.
4. Screen for the Enterprise Master Person Index (EMPI) 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 medical assistance that includes each applicant child as a member.
6. Determine each child’s eligibility for medical assistance, change living arrangement codes and remove each child from existing active/pending Georgia Gateway cases, within one business day of application.
7. Close the child out of an existing Georgia Gateway family case for the ongoing month and register a new medical assistance case coding the child’s living arrangement, for a child active in Georgia Gateway.
8. Make the appropriate Class of Assistance (COA) determination and complete the Medical Assistance Application via Georgia Gateway and Georgia SHINES, for a child not active on Georgia Gateway.
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 medical assistance and IV-E via the Eligibility Summary page in Georgia SHINES.
11. Update the residential and mailing address, determine if a family has tried to add the child to a medical assistance case and update the class of assistance, for a child exiting foster care.
12. Complete a Continuing Medicaid Determination (CMD) for Child Under Age 19, Chafee, or Former Foster Care Medicaid, upon receiving updated placement information at discharge or exit from foster care for a child of any age.
    1. The caregiver for children under age 18 may add the child to an existing Family Medicaid case or be added to the new Family Medicaid case.
    2. Foster youth over 18 will be CMD to Child Under Age 19, Chafee, or Former Foster Care Medicaid. These youth must renew their Medicaid annually by verifying Georgia residency. NOTE: The child’s Medical Assistance case should not be closed when the child is exiting foster care.

The Social Services Supervisor (SSS) will:

1. Review the case record in Georgia SHINES to ensure documentation of the following:
   
    
   1. Medical history and insurance information.
   2. Signature, saving and submission of The Medical Assistance Application.
   3. Notification of the child’s entry into or exit from foster care via the Amerigroup GA Families 360° DFCS Referral Form. NOTE: The NOC in Georgia SHINES must be submitted to notify RevMax of any foster care exits.
2. Staff any issues or concerns regarding the child’s Medical Assistance case or medical care with the SSCM (see policy 19.6 Case Management: Supervisor Staffing).

PRACTICE GUIDANCE

Eligibility Determinations

All funding, reimbursability and medical assistance eligibility determinations for foster care or adoption assistance are the responsibility of the 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 medical assistance coverage for children in out-of-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 name of insured are important in processing the application for medical assistance. 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 medical assistance coverage under several Classes of Assistance (COA). The RMS determines the COA and processes the medical assistance determination in Georgia Gateway. The COA aligns with the funding determination (see the Medicaid Manual Chapter 2100: Classes of Assistance for the eligibility requirements of each type of medical assistance).

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 categorically eligible for Medicaid. Although most children in foster care are eligible for Medicaid, children whose foster

care is paid by state funds may not be eligible for Medicaid. Consequently, the medical assistance COA for which these children qualify must be determined. Each COA has resource limits and certain deductibles (see the Medicaid Manual Chapter 2100: Classes of Assistance for the eligibility requirements of each type of medical assistance).

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 child’s monthly Medicaid card.

PeachCare for Kids®

PeachCare for Kids® provides comprehensive health care for children who do not qualify for medical assistance and do not have any other form of insurance. The child must meet citizenship/alienage requirements. PeachCare for Kids® is available to children from birth through the last day of the month of a child’s 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® 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.

Upon receipt of the Amerigroup GA Families 360° DFCS Referral Form notifying of a child’s entry into foster care, Amerigroup will:

1. Ensure the child is enrolled on their roster as a member.
2. Access each child’s Virtual Health Record (If available) to begin care coordination planning and developing each child’s individualized care plan.
3. Assign each child to a CCT.
4. Assign each child a primary care physician (PCP) and primary care dentist (PCD).
5. Contact the primary care provider assigned to the child to obtain the most recent information available and required historical data.
6. Provide ID cards to members via a secure portal on the Amerigroup website.

7. Coordinate medical assessments and development of an individualized care plan for each child.

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 GA Families 360° DFCS Referral Form

DFCS communicates with Amerigroup, RevMax, and DCH utilizing an electronic notification form (E-Form) entitled Amerigroup GA Families 360° DFCS Referral Form. It is the primary means for communicating information about a member in Amerigroup. The form must be completed and sent to Amerigroup, RevMax, and DCH within 24 hours of a youth entering foster care. It should be thoroughly completed to include demographic information, medical information, placement information, the identified CCFA provider and other referrals (e.g., Babies Can’t Wait). The 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 the form as an update as soon as the information is obtained. Accurate and timely communication with Amerigroup and RevMax is vital to the Medicaid eligibility determination and the assignment of an Amerigroup CCTs and service providers. Important decisions regarding the assignment of primary care providers and referrals are made based upon the information submitted on the form.

FORMS AND TOOLS

Amerigroup GA Families 360° DFCS Referral Form 

PeachCare for Kids